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When to use Heat or Ice for Pain and Injuries

You have probably heard of the benefits of using heat or ice for sports injuries, but knowing exactly when it is best to use each one makes a massive difference in your injury recovery time. Treatment varies depending on the injury.

Acute Sports Injuries

Acute injuries and acute pain are usually due to trauma. The injury may cause you to feel a severe, or sharp immediate pain and potential causes include a direct blow to the area, a fall, or an accidental twisting movement.

Treat Short Term Injuries with Cold Compress

Upon an acute sports injury, the aim is to control swelling, inflammation, bleeding, and pain. Apply an ice compress to the injury as soon as possible to cool down tissues, lower their metabolic rate and nerve conduction velocity. This results in vasoconstriction of surrounding blood vessels and reduced inflammation.

Apply ice to the injury, keeping the ice in contact with the injury for at least 20 minutes, and reapply every two to three hours for the next 48 hours if possible. Always wrap the compress in a light towel to prevent ice burns.

After 48 hours the injury starts it’s natural healing and remodelling process and stops bleeding. When the signs of inflammation diminish after a few (minimum) 3 days of rest and cold treatment, you can then alternate between hot and cold treatments. Apply ice for 10 minutes, and immediately then apply 10 minutes of heat. This should result in an increased vascular supply to the injured site, as the vasoconstriction that occurred using ice will reverses to vasodilation when heat is applied, allowing blood to pool to the damaged tissues to promote quicker healing.

If you are treating knee pain or knee injuries, remove your knee braces before applying cold or hot treatment. If you have a knee brace for running or a hinged knee brace, you’ll need to leave it off for the duration of treatment.

Chronic Sports Injuries

Chronic pain and sports injuries appear less suddenly than acute pain and injuries do. Chronic injuries gradually build up over days, weeks, or even months. Usually they are caused by overuse of a muscle or by a biomechanical abnormality. Some chronic injuries occur when an acute injury has failed to heal due to the absence of appropriate treatment and an early return exercise or sport.

Heat Compress is Ideal for Treating Chronic Injuries

For chronic injuries, apply a heat compress to the injured site or region of pain for 15 to 20 minutes. You can use a warm, damp towel, a hot water bottle, a heat rub, or a heating pad. If you use a heating pad or hot water bottle, place a cloth or some protection between your skin and the bottle or pad to prevent burns, as with the ice.

Using heat to treat chronic sports injuries and pain soothes aching muscles and joints, relaxes tight muscles, increase blood flow to the injury to reduce stiffness and increase the elasticity of tendons and ligaments.

In general, heat therapy is also recommended prior to exercise for those who have chronic injuries. Heat warms the muscles and helps to increase range of motion. The only time you should ever consider using cold to treat a chronic injury is post exercise when inflammation may reappear, for example, on the knee for swelling on or around the patella. Applying ice at this point reduces any residual swelling.

Ice treatment

How it works

Ice treatment or cold therapy reduces blood flow to a particular area, particularly beneficial for inflammation and swelling. Especially if the pain or injury is around a joint or tendon. Ice can temporarily reduce nerve activity, desensitising the Pacinian corpuscles, which relieves pain, and reduces muscle spasm.


There are several cold treatments for pain and injuries:

  • ice packs or frozen gel packs

  • coolant sprays

  • ice massage

  • ice baths

When NOT to use ice?

Please note even though ice is a recommended treatment for pain, inflammation and swelling it is important to NOT ice the wound for too long as it can stiffen your joints, therefore increasing pain. Another common mistake is using ice to treat chronic muscle pain.

Muscle pain does not necessarily mean there is an injury. Common chronic pain problems often mistakenly treated with ice include back pain and neck pain.

Do not use ice for:

  • Chronic back pain and neck pain

  • Left shoulder pain if you have a heart condition

  • Front or side of the neck pain.

Heat treatment

How it works

Heat treatment or heat therapy works by increasing the circulation and blood flow to a particular area due to the increase in temperature. Improving circulation helps to reduce stress and tension in the affected area, hence why it is useful in treating chronic pain. Improving blood flow aids in healing damaged tissue and relaxes and soothes the muscles. Heat therapy may be used for a longer period than ice, often effective within 15-20 min.


  • Dry heat /“conducted heat therapy” includes heating pads, dry heating packs, and saunas. This heat is easy to apply.

  • Moist heat/ “convection heat” includes steamed towels, moist heating packs, or hot baths. Moist heat may be slightly more effective due to less application time for the same results.

When NOT to use heat?

  • A bruised or swollen area

  • Inflammation

  • Acute Injury

  • Open wounds

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