Apr 5, 2017
Heat vs. Ice
Lisa Cox

The question I get asked more than any other has to be: “Should I ice my injury or put heat on it?” There are several options and techniques for cold and hot therapy, and knowing the differences between each one can help answer the above question.

First, let’s go over the effects cold and heat have on the body. Cold therapy is a vasoconstrictor (decreases blood flow to the area), which will reduce inflammation, pain, and swelling. On the other hand, heat therapy is a vasodilator (increases blood flow to the area), which will relieve joint stiffness and muscle spasms.

The most common type of cold therapy is applying an ice pack or ice bag to the skin for 15 to 20 minutes at a time. This method can be used on any injury.

Taking it one step further, my go-to for acute ankle sprains is an ice bucket. It’s as simple as it sounds — all you need is a scoop of ice and a cooler of water big enough to submerge the injured ankle into. I have athletes stick their foot in the ice bucket for 10 to 15 minutes, then take it out for the rest of the hour and repeat this cycle for the remainder of practice.

Heat therapy is not recommended for acute injuries… Instead, it’s most beneficial to use heat therapy prior to activity.

Another form of cold therapy that I use a lot is an ice massage. This technique involves freezing water in a small paper cup, peeling the top layer off of the cup, and rubbing the ice on the injured or painful area for seven to 10 minutes. This method is most effective on shin splints, tennis elbow, and quadriceps or hamstring strain.

The last technique I will discuss involves Polar Care and Game Ready units. These have to be prescribed by a physician and are most commonly used after surgery. The units consist of a cooler connected to a hose that circulates ice water to a Velcro wrap. The wrap can then be placed on the injured body part. There are several different wrap attachments for the shoulder, back, hip, knee, and ankle.

Heat therapy is not recommended for acute injuries (injuries that have occurred in the past 48 hours). Instead, it’s most beneficial to use heat therapy prior to activity. This will help increase tissue extensibility, allowing for improved stretch and flexibility.

In addition, I advise athletes never to use heat prior to bed because it increases the blood flow to the injured area to prepare it for activity. The increased blood flow without activity will cause inflammation and swelling, which will lead to pain.

Tools and modalities for heat therapy include heating pads, adhesive heat patches, whirlpools, and therapeutic ultrasound. Sessions of using a heating pad or sitting in a warm whirlpool should last for 15 to 30 minutes. Therapeutic ultrasound is a modality most commonly used in physical therapy that provides deep heat to soft tissues. The deep heat facilitates tissue extensibility and promotes healing.

Ice and heat can also be used together to create a circulation pumping effect. For example, apply ice for 10 minutes, then apply heat for 10 minutes, and then repeat the process. This causes the blood vessels to dilate and constrict in a short amount of time to reduce swelling in the injured area. I tend to use this method after the first three days of an injury.

To summarize, cold therapy is best for new injuries, such as sprains, strains, tendonitis, and muscle spasms. Always use ice immediately after an injury and after activity once the injured athlete returns to play. Meanwhile, heat therapy is best for chronic injuries, including arthritis, joint stiffness, and low back pain. Heat is beneficial prior to practice or a game once an injured athlete returns to play.


Lisa Cox, ATC, is the Head Athletic Trainer at Anderson County High School in Clinton, Tenn. She is employed through Clinton Physical Therapy Center. She can be reached at: [email protected]


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