Hot or cold? How to decide whether to use heat or ice when treating an injury.

with advice from Lisa Cox, ATC
and Mitch Kaye, PT

Hot or cold? How to decide whether to use heat or ice when treating an injury.

We have all had that sinking feeling after hearing a pop in a joint or feeling a wrench in our back. The pain begins, and immediately the gears start turning in our head: What’s better for this type of injury? Should I use a heating pad? An ice pack? Can I treat this at home or do I need to consult with a specialist, like a physical therapist? Here are some guidelines to remember as you recover.

When to use ice.Ice is the best solution immediately following an injury. Ice is a vasoconstrictor; it constricts blood vessels. Icing damaged tendons or muscles that are inflamed will prevent torn open vessels from swelling so much and from further compressing normal blood flow to body parts. Lisa Cox, a certified athletic trainer at Clinton Physical Therapy Center (a Physiquality network member in Tennessee), recommends always icing an injury or sprain every 1-2 hours for the first 48 hours. She says, “If possible, try to elevate the injured body part above your heart while applying ice.” Physiofit Physical Therapy and Wellness, a Physiquality network location in California, reminds readers to follow the acronym R.I.C.E. after injury: Rest, Ice, Compression, and Elevation.

Another benefit of icing post-injury is that cooling the injured area reduces inflammation, decreases soreness and helps the healing process. Lisa says that this is why you see baseball pitchers and quarterbacks icing their shoulder or elbow after games. She points out, “Injuries such as an ankle sprains, knee injury, shin splints and plantar fasciitis respond well to ice.”

PTPN Director of Quality Assurance Mitch Kaye, PT, notes that “elderly people, young children, and people with diabetes must be very careful with cold treatments.” If you have any questions about cold therapy, ask your healthcare practitioner for advice.

To ice an injury or sprain, you can use a re-usable ice pack, put ice in a Ziploc bag, or even use a bag of frozen peas or corn. To make your own re-useable ice pack, Mitch suggests mixing one cup of alcohol with two cups of water and freeze in a Ziploc freezer bag; the solution freezes at a lower temperature and is more malleable around joints. (If you want to buy an ice pack that compresses while cooling, consider buying an ActiveWrap heat and ice pack for your ankle, knee or back.)

Remember that you should apply ice for no longer than 20 minutes at a time; Lisa recommends allowing your skin to return to room temperature before applying ice again. Place a thin towel between the ice pack and your skin to prevent irritation and even frostbite. And never ice prior to activity — doing so may cause further injury.

When to use heat.So when should you use heat? Since heat is used to relax muscles and loosen tissues, it is best used prior to participation in activities, and should never be used in the first 48 hours after a new injury. Lisa notes that chronic or long-term injuries tend to respond well to heat. For example, she says, “apply heat to your quadriceps, a hamstring strain or low back strain prior to participating in an activity.”

If you don’t have a heating pad at home, Mitch suggests this method for creating one:

  • Fill a cotton tube sock 3/4 of the length with plain white rice, beans, flax seeds, or oats, and sew or tie the end shut.
  • Heat this in the microwave on a pie plate (to keep it clean) for 2 minutes. Be careful. It can catch fire if you cook it too long!
  • The pack will be very hot at first, so wrap it in a washcloth before you place it on your skin. As it cools, you can remove the washcloth.
  • It will stay warm for about 20 minutes.

You can use the compress over and over. For a pleasant aroma, add some lavender or sage.

Be sure to use a heating pad, heat compress or hot, wet towel for no longer than 20 minutes at a time, or take a hot bath before activity. “Never sleep on a heating pad,” Lisa warns, “due to the risk of burning your skin or possibly causing a fire.” And listen to your body — if the injury is warm or hot to the touch, you should never add more heat to the location; cool it off with ice instead.

In either case, Mitch says, “Don’t use heat or ice over insensitive skin or when conditions of decreased circulation exist.” He also points out that lotions or creams that produce a hot or cold feeling on the skin do not have the same physiological effects as the application of heat or ice, so don’t expect the same result if you use a cream instead of an ice pack or heating pad.

For minor aches and pains, heating before activity and icing afterwards may be enough to keep your body healthy and to avoid serious injury. However, keep an eye out for the following red flags:
Keep an eye out for these red flags.

  • Pain that gets worse instead of better
  • Pain after resting for a few days, or when you wake up
  • Chronic swelling in your joints, or bruises that don’t heal
  • Knees or elbows (or other joints) that lock or are unstable

Any of these problems is a sign that you need to consult with a doctor or physical therapist about your pain or swelling. Trying to treat such issues at home with heat, ice and anti-inflammatories could end up making your problem worse instead of better.

Lisa Cox, ATC, is a Certified Athletic Trainer at Clinton Physical Therapy Center, a Physiquality network member in Clinton, Tennessee. She works with patients with sports injuries and orthopedic issues, and helps implement the CPTC Sports Enhancement Program for local high school teams.

PhysioFit Physical Therapy and Wellness is a Physiquality network member in Los Altos, California.

Mitch Kaye, PT, oversees all aspects of clinical review and quality oversight for PTPN, Physiquality’s parent company. Mitch also assists PTPN regional offices with quality assurance program management through ongoing training and support, and he meets with members, physicians and payers as needed for program development and problem resolution.

ActiveWrap heat and ice packs provide instant relief for aches and pains. Designed in conjunction with orthopedic physicians and physical therapists, and backed by top coaches and athletes around the world, these hot cold packs were designed to fit specific joints and trouble spots.

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For further reading, look through our selection of articles on injury prevention, in addition to the below links:

Meine, Skyler. Why ice and heat treatments work for injuries., January 20, 2011.

Kolata, Gina. Sports injuries: When to tough it out. New York Times, March 30, 2010.

R.I.C.E. PhysioFit Physical Therapy and Wellness.

Self-treating injuries: Heat or ice? Physiquality.

The material and information contained on this Web site is for information only and is not intended to serve as medical advice or consultation.

Consult your personal physician before beginning any exercise program or self-treatment.