Heat vs Ice. When to use what

One of the most common question patients ask me on a day to day basis is should I use Ice or heat for this injury? I can understand why this can be confusing considering the amount of conflicting information we are given about when to use what. So I’m out to set the record straight.. pay attention because using the wrong treatment on the wrong injury can sometimes just make matters worse!

Ice is one of the most important forms of treatment in the acute stages of most injuries. By acute I’m talking the initial 48 hours post injury, also known as the inflammatory phase. Several responses take place during this time manifested by pain, swelling, redness and increased local temperature. Applying ice here assists with minimising swelling and bruising by decreasing blood flow to the injured area and also provides short term pain relief. Ice should be applied for up to 20 minutes and can be done as regularly as your scheduale will allow during this initial period.

Heat on the other hand is great for chronic conditions where muscle spasm and stiffness are the main problem. For example someone with longstanding hamstring tightness would be a good candidate for heat treatment. Heat promotes relaxation by increasing blood flow to the area and assisting with improving tissue elasticity and flexibility.

The exception to this rule is with back and neck pain. Often when you injure your back or neck acutely (ie bend over to pick something up and develop sudden back pain) heat will actually give you more relief than ice. The reason for this being that with there is often a large amount of protective muscle spasm associated with back and neck pain. Heat helps to reduce this muscle spasm and provide short term pain relief while your waiting to see your physio!

And of course there are also some cases where heat and ice can be used in conjunction. For example, a patient with chronic Achilles tendinosis (inflammation of the Achilles tendon) may benefit from using heat prior to exercise, however post exercise ice is beneficial to settle down any inflammation that may have been stirred up during activity.

If your still confused (hopefully not) consult with your physiotherapist about which treatment will be of most benefit to you.

When applying either of these treatments remember:

  • Wrap your ice or heat pack in a thin towel to prevent skin burns or irritation from occurring
  • Don’t apply either for longer than 20 minutes at a time
  • Never sleep with an ice or heat pack

Some Smart Icing Ideas:

Sprained Ankle? Submerge your ankle in a bucket of water and slowly add ice to the water creating a slushy. Try and brave this out for 20 minutes I dare you.

Shin Splints? Freeze a foam cup of water, peel off the edges and give yourself an ice massage.

Remember heat and ice are short term answers. If you carrying an injury needing these sorts of treatments, chances are you may benefit from further advice on how to get you back on track.


Need an ice pack? Ice ‘n’ easy’s are fabulous re-usable ice packs that wont clog up your freezer, and they are especially good for those of you prone to suffering niggles here and there. Otherwise frozen peas are a winner too.

For more information feel free to contact the practise on (02) 9328 3822

One thought on “Heat vs Ice. When to use what

  1. Mark Bakewell October 17, 2012 / 8:48 am

    Seems all logical stuff . maybe you could touch on a hangover and the utilisation of heat / cold for cure .

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