Heat vs. Ice

Welcome to “Ask the Athletic Trainer,” an occasional series in which our athletic trainer, Lauren, answers questions she commonly encounters.

Today’s question: When should I use heat vs. ice?

As an athletic trainer, I get this question quite frequently. Let’s start by discussing the basics of our body’s response to injury. When an acute injury happens, the body quickly responds by releasing a number of chemicals to the injured area. This is the beginning of the inflammatory response – our body’s natural healing process. This causes pain, swelling, redness, heat and loss of function.

 When to use ice

Most of the time, ice is used for ligamentous injuries.  Let’s consider the common acute injury, a sprained ankle. This is the best time to use ice. We want to start calming down the inflammation and swelling of the superficial tissues. For this particular injury it is good to ice right away and keep it moving. What do I mean by “keep it moving”? After you ice for 20 minutes, start moving it by drawing the alphabet in the air with your foot, for example. This will help prevent stiffness.

Quick tips: Don’t have an ice bag? That’s ok! I will use crushed ice in a resealable plastic bag – just press the air out.  I also like to fill small paper cups about ¾ full of water and put them in the freezer. Later, you can use them to perform an ice massage for a few minutes on the injured area. If you are using an ice pack (the blue ones you put in lunch boxes), make sure you put a paper towel under it to avoid ice burn – yes this is a thing!

What if you are saying, “OK, Lauren, I don’t have any of those things handy”? You can use a frozen bag of vegetables (peas work great!).

When to use heat

Now about heat: This is best used on chronic injuries and muscles. I will have my injured athletes come in to heat chronic back pain, quads, hamstrings and calf tightness before a practice or game, using a moist hot pack. However, this heat will only warm up the superficial layer. Therefore, a proper warm up is also extremely necessary.

In my experience, heat has been the most beneficial for chronic lower back pain as well. For chronic lower back pain, it is best to lie on your back with your knees up and bent at a 90 degree angle, with a heating pad or moist hot pack under your lower back. Caution: When using moist heat make sure you put 2-4 folded towels over the moist heat because it will get very hot really quickly. Most heating pads have a cover over them. However, putting towels between you and the heating pad is always best to avoid burns! If you are new to using a heating pad, start on a lower setting to get a feel for how hot you are comfortable with and start at 10-15 minutes.

Some chronic and acute muscle injuries require ice as well as heat. For example, applying heat to calf or shin splint tightness before you going running is best. After you run and cool down, ice massaging those muscles will feel great as well.

For a rule of thumb, if you heat muscles before practices, games, activities, etc. and accompany the heat with a proper warm-up routine, you are less likely to “pull a muscle.” Icing injuries after practices and games can help an injury recover.

It is always good to consult your physician if you have additional concerns or have any conditions that would make ice or heat treatments inadvisable. If you have decreased sensation, be extra cautious to avoid tissue injuries from the heat or cold.

If you have tried these heat and ice tips and still have pain, strengthening exercises may be warranted, and it would be good to consult your physician for recommendations.

Lauren is a Certified Athletic Trainer with the National Dizzy & Balance Center.

Article Citation:

  • Michel P.J. van den Bekerom, Peter A.A. Struijs, Leendert Blankevoort, Lieke Welling, C. Niek van Dijk, and Gino M.M.J. Kerkhoffs (2012) What Is the Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults?. Journal of Athletic Training: Jul/Aug 2012, Vol. 47, No. 4, pp. 435-443.
  • Peter K. Thain, Christopher M. Bleakley, and Andrew C. S. Mitchell (2015) Muscle Reaction Time During a Simulated Lateral Ankle Sprain After Wet-Ice Application or Cold-Water Immersion. Journal of Athletic Training: July 2015, Vol. 50, No. 7, pp. 697-703.
  • Zachary Y. Kerr, Thomas P. Dompier, Sara L. Dalton, Sayers John Miller, Ross Hayden, and Stephen W. Marshall (2015) Methods and Descriptive Epidemiology of Services Provided by Athletic Trainers in High Schools: The National Athletic Treatment, Injury and Outcomes Network Study. Journal of Athletic Training: December 2015, Vol. 50, No. 12, pp. 1310-1318.