Hurt yourself and aren’t sure whether you should be applying heat or ice to help your injury best?
While some tend to favour a heat pack, you don’t have to get far into watching a professional sports game to see ice instantly being applied to a new injury, making it seem to be the correct, ‘normal’ thing to do. But given that heat and ice are opposites and cause very different reactions to the area they are applied to, what’s the real answer – and what does the research say?
Interestingly, this has been a much-debated issue over recent years, with many health professionals changing their injury recovery recommendations and many professional regulatory bodies changing their guidelines. Given that the goal of any post-injury care is to help you recover safely and effectively so you can get back to normal function as quickly as possible, today our physios have reviewed the evidence and dived into the age-old question of whether you should be using a heat pack or an ice pack on your injury.
Using Ice On Your Injury
The notion of applying ice to an injury when it first develops has been a cornerstone of first aid since the 1980s. The concept arose because when ice is applied to the skin, it causes the blood vessels in the area to narrow in a process called vasoconstriction. This reaction occurs because your body always wants to maintain a stable body temperature, so this way, less blood circulating through the body is exposed to the cold. As a result of the narrowing vessels, blood flow to the injured area is restricted, reducing swelling, bleeding and bruising. The less swelling you have, the greater your range of movement remains, and the less your pain is – and the ice can also help ‘numb’ the nerve endings and slow down the pain messages your nerves send to your brain.
While the way ice works makes sense, recent re-evaluation of this concept decades later has found a key flaw – one that, paired with new research about the limited effects of ice on soft tissue injuries, has seen ice revoked from its initial RICE protocol by the very person that coined it over 40 years earlier, American sports doctor, Gabe Mirkin. This is because while swelling and inflammation are associated with pain, it is also an essential part of wound healing where inflammatory cells in the body recognise the new damage and recruit other cells in the body to the area to kickstart the very complex healing and repair process that our body makes seamless and intuitive. As it turns out, by interfering with this initial inflammation, we limit the arrival of immune cells and interfere with our body’s processes – which is now thought to potentially delay healing.
Before you rule out ice…
With all this said, there are a few extra things to consider. First, while inflammation kickstarts recovery, prolonged swelling places pressure on the damaged tissues, restricts movement, and can increase pain. This means that when the injury is to the lower limbs like an ankle or a knee, it may significantly affect a person’s quality of life and ability to perform regular activities for some time – and not everyone can take days of downtime every time they roll on an ankle or get an injury.
Next, if a person can’t move, this may also negatively affect their healing given that the original recommendation for Rest (forming the ‘R’ in RICE) has also been revoked, changing to ‘Optimal Loading’. As musculoskeletal cells are stimulated by being loaded (like when walking), optimal loading means having balanced, incremental physical activity in the early stages of recovery to help promote cell regeneration. It is called ‘optimal’ because the ideal amount of loading varies greatly between tissues and is relative to its normal role and function. This is opposed to resting completely, which may contribute to a poorer healing outcome when done for long periods.
Using Heat On Your Injury
Unlike ice, there is very little debate about using heat on injuries at appropriate times. Whether it’s delivered via heat pack, hot water bottle or a hot sauna, heat therapy works by raising the temperature of the tissue it comes into contact with. This causes blood vessels to dilate (widen), increasing the blood flow in the area, which is thought to promote healing by increasing the supply of nutrients and oxygen to the delivery site that is supplied in the blood.
Research shows that the effects of heat therapy also include short-term reductions in pain, and temporarily increases the elasticity of ligaments and tendons which improves a person’s range of motion in the area. This can make heat beneficial for helping manage injury pain and promote function after the initial inflammatory phase and for ongoing problems like low back pain, where heat has been shown to help reduce pain.
Ice or Heat: What’s The Verdict?
Unfortunately, there is no one-size-fits-all answer, and assessing what to use does vary on a case-by-case basis with no consensus from the evidence. It is clear that the view on using ice for injuries has changed from being the go-to cure for all injuries, to being a method that can be purposefully selected and applied for a short time. It should be used for no more than ten minutes and not directly onto the skin, when wanting to reduce pain immediately after an injury has occurred, maintain some movement in the area, limit bleeding or prevent bruising.
If you are continuing to have pain in the days or weeks following an injury, or you have pain with no notable swelling present, it may be worthwhile to try heat first to reduce any interference with your body’s healing process, ensuring not to apply the heat for too long or use a heat that is too high.
Perhaps even more impactful on the outcome of your injury than if you choose to use heat or ice, is ensuring that you take the right care of your injury, address the causes, and have a proper recovery and rehabilitation plan. This is where our experienced physiotherapists come in. We’ll perform a comprehensive assessment, diagnose your injury, and create a tailored treatment plan to help you get the best outcomes – including discussing whether heat or ice is best at different phases of your recovery.
Book your appointment with your local Allsports physio team online or call the clinic nearest you.
 Evidence for Rest, Ice, Compression, and Elevation Therapy in the Treatment of Ankle Sprains in Adults
 Emergency Medicine Journal on Cryotherapy
 Why Ice Delays Recovery
 Is it time to rethink RICE for soft-tissue injuries?
 Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair
 ResearchGate – Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury
 PubMed – Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury