Please upgrade your internet browser.

Our website was designed for a range of browsers. However, if you would like to use many of our latest and greatest features, please upgrade to a modern, fully supported browser.

Find the latest versions of our supported browsers.

You can also install Google Chrome Frame to better experience this site.

When to Use Ice or Heat -- How to Treat Sprains, Strains, and Other Sports Injuries

By Dr. Daniel Trimberger II




Sports Medicine Recovery Journal

Featured Article:

Bicep Tenodesis Surgical Repair: What To Expect

Bicep tenodesis is a routine procedure. Nonetheless the prospect of surgery can be stressful for patients and loved ones prior to the procedure. That said, from presurgical anesthesia preparations to idiosyncrasies of the surgery itself, there are some basic concepts to understand beforehand. How long does a standard bicep tenodesis traditionally last? How long will you be monitored in the recovery room after the procedure?” We will answer those questions and others in this article.

Read More

Team Physicians for:

Team Physicians for the Portland Timbers and Portland Thunder

 when to use ice or heat, ice therapy, heat therapy, ice heat therapy, how to treat sprains, how to treat strains, what is the rice method, rice method, rice therapy, ice or heat, when to ice and when to heat, when to ice or heat, ice or heat for back pain, ice heat, ice or heat for pulled muscle

Whether you’re on the playing field or in the house, the occasional bump, bruise, sprain or pang is inevitable. These injuries may be sudden or the result of overuse and gradual wear and tear. Fortunately, less severe aches and pains may not require professional medical attention. In fact, many common injuries can be effectively treated with ice therapy, heat therapy, or a combination of the two. However, knowing when to use heat or ice and whether to use ice or heat first can be tricky. In this post, we will explain the proper at-home care for many frequently asked sports injury questions, such as how to treat a sprained ankle and whether you should use heat or ice for muscle strain. Before we jump into treatment, it’s important to understand the symptoms and causes of many typical sports injuries.

Common Aches, Pains, and Soft Tissue Injuries

Sprains

Whether the result of a slip around the house or a misstep on the playing field, many of us have experienced a painful sprain or two. A sprain is a common sports injury that generally occurs in the wrists, knees, and ankles. Throughout the human body, tissues known as ligaments support joints by connecting bones to other bones. A sprain is the result of the tearing or stretching of one of these ligaments too far. Common sprain symptoms include swelling, pain, discomfort, and difficulty moving the affected joint or limb.

Strains

While ligaments connect bones to other bones, tendons attach muscles to bones throughout the body. Overexerting a muscle or stretching a tendon or muscle too far can result in a strain. Muscle strains involving the lower back, legs, and shoulders are common. Typical symptoms of strains include pain, general stiffness, weakness, swelling, muscular spasms, and difficulty moving the affected area.

Cramps

While ligaments connect bones to other bones, tendons attach muscles to bones throughout the body. Overexerting a muscle or stretching a tendon or muscle too far can result in a strain. Muscle strains involving the lower back, legs, and shoulders are common. Typical symptoms of strains include pain, general stiffness, weakness, swelling, muscular spasms, and difficulty moving the affected area.

At-Home Injury Care: What Is the Rice Method?

For years, the R.I.C.E. method -- an acronym for rest, ice, compression, and elevation -- has been an effective treatment for many common aches and pains. After suffering an acute injury, such as a mild sprain or strain, the RICE technique can help dull pain, minimize swelling, and expedite the recovery process. Over-the-counter medications such as nonsteroidal anti-inflammatory drugs (NSAIDS) can also be used to help with pain and swelling.

R Is For Rest

After an injury, it’s imperative that the body is given time to heal and the best way to do this is to rest it. As painful as it may be to miss a workout or practice, pushing your body too far too soon can increase the severity of the injury and only prolong its recovery. After an injury, it’s important to limit any strenuous activities involving the limb or area. Crutches, splints, and bandages can be used to support injuries while performing weight-bearing movements.

I Is For Ice

It’s important to apply ice to the area immediately following an injury. Ice or ice packs will cause blood vessels to constrict and reduce blood supply to the injury. Reducing blood flow to the area minimizes swelling after an injury. Ice may be necessary for the first few days following an acute injury to prevent swelling.

C Is For Compression

Another reason to prevent swelling after an injury is to minimize pain, sensitivity, and also shorten the recovery time. Compression reduces inflammation by preventing blood and other fluids from accumulating around the injury. Different parts of the body will require different shapes and styles for the best fit but, no matter the area or injury, there are many types of compression gear available.

E Is For Elevation

The last step of the RICE technique is elevation. As a general rule, after an injury, individuals should try to keep the affected area higher than their heart. Elevating the injury above the heart will decrease the blood flow to the area, decreasing post-injury swelling, and aid the recovery process. It may be necessary to use a chair, bed, or pillows to prop the affected limb or area and achieve the correct elevation.

Can you walk with a torn meniscus? This depends on the severity of the injury. Many individuals are still capable of putting weight on the affected knee and even walking normally after a meniscus injury. In fact, many athletes can even continue playing after a meniscus injury. That said, initial levels of functionality can be deceiving, as it may take a few days for knee pain, swelling, and stiffness to set in after the injury occurs.

If you are having difficulty extending your leg following an injury, or if your knee locks up, this could be the result of a common meniscus injury known as a bucket handle meniscus tear, characterized by loose cartilage adrift in the knee. Knee instability and locked knee symptoms, including the knee locking up during normal movement, are all common following a meniscus tear.

During the initial trauma, many individuals report not only feeling a pop in the knee, but to also hearing an audible popping sound. This pop can also coincide with debilitating pain. Knee popping and locking is an unsettling experience for many, but this is to be expected with more severe meniscus tears. Your doctor will use imaging testing, such an X-ray or magnetic resonance imaging (MRI), to accurately diagnose your knee injury.

How to Treat a Sprain, Strain, and Stiffness -- When to Use Ice or Heat?

Knowing exactly when to use heat or ice can shorten recovery time and help with chronic aches, pains, and stiffness. Treating an injury can be tricky and not all sports injuries or conditions will require strictly ice or heat therapy. In some cases, both ice therapy and heat therapy can play a crucial role in the rehabilitation process. Generally speaking, ice therapy is more appropriate for new injuries, like sprains and strains, whereas heat therapy is typically better for treating chronic conditions.

The RICE method is useful immediately following a sprain or strain and can also help with swelling or sharp pain following rigorous activity or exercise. Heat is often best for tight muscles, sore muscles, as well as the stiffness and pain associated with arthritis. Heat can also be used following an acute injury to increase blood flow once the swelling has subsided. Remember, though, that applying heat too soon following an acute injury can increase swelling. After sustaining a sudden injury, ice therapy should be used for the first 24 to 72 hours and, after that, individuals can transition to heat therapy in order to increase blood flow to the area.

Certainly, there are exceptions to these rules of thumb and some injuries may respond more appropriately to a combination of both ice and heat therapy. A recent study determined that both ice and heat therapy effectively reduced damaged muscle tissue following strength training, however, cold therapy was more effective for treating pain immediately following a workout and up to 24 hours later.

Each injury will require different care and there are circumstances when ice or heat may be inappropriate for a specific injury or condition. For example, using heat on a new injury may promote blood flow to the area and increase the risk of swelling. Using ice for lower back pain related to muscle stiffness may actually only exacerbate the offending stiffness. Both ice and heat play an important role in the recovery process after an injury and there are a few guidelines to follow for effective ice and heat therapy.

How to Perform Ice Therapy

Ice therapy is typically used for shorter periods of time than heat therapy. Effective cold therapy involves multiple daily treatments, up to 20 minutes at a time. Remember, icing a sprained ankle, strain, or any injury for longer than 20 minutes at a time is not recommended. Some individuals may need just a single daily treatment while more severe sprains and strains may require multiple daily ice therapy applications. To prevent skin burn, individuals should place a layer of material between the skin and the ice pack or ice product. Wrapping an ice pack or bag of ice in a towel to prevent direct contact with the skin generally does the trick.

How to Perform Heat Therapy

There are many products on the market that penetrate deep tissues for effective heat treatment. Whether dry heat or moist heat may be more appropriate depends on the condition. A heating pad is an example of a dry heat source, whereas a warm bath is a popular moist heat therapy. Research has shown that moist heat may be superior to dry heat when it comes to penetrating deeper tissues. Therefore, moist heat may be more effective for treating denser muscle tissues, such as the quadriceps. During heat therapy treatments, it’s important to use a comfortable level of heat to minimize the risk of burns. When it comes to a warm soak in a hot tub, whirlpool or bath, the US Consumer Product Safety Commission does not recommend soaking in temperatures in excess of 104 degrees Fahrenheit Heating pads or heating packs should be wrapped in a towel or layer of fabric to prevent direct contact with the skin.

While heating pads and packs may be ideal for wider areas such as the lower back, smaller joints may require other types of heating products for optimal treatment. For example, those suffering from arthritis pain may choose to fully submerge the joint in a paraffin bath. While minor aches and pains may benefit from short 15 to 20 minute treatments daily, moderate symptoms may need extended treatment. Those with chronic muscle soreness may see good results from a soak in a warm bath for an hour or two.

(Note: Heat therapy may not be appropriate for people who are pregnant or people with peripheral vascular disease, heart disease, hypertension, diabetes, deep vein thrombosis, and other conditions.)

Frequently Asked Questions: When Do You Ice and When Do You Heat?

Determining when to use ice or heat therapy can be complicated. To assist, we’ve answered below some of the most frequently asked questions about when to ice and when to heat acute injuries and chronic conditions.

Should I use ice or heat for back pain?

Heat therapy is particularly helpful with chronic conditions, especially muscle stiffness and soreness. Localized stiffness may benefit from heating packs while regional stiffness and denser tissues may respond better to a warm bath. If the lower back pain is the result of a recent injury, such as a muscle strain, it’s best to follow the R.I.C.E. method for the first few days then, after about 72 hours, transition to heat therapy.

Should I use ice or heat for pulled muscles?

A pulled muscle should first be treated using the R.I.C.E. method. During the first 72 hours, heat should be avoided to prevent increased swelling and inflammation. After about 72 hours, heat can be incorporated into treatment to increase blood flow and aid the overall healing process.

Should I use ice or heat for swelling?

After an acute injury, ice should be used to minimize swelling for the first two to three days. After this period, heat can be used to increase blood flow and assist the natural healing process. Applying heat too early may cause additional swelling by increasing blood flow to the injury.

Should I treat a sprained ankle with ice or heat?

A sprained ankle will require both ice and heat at different points in the recovery. Initially, treatment will focus on rest, ice, compression, and elevation. After about 48 to 72 hours -- or once the swelling has satisfactorily decreased -- heat can then be used to increase blood flow to the injury and aid your recovery.

Should I use heat or ice for muscle spasms?

Heat therapy increases blood flow and this improved circulation may help with muscular spasms throughout the body. Massage and stretching may also alleviate pain and discomfort associated with a spasmodic muscle.

Should I use ice or heat for neck pain?

Many patients ask whether or not to use heat or ice for stiff neck muscles. Neck pain associated with chronic pain, general muscle soreness, or stiffness should be treated with heat therapy. However, a new injury usually calls for the RICE method to be used for the first two to three days, and then individuals may transition to heat therapy.

Should I use ice or heat for shoulder pain?

For new or acute injuries, the RICE technique is recommended for the first 24-72 hours. Once swelling has subsided, heat therapy can be used to help increase blood flow to the area and aid recovery. Heat therapy can also be used to help with the stiffness, aching, and general pain associated with a chronic condition, as needed.

Should I use ice or heat for knee pain?

The type of knee injury will help determine the proper ice or heat regimen moving forward. For new acute injuries, the RICE method should be used immediately following an injury, and then heat can be applied after two to three days to increase blood flow. For chronic injuries, pain, stiffness, and soreness without swelling, heat may be more appropriate. Heat therapy may help with arthritis, knee pain, and stiff joints by using heat packs, pads, and submerging the affected area in warm water. In some cases, gel packs may be more effective than traditional heat packs, due to their ability to form around the joint and penetrate tissues.

Sports Medicine Oregon -- Acute Injury and Chronic Pain Specialists

The RICE method, ice therapy, and heat therapy may relieve pain and discomfort associated with many common aches and pains, but more severe injuries and chronic conditions will require medical intervention. At Sports Medicine Oregon, we can provide the latest conservative care treatments at our state-of-the-art facility, with services ranging from outpatient physical therapy and the latest regenerative injections to minimally invasive arthroscopic surgery. If you are dealing with a nagging sports injury or a chronic condition, our experienced medical team will tailor a specific treatment strategy based on your specific injury or condition to help you live the active, pain-free lifestyle of your dreams.

Remember, we update our Sports Medicine Oregon blog monthly, so be sure to tune in often to stay up-to-date on the latest sports medicine news and views!