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The Ice Versus Heat Debate, Which Should I Use?


13th March, 2012

ice-cubesThere have been many conflicting studies in the past as to when ice should be used as opposed to heat treatment.  Recent research has given more definitive answers.

The safest choice for treatment of injuries is ice. This method is best for an injury or pain less than 72 hours old, or any injury that continues to produce swelling. Ice decreases pain, relieves muscle spasms, stimulates circulation in areas of chronic discomfort and has a calming effect on nerves. It also reduces tissue damage by causing vasoconstriction (closing of small blood vessels). This helps limit the amount of swelling and inflammation that occurs immediately after the injury.

Ice treatment has been shown to be beneficial if used in the 72 hours following an injury at a frequency of 10-15mins every hour and a half.  Ideally, ice should be used at this frequency until the ache/pain has decreased to the point where it is not felt at night or on waking in the morning.

To get added results for treatment of swelling, elevate the area being iced.

Ice treatment is usually applied with ice packs, cold/ice whirlpools, ice massage or cold/freeze sprays and gels.

Ice Application Tips:

  • Wrap a tea towel over a bag of frozen vegetables, bagged ice or ice pack
  • For hands or feet, soak in a bucket or bowl of icy water for 10-15 minutes maximum


  • Ice or cold packs should never be put directly on the skin due to the risk of frostbite. In fact, cold packs can be even colder than natural ice
  • Neither ice nor cold packs should be used for longer than 20 minutes
  • Do not use over insensitive skin or areas of poor circulation
  • Elderly people, young children and diabetics must be careful with cold treatment. Ask your health care practitioner for advice.

Heat promotes muscle relaxation, stimulates circulation and relieves stiffness and chronic aches. It is best used with chronic, long-standing problems or injuries that have no inflammation or swelling.

Muscle soreness and spasms are the most common symptoms treated with heat. Its effectiveness is achieved by increasing tissue temperatures and blood flow, thereby drawing nutrients into the area to assist in the healing process. This treatment can also help with osteoarthritis to increase range of motion and, therefore, decrease pain.

Heat treatment is usually applied with a dry or moist heat pack, ultrasound, warm whirlpools, paraffin baths and infrared lamps.

hot water bottle2Heat Application Tips:

  • Use an electric heating pad, hot water bottle or wheat warmer
  • Place a cloth layer between the heating pack and the skin
  • Apply for no more than 20 minutes


  • Heat should be applied for only 15-20 minutes maximum
  • It should not be placed over insensitive skin (areas where you have decreased skin sensation or numbness)
  • It should not be placed over a recent injury until the swelling is controlled

How long should I wait between ice or heat sessions? With any heating or icing, if a repeat session is needed, wait until the skin is completely back to normal in appearance and temperature. This usually takes between 30 and 60 minutes, depending on the individual's response. Never reapply heat or ice before the skin has completely recovered. Ideally, leave an hour and a half between ice/heat applications.

Treatment with Hot & Cold

Alternating hot and cold applications are good for encouraging a circulatory effect on problems that are chronic.

If you apply the wrong modality for your injury you could make matters worse. Seek advice from your health care practitioner if you have any concerns.

Don't miss next week's blog... Neck Pain - What's the Cause? 

Contributing Author:

Shelley Doole DC MChiro



Back Designs Inc [online]. (1989-2012) [Accessed 26th February 2012]. Available from: http://www.backdesigns.com/Ice-vs-Heat-When-and-what-to-use-W29.aspx.

Sunitha J. Cryotherapy – A Review. Journal of Clinical and Diagnostic Research [serial online] 2010 April [cited: 2010 April 5]; 4:2325-2329.

Taber, et al. Measurement of reactive vasodilation during cold gel pack application to nontraumatized ankles. Physical Therapy / April, 1992.

The Use of Ice in the Treatment of Acute Soft-Tissue Injury. A Systematic Review of Randomized Controlled Trials; Chris Bleakley, et al, The American Journal of Sports Medicine 2004, Volume 32.


Disclaimer: This blog offers advice only, if you are unsure of your own circumstances, you are advised to check with a medical professional.