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Heat Or Ice?

ice vs. heat

Frequently when patients come in for treatment they are often confused regarding whether to apply ice or heat to their injury. In many cases, they have chosen the wrong application. This brief article will provide a few simple guidelines and a better understanding of which application would be appropriate based on your injury and symptoms.


Application of ice or cold is referred to as cryotherapy. Cryotherapy will initiate a sympathetic nervous system response. This is the fright, flight or fight response.

Cryotherapy will decrease the sensory nerve input and creates an anesthesia effect thus decreasing pain. It also decreases muscle spasm and cramping which is simply an involuntary muscle contraction. Since the sensory nerve input is being interrupted, the motor response causing muscle contraction is decreased creating temporary relaxation.

Ice or cold packs should be applied immediately after the initial injury during the acute injury phase and is continued for 48 to 72 hour after initial injury depending on severity. Cryotherapy causes vascular contraction also known as vasoconstriction. This constriction prevents swelling by forcing interstitial fluid out of the vasculature in the affected area through the lymphatic vessels. This reduces inflammation and acts as an analgesic, temporarily reducing pain by decreasing the sensory input.

Proper application of ice or cold packs is important. Gel packs and ice packs stored in a freezer can be utilized. A baggie filled with ice and two to three finger widths of water may also be used. Adding water will actually provide a colder application and allow the low temperature to be distributed evenly over the affected area. Always have a barrier between the ice and your skin. This can be a thin towel, cloth/clothing or a plastic baggie. DO NOT APPLY ICE DIRECTLY TO SKIN. Keep ice on the affected area for 15 to 20 minutes. DO NOT EXCEED 20 MINUTES. Keep ice in place through these 4 phases: cold, burning, achy, numb (remember CBAN). Initially, the application will feel cold, then a burning sensation will develop followed by an achy feeling and then numbness will occur.

It is best to apply cryotherapy on top of the injured area while in a neutral, relaxed position. This will assure minimal tissue tonicity (tension) and no compression allowing the cold to penetrate as deep as possible. The cold application will be complete upon a numbing feeling or 20 minutes of application, whichever occurs first. Rule of thumb: 20 minutes on, 40 minutes off. For successive application apply ice for durations of 20 minutes, once per hour as needed.

Another form of cryotherapy is ice massage. Ice massage is best suited for localized areas and superficial soft tissue structures such as tendons and ligaments. For example Achilles tendonitis, tennis elbow, golfers elbow, patellar tendonitis, ankle or wrist sprains, and similar conditions.

Ice massage is best applied using an ice cube, frozen bathroom Dixie cup filled with water or a cryocup. Ice is applied directly to the skin in the affected area and is massaged in the local area where pain and inflammation has occurred. Do not hold ice in one spot, keep the ice moving. Again, follow CBAN (cold, burning, achy then numb). Continue treatment until ice cube melts, when numbness occurs, when skin becomes rosy in color or after 5-10 minutes, whichever occurs first.

Other forms of cryotherapy include ice baths and contrast bathing. 


Application of heat will initiate a parasympathetic nervous system response. This is the relaxation response. 

Heat application is typically applied after the acute injury phase (48 to 72 hours after the injury occurred). Applying heat causes vascular dilation also known as vasodilation. This dilation opens blood and lymphatic vessels, increasing circulation and relaxing connective tissue which fosters increased blood supply and nutrition to the injured area. With the increased blood supply will be increased oxygen which is carried in red blood cells. Oxygen is essential for tissue repair and stimulates the healing process.

Heat will produce an anesthesia effect by decreasing pain and muscle spasm. In addition, heat provides prolonged relaxation of hypertonic (tight) tissue leading to early mobilization.

Heat may be applied in many forms, gel packs specifically design for microwave ovens, hot packs, hot water bottles, electric heating pads and wet towels heated in a microwave. There are products sold that can be used as both a hot or cold pack. We sell one of these products from Nature Creation. Use moist heat whenever possible. Moist heat will tend to penetrate better than dry heat.  Apply heat on top of relaxed, non-compressed tissue for optimum benefit.

Always take CAUTION not to cause burns. An effective practice to avoid burning is to wrap the heating device in a terry cloth towel and determine how many layers allow for comfortable and adequate heat penetration.

Keep heat on affected area for 15 to 20 minutes. DO NOT EXCEED 20 MINUTESRule of thumb: 20 minutes on, 40 minutes off.  Exceeding 20 minutes may cause plasma to permeate into the interstitial space between cells causing inflammation, a condition we want to avoid.

Heat applications may be repeated as often as needed. Again, successive treatments should be applied for 20 minutes once per hour. DO NOT USE HEAT ON ACUTE INFLAMMATION OR INJURY.

Athletes Performance Care is an alternative medicine practice specifically dedicated to assessing, evaluating and resolving conditions associated with soft tissue injuries. We accomplish this by utilizing a specialized modality known as Active Release Techniques®, ART. ART is an advanced movement based medical massage technique that restores normal function to compromised tissue. The conditions that we treat are all related to muscles, tendons, ligaments, myofascia and peripheral nerve impingements. ART resolves repetitive stress/strain injuries and cumulative injury disorders resulting from overtraining, overuse, athletics, occupational activity or injuries occurring from activities of daily living (housework, yard work, gardening, snow shoveling, etc…).