Should I Use Heat or Ice?
I am asked this question on almost a daily basis and it’s a good one. Most of us follow the age-old advice that we should ice (or RICE) acute injuries like ankle sprains and use heat on older injuries and muscles strain. But what is the actual evidence that this is true? There is certainly anecdotal evidence that ice reduces pain, decreases swelling and improves function when it comes to acute injury but how many of us have tried heat in this situation? I also hear from many people that they don’t actually like the feeling of ice and prefer heat.
Types of injury
Acute injuries are those that result from a trauma such as ankle sprain, a fall, etc. In this situation our body reacts with pain, swelling, redness, and inflammation (1). Non-acute injuries result from things like over-stretching a muscle and/or tendon during exercise or maybe sleeping the wrong way for example (1). These types of injuries can cause pain but typically do not come with redness or swelling and they may or may not have inflammation associated.
What we know about heat
Heat increases blood flow by dilating blood vessels and therefore delivers nutrients to the heated tissues (1). It also increases tissue elasticity and has shown to be a good pain reliever in low back and neck pain (1,2).
What we know about ice
Ice decreases blood flow to tissue by constricting blood vessels (1). Ice has also shown to be a good pain reliever (1, 2, 5). Ice also decreased muscle spasm in some studies (1). There is no evidence currently to suggest that ice has any effect on healing or the time it takes to return to regular activity and sport (2,3,5).
Back to the question
In the past, the advice was to use ice because it was thought that we should minimize the effects of acute injury (swelling, redness, inflammation) and we should use heat on non-acute injuries to increase blood flow and elasticity to muscles, tendons and other tissues to promote healing. However, recently clinicians have been asking: why are we trying to shut down our body’s natural response to injury (6)? And is inflammation in acute injury really such a bad thing (6)? The evidence from most scientific studies show that ice does NOT in fact promote healing and does not improve the chances we will get back to our regular activities any faster (2-6). However, there is also not a lot of evidence to show that ice is detrimental to healing either when used on acute injuries. It also does reduce pain which is certainly something to consider when you have just sprained your ankle or strained your back! Therefore, considering that there is little evidence that ice causes harm, my advice is use whichever feels better to you!
Guidelines for using heat and ice on your injury
- Apply only for a short time (10-15 minutes for ice, 15-20 minutes for heat)
- Always ensure there is something such as a towel between your skin and the heat or ice
- Make sure your skin comes back up or back down to regular temperature before reapplying heat or ice to your injury
(1) Melanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Post Graduate Medicine. 2015 Jan; 127(1):57-65.
(2) Garra G, Singer AJ, Leno R, Taira BR, Gupta N, Mathaikutty B, Thode HJ. Heat or Cold Packs for Neck and Back Strain: A Randomized Controlled Trial of Efficacy. Acad Emerg Med. 2010 May;17(5):484-9.
(3) Collins NC. Is ice right? Does cryotherapy improve outcome for acute soft tissue injury? Emergency Medicine Journal. 2008 Feb; 25(2):65-68.
(4) Galiuto L. The Use of Cryotherapy in Acute Sports Injuries. Annals of Sport Medicine and Research. 2016; 3(2):1060.
(5) Hubbard TJ, Denegar CR. Does cryotherapy improve outcomes with soft tissue injury? J Athl Train 2004 Jul-Sep; 39(3): 278-279.
(6) Jam B. Questioning the use of ICE Given Inflammation is a Perfectly Healthy Response Following Acute Musculoskeletal Injuries. Advanced Physical Therapy Education Institute. May 20, 2014. Clinical Library.
Jenn Nagle is a registered physiotherapist and graduated with her MScPT from McMaster University in 2014. Prior to this she obtained a Specialist Honors BSc from York University in Kinesiology and an Honors BA in History, Psychology and Women’s Studies from the University of Toronto. She has an active interest in sports and physical activity having once been a post-natal fitness instructor and personal trainer. Jenn enjoys working with clients of all ages but especially likes working with older adults. She can be contacted through her business: Streetsville Sports & Physiotherapy