By Christine Johnston BA, CSCS, CAT (C)

One of the most common questions when it comes to the treatment of
injuries is when to use ice versus heat. Both of these modalities have
their place in the treatment protocol for the care and prevention of
injuries but the question is which one to use when?



There are several instances in the treatment of injuries that heat can be used. One of these is as a warm up tool by bringing heat to the area and increasing the blood flow. This is also a great method of prevention by ensuring your body is ready for performance.

Secondly, heat can be used to treat an injury once the swelling has gone down. You can determine this by testing the area for radiating heat or if there is any redness to the area. Once the heat has dissipated and the swelling has ceased then you can apply heat. This period of the injury cycle is also known as the sub acute stage of injury usually 48 to 72 hours after injury has occurred.

In order to best understand what heat treatment does for the body, we must take a look at the effects it causes at a deeper level. Heat causes the blood vessels to dilate causing an increase to blood flow to the area increasing the nutrients to the area for healing and pumping the garbage out cleaning up debris. Heat furthermore creates warmth and lubrication to the area preparing it for what you are going to ask from it during activity. It encourages tissue healing by relaxing the scar tissue into better alignment and can increase range of motion before you play. You can also use heat in treating muscle spasm. By putting heat on an area in spasm, it will cause the muscles to relax breaking the pain spasm cycle. 

Heat may be applied for 10 to 20 minutes depending on the size of the desired treatment area. Examples of ways to use heat is with heat packs, moist heat packs, microwaveable heat packs, hot water bottle or warm whirlpool.



Much like heat, ice can be used in several instances when treating injuries. Ice is best used for acute injuries. Acute means the first 24 to 48 hours after an injury occurs, in other words as soon as injury happens ice is the modality to use. Ice is best used at this time to decrease pain and close the boundaries of the inflammation. If you do not treat an injured area, the boundaries stay open and the swelling will continue which can cause significant problems additional to the injury itself.

Secondly ice is a great tool for the prevention of injuries and the continual care of injuries by applying this modality after activity. This will keep swelling and pain to a minimal and allow the area to continue to perform while it returns to its pre-injury state.

How does ice work at a deeper level? The ice slows down blood flow by vasoconstriction of blood vessels, or narrowing the blood vessels therefore limiting the amount of inflammation to the area. This will limit the amount of swelling and garbage to the injured area which will in turn make the recovery quicker. It can also decrease pain by changing the firing of the neurons as well as slow cellular metabolism. Similarly, ice is a great method of treatment for muscle spasm as it changes the firing of the neurons breaking the pain spasm cycle.

Ice may be applied for 15 minutes every hour. Some examples of how to apply ice are, cold packs, ice bags, crushed ice, snow, instant cold packs, ice massage, ice bucket or cold whirlpool.


Therefore in closing, heat is to warm up or loosen the tissues. Heat can be put on anytime after 48 to 72 hours after injury and any time after that as a warm up tool. Ice on the other hand is to cool down an injured area right after an injury occurs. Furthermore it can be used to prevent injuries from occurring by using it after activity. Both heat and ice are great tools for the treatment of pain and muscle spasm and each in their own respect in the treatment of injuries. Always ensure the skin is properly protected when using these modalities and a treatment session should not exceed 15 to 20 minutes.

Christine Johnston is a Certified Athletic Therapist and a Strength and Conditioning Coach in Winnipeg.

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