Ice or Heat?


When to use Ice or Heat?

The question ‘When to use Ice or Heat?’ is a question we get asked in the clinic regularly, and the answer can vary depending on each individual’s situation. There are times when we can give a definitive answer. This is normally linked to how long you have had the injury and what stage of healing it is at.


Ice is usually used for new/acute injuries of up to 72 hours. The injured muscle or joint feels hot in comparison to the other non injured side. It can be painful, swollen and redenned. These symptoms indicate inflammation and ice is recommended. The application of ice minimises the extent of the damage and inflammation and accelerates recovery.

Follow the PRICE regime after an acute injury

Protect: Use different supports and aids to protect the injured area and aid movement. A good example of this would be an ankle sprain where an ankle support helps to protect the joint and crutches enable you to move around.

Rest: This avoids causing more inflammation by not irritating the damaged area and allowing time for the healing process to take place.

Ice: Can be applied in several ways from ice bags to a pack of frozen peas from the freezer. It is important that there is a barrier between the ice bag and your skin. Use a towel to wrap the ice bag in. There is some debate on how long to apply the ice on the injured area and how many times a day. The consensus is that ice loses it effectiveness after 15 mins so does not need to be applied any longer than this. We recommend repeating the application 4 times daily.

Compression: Apply compression to the injury at the earliest opportunity in order to limit and reduce the swelling. This can be effective for muscle strains and ligament sprains. Orthopaedic support and compression bandages are good for keeping an even compression over the area and providing some support.

You should check your extremities (fingers and toes) for signs that the compression is not too much as this can cause diminished circulation, turning them blue, going cold and a change in sensation. We would also recommend removing compression when sleeping for this reason.

Try and elevate the injured part at the earliest opportunity to further help reduce the swelling.


Heat is used for chronic injuries, normally more than two weeks old. There is much debate about the definition of chronic. Some describe it in terms of time frames, others in terms of the stage of healing. For the purpose of this information page it does not really matter. A chronic injury is usually characterised by stagnation in terms of healing. The injured part will usually feel the same temperature as the non injured side. Sometimes it may be accompanied by slight swelling. There is a strong sense that the body has finished it’s healing process but left some residual deficits that continue to cause a problem.

Why heat?

Heat over the injured part will increase the blood flow to it and therefore stimulate activity around the area. If it is a swollen joint, this will help reduce swelling and flush out any inflammatory agents around the injured site. The provision of increased blood supply with greater oxygen and nutrients can help speed up the healing process and decrease pain. If it is an injured muscle then heat can reduce muscle spasm.  A decrease in muscle spasm will decrease pain and help you to move more normally.

Application of heat

This can be applied by using a microwavable heat bag, a hot water bottle, regular heat packs/pads or having a hot bath. A comfortable warmth is desirable for a period of 20-30 minutes.

Exceptions, debates and personal choice of  Ice or Heat

Ice treatments might also be used for chronic conditions, such as overuse injuries in athletes. This could be, for example, when a tendon repeatedly becomes inflamed over a long period of time. This can be described as ‘an acute on chronic injury’. In this situation your osteopath may advise you to apply ice immediately after activity to minimise the degree of swelling. Heat before activity will relax and loosen tissues.

Alternate Heat and Ice

Both heat and ice can be used if there is chronic swelling of a joint, for example if there is a long standing ankle problem. We have mentioned that heat increases blood flow (vasodilator) and ice decreases blood flow (vasoconstrictor). With chronic swelling there is a theory that a pumping action can be achieved by placing the heat on the injured area for 5-10 minutes and then applying the ice for the same period of time. This cycle is often repeated for up to 30 minutes. When hot and cold water is used to achieve this effect it is known as a contrast bath.

Where pain is the primary problem with a chronic injury (such as low back pain), the choice of using ice or heat can be a personal preference. On one hand ice has the effect of distracting away from the pain whilst heat can help relax the muscles around the painful area.


Ice is the treatment of choice for hot, inflamed, acute injuries. It helps reduce blood flow and lessen the extent of damage. Heat should never be used on acute injuries.

Heat is the treatment of choice for most chronic injuries. It helps increase blood flow and can reinvigorate the healing process of a stagnant condition.

A qualified practitioner is the best person to determine whether to use ice or heat.