Should you use ice or heat for injury rehabilitation?
Injuries are an unfortunate reality for many people, but when it comes to injury rehabilitation and pain management, one of the most common questions people have is whether to use ice or heat for treatment.
Both ice and heat can be effective in managing pain and promoting recovery, but understanding when to use each modality is crucial for optimal healing, as they work in very different ways.
The role of ice
Ice, in the form of ice packs or cold compresses, is commonly used in the initial stages of an injury, at the first onset of pain. Its primary purpose is to reduce pain as the ice can also have a mild anesthetic effect by numbing the area and providing pain relief. Studies have shown beneficial use of ice prior to exercise in the early stages of rehabilitation, by reducing effusion related muscular inhibition – therefore by applying ice prior, you improve the activation and beneficial effects during exercises.
When to use ice
Acute injuries: Ice is particularly useful for acute injuries, such as sprains, strains, or fractures. Applying ice within the first 48 hours after an injury can help reduce pain.
Inflammatory conditions: Ice can be beneficial for managing inflammatory conditions like tendinitis or bursitis. Applying ice to the affected area can help alleviate pain and allow greater adherence/tolerance to loading.
Post-exercise recovery: Ice can be used as part of post-exercise recovery, especially after intense or strenuous workouts. Applying ice to muscles or joints can help reduce muscle soreness, when used in contrast with heat, can promote blood flow.
The role of heat
Heat therapy, typically in the form of heating pads, hot water bottles, warm baths or saunas, is generally used in the later stages of injury rehabilitation. Heat promotes blood circulation, relaxes muscles, and enhances recovery post-exercise. It can also provide pain relief by soothing tight or stiff muscles.
When to use heat
Chronic Injuries: Heat therapy is often beneficial for chronic injuries by reducing pain and promoting muscle relaxation. Arthritis or muscle strains that have moved beyond the initial acute stage can involve muscle tightness, stiffness or spasms. Heat shouldn’t be used on new injuries as it can increase blood vessel permeability and be counterproductive to oedema management.
Training recovery: Delayed Onset Muscle Soreness (DOMS) is a natural part of training hard, with some people enjoying that ‘worked hard’ ache, for others it can be demotivational for their rehabilitation and training. Heat is effective for improving recovery from DOMS by inducing physiological changes at a cellular level, such as growth hormone factor release and reduction in creatine kinase levels. As well as a more general reduction in pain levels post-exertion, with a soothing effect and helps to relax tight muscles by making the tissues more supple.
Before physical activity: Applying heat before physical activity or exercise can enhance blood flow and loosen up the muscles, reducing the risk of injury. This is not a replacement for a thorough warm-up routine, along with the practicalities of having a sauna and/or hot bath near where you are training! Heat pads or hot water immersion could be useful when doing rehabilitative exercises for small, isolated joint conditions such as thumb osteoarthritis or hallux valgus exercises.
Finding the balance
In some cases, a combination of ice and heat may be recommended. This approach, known as contrast therapy, involves alternating between cold and hot treatments. The cold application reduces inflammation and pain, while the heat promotes blood flow and relaxation. Contrast therapy can be particularly useful for chronic conditions or during the later stages of injury rehabilitation.
Heat and ice are both useful, primarily through reduction in pain, so how you choose to utilise these tools in your rehab will be unique to you. Hopefully with the info provided, you will be able to inform a decision yourself on this. As always, if you’re unsure, always consult a professional, or get in contact with one of our team!
McGorm, Hamish; Roberts, Llion A.; Coombes, Jeff S.; Peake, Jonathan M. (2018). Turning Up the Heat: An Evaluation of the Evidence for Heating to Promote Exercise Recovery, Muscle Rehabilitation and Adaptation. Sports Medicine, (), –. doi:10.1007/s40279-018-0876-6
Dubois B, Esculier J (2020), Soft-tissue injuries simply need PEACE and LOVE British Journal of Sports Medicine;54:72-73.
Bleakley C, Glasgow P, Phillips N, Hanna L, Callaghan M, Davison G, Hopkins T, Delahunt E (2010). Management of acute soft tissue injury using Protection Rest Ice Compression and Elevation: Recommendations from the association of chartered physiotherapists in sports and exercises medicine (ACPSM). https://www.physiosinsport.org/media/wysiwyg/ACPSM_Physio_Price_A4.pdf