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Should You Ice or Heat an Injury?

At some point, we all strain or irritate a muscle or ligament. The resulting pain can have a big impact on our daily life. To ease that pain, is it better to use ice or heat?

Ice packs and heating pads are among the most used treatments in orthopedics. So, which one is the right one to use for an injury — ice or heat? And how long should the ice or heat treatments last? Read on for information about treatment of injuries with ice packs and heating pads.

Ice Treatment

Ice treatment is most used for acute injuries. If you have had a recent injury (within the last 48 hours) where swelling is a problem, you should be using ice. Ice packs can help minimize swelling around the injury, reduce bleeding into the tissues, and reduce muscle spasm and pain.

Ice constricts, or narrows, blood vessels. Constricting blood vessels inhibits the body from allowing inflammation in the iced area.

Ice packs are often used after injuries — like wrist sprains — have occurred. Applying an ice pack early and often for the first 48 hours will help minimize swelling, and decreasing swelling around an injury will help to control the pain. Ice treatments may also be used for chronic conditions, such as overuse injuries in athletes. In this case, ice the injured area after activity to help control inflammation. Never ice a chronic injury before activity.

You can make ice packs with ice cubes in a plastic bag or wet tea towel; a pack of frozen peas is also ideal and can go in and out of the freezer. Some people have cold allergies, which cause ice to burn the skin. Put at least a thin towel between the ice and skin to avoid burns. Never place ice directly on an injury; keep the pack moving to avoid ice burns. Never treat with ice for more than 20 minutes, and remove the pack immediately if the injury appears bright pink or red.

Greater than 20 minutes of icing can cause reactive vasodilation, or widening, of the vessels as the body tries to make sure the tissues get the blood supply they need. Studies have also shown 30 to 40 minutes in between icing sessions are needed to counter this reaction. The suggested time for icing is 20 minutes on and at least 30 minutes off.

NOTE: Don’t use ice packs on the left shoulder if you have a heart condition, and don’t use ice packs around the front or side of the neck.


Heat Treatment

Heat does have its role. Heat works best in larger muscle groups. As an example, heat helps to ease back muscle spasms — if the spasms are not caused by a new fall or injury.

Heat dilates, or widens blood vessels, allowing more inflammation to flow to an injured or painful area. Moist heat or heat pads work best when used for 15 minutes on at a time and at least 30 minutes off.

Heat treatments should be used for chronic conditions to help relax and loosen tissues and to stimulate blood flow to the area. Use heat treatments for conditions such as overuse injuries before participating in activities.

Do not use heat treatments after activity, and do not use heat after an acute injury. Never use heat where swelling is involved because swelling is caused by bleeding in the tissue, and heat just draws more blood to the area.

Heating tissues can be accomplished using a heating pad, or even a hot, wet towel. When using heat treatments, be very careful to use a moderate heat for a limited time to avoid burns. Never leave heating pads or towels on for extended periods of time or while sleeping.

Other Precautions

Don’t use cold or heat packs:

  • Over areas of skin that are in poor condition

  • Over areas of skin with poor sensation to heat or cold

  • Over areas of the body with known poor circulation

  • If you have diabetes

  • In the presence of infection

Rules to Remember

  • If an injury has occurred to any body part within three days, ice is preferred — 20 minutes on and 30 to 40 minutes off.

  • Use ice for pain in joints such as wrists, elbows and finger joints.

  • If pain or inflammation persists beyond three days, contact your doctor for an evaluation.




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