Ice or Heat – What to Use for Injuries?

Using heat packs or ice for injuries is nothing new, however, it is likely that you still don’t know which one to use! “Should I use heat or ice” is one of the most common questions I get in the office, so lets try and straighten things out a bit.

So which is it?

The problem with hot / cold therapy is that there is no certainty that one or the other will work and yes, everyone responds differently.  I recall treating 2 similar neck injuries, both female, both the same activity, and both similar size and build, but one lady stated that ice helps, the other stating the opposite.  So, yes people do have a preference and each individual is sensitive to different forms of therapy however, there are some general guidelines that should be followed.

When Should You Use Ice? 

Typical uses for ice are within the first 72 hours following an injury! This timeframe is known as the acute phase of healing and ice should be used to help reduce swelling, pain and inflammation.  It is possible for the acute phase to last longer than 3 days and can be up to 5 days.  Never apply heat to an acute injury as it will increase inflammation! 

How Long Should You Ice?

Ice and heat times should be adjusted based on the joint or area of the body affected.  For example, the butt (glut max) is a very large muscle and may need 15-20 minutes while a small finger or wrist may only need 10-12 minutes.  A good average is about 12-15 minutes and you should ice with a damp cloth and never skin on skin as this increases the chance of frost burn.

What Else? 

Icing is great but you need to add at least one more element, compression and elevation to make it more effective.  Inflammation is essentially the collection of fluid and blood following an injury. Compression helps to reduce the amount of fluid going into the joint and therefore slows the rate of inflammation.  Elevation (above the heart) does a similar thing in that it allows fluid to drain back to the heart where it re-absorbed. This prevents pooling of fluid to the joint and reduces pain.

Sub-Acute Phase

The sub-acute phase occurs about 5-21 days after an injury.  This is when you can start to introduce heat to the area, but you may not want to place heat here exclusively.  This is where you can use contrast bath therapy.  This method is where you alternate hot and cold to help increase blood circulation and to reduce inflammation at the same time.

How To Contrast Bath?

1.     Start with ice therapy first to flush out some inflammation for 5 minutes

2.     Heat for about 3 minutes

3.     Cold for 1 minute

4.     Heat for 3 minutes

5.     Cold for 1 minute

6.     Heat for 3 minutes

If this is your first time doing this or the first time applying the contrast bath to your injury I would do only one cycle to at first.  It is possible for you to do this for about 20-30 minutes or about 2 cycles.

Using hot and cold therapy during the sub-acute phase can be helpful with regard to use (athletic events, walking, rehabilitation).  For example, if you sprained an ankle and you are attempting to rehabilitate it, you may want to start out with a few minutes of heat prior to activity to get the joint nice and loose. After you have stressed the area and doing the appropriate exercises, you would want to ice the area to reduce possible inflammation.

Heat Therapy/Thermotherapy

Heat is used typically in chronic injuries that have been present from 21 days and longer (can last for years).  If you are still having pain and problems after about 7-10 days you should seek medical attention as this problem will likely not go away without some intervention.  Heat allows muscles to relax, reduces spasms, tension and increases circulation to the joint.

How long do you heat for?

You should heat an area with warm moist heat for about 10-15 minutes depending on body size. Never skin on skin so that you avoid being burned.

Never Do This With Heat!

NEVER lay on the heat source!  This not only increases chances of injury and burns but also compresses the blood vessels.  Remember, heat therapy helps to dilate (expand) blood vessels to help increase circulation but laying on the heat source compresses tissues and blood vessels and is the exact opposite of what you are trying to do.


Everyone is different and everyone responds to different therapies but knowing what phase of care/ healing you are in can help you make the best decision with modalities such as ice or heat.

Was this useful? What other common questions do you have? Comment below!

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