When and how to use cold or heat with injury and pain
Should you use ice? Or, heat?
For years, I have used both heat and cold applications as part of my practice in physical therapy. Recommendations for both have been made countless times. In the past, I recommended cold applications including ice packs or gel cold packs in the first acute phase of a soft tissue injury, with the acute phase lasting up to 48 hours after injury. Then, depending on swelling, bruising, or pain, the recommendation might switch to use of heat or a combination of heat/cold. If the injury became a chronic problem, then I would recommend heat.
It seems that in the articles I have recently read, the use of ice/cold packs may help with pain tolerance but it does not speed up recovery. The application of ice packs to a sprained ankle immediately after the injury may help reduce swelling and pain when applied for up to 20 minutes but not if it is applied for 30 minutes. When applied for longer than 20 min, swelling can actually increase. Ice that is applied for too long (longer than 20 minutes) can impede the body’s natural ability to heal. Cryotherapy, where the whole body is cooled, can be beneficial in rapid recovery in between frequent exercise sessions.
What does current research say about heat?
Heat should NOT be applied on areas where there is active bleeding or bruising as heat causes a dilation of the blood vessels. Heat can be helpful in reducing delayed onset muscle soreness and low back pain.
When should ice or heat NOT be used?
If you have diminished sensation from either nerve injuries or from diabetic complications
If you have an open wound
If you have a medical issue such as multiple sclerosis or cancer, it would be best to discuss with your medical provider who knows your history
My thoughts on the use of heat and/or ice at this time are(as I am sure my thoughts evolve as research unfolds):
If it helps your pain, use either heat/hot pack for 10-30 minutes or ice/cold pack for 10-20 minutes
If an injury has just happened, I am still likely to use some type of cold application, but for a limited timeframe such as 20 minutes every 2-3 hours in the first 24-48 hours after injury or surgery to help with pain control
Use exercise, like dynamic stretching and gentle whole-body movement, as a warm up instead of heat
Use gentle whole-body movement as a cool-down instead of ice
Consider whole body cold immersion in between exercise sessions for recovery especially when training for an event or completing high intensity workouts with increased frequency
If you want to try heat application to see if it helps, here’s how to make a pack for use at home:
Take a sock or stocking and fill it with dried rice. Close up the end of the stocking by tying a knot. You can microwave it for several minutes until warm. Apply this to the area that is sore/painful being mindful of the heat intensity. You may need to place a towel layer between your skin and the hot pack to avoid burns.
If you want to try cold application to see if it helps, here’s a way you can make a pack at home:
Mix 3 cups of water with 1 cup of rubbing alcohol. Place in a Ziploc bag and try to get the extra air out of the bag. Double bag it with another Ziploc bag. Place in the freezer. The addition of alcohol will keep the water from freezing solid and you will be able to mold the cold pack to your body. Before you apply the cold pack to your skin, place a towel between your skin and the pack to avoid any frostbite.
For additional reading, here are some sources on the use of heat and cold for injury recovery and pain management:
Kwiecien SY, McHugh MP. The cold truth: the role of cryotherapy in the treatment of injury and recovery from exercise. Eur J Appl Physiol. 2021 Aug;121(8):2125-2142. doi: 10.1007/s00421-021-04683-8. Epub 2021 Apr 20. PMID: 33877402.
Wang ZR, Ni GX. Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture? World J Clin Cases. 2021 Jun 16;9(17):4116-4122. doi: 10.12998/wjcc.v9.i17.4116. PMID: 34141774; PMCID: PMC8173427.
Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015 Jan;127(1):57-65. doi: 10.1080/00325481.2015.992719. Epub 2014 Dec 15. PMID: 25526231.
Take good care,
Sharon