Hard as it is to admit, we humans are prone to injury, and the more active we are, the likelier we are to hurt ourselves at one point or another. The good news is there’s an easy, safe and inexpensive way to treat the most common aches and pains — by simply applying heat or ice. So, here’s the million-dollar question: How do you know when to use ice and when to use heat? And will using the wrong therapy make matters even worse?

We met recently with Jared Cloud, D.O., a physician on the medical staff at Texas Health Arlington Memorial, and a family and sports medicine physician with Sideline Orthopedics & Sports, a Texas Health Physicians Group practice, to separate fact from fiction when it comes to soothing our injuries with heat and ice.

To get started, what common injuries are best treated by ice?

Jared Cloud, D.O.
Jared Cloud, D.O.

Acute injuries are best treated with ice to numb sharp pain and reduce inflammation. Ice works to calm down damaged tissues that are swollen and inflamed.

“Usually for brand new injuries or reaggravated injuries that are in the acute inflammatory phase, which occurs immediately after injury and lasts for a few days, you’re going to want to use ice instead of heat,” Cloud says. “Swelling to the area is going to increase because of that inflammatory response and if you use heat, you’ll increase the blood flow to that area and potentially increase swelling — which is going to hurt. By using ice, you’re going to decrease the temperature of those tissues and cause those blood vessels to constrict, decreasing the swelling to that area.”

How often should ice be applied?

As a rule of thumb, Cloud recommends treating that pain for the first 72 hours, using the acronym RICE, meaning Rest, Ice, Compression and Elevation of the injured body part. This course of action will help slow down the inflammatory response that your body will naturally create following an injury. At the same time, it will decrease blood flow to the area and, ultimately, decrease the amount of swelling to provide adequate pain control.

To keep things as safe as possible, Cloud recommends 10-20 minutes on and at least 20 minutes off for ice treatment so the treated area can get back to body temperature. This will not only help to avoid potential damage below the skin but cold burns as well.

Some injuries that are still actively swelling will require ice treatment longer than the initial 72 hours.

“The acute inflammatory phase can last up to 7 days,” Cloud adds. “Once you start to notice that the inflammation is done, you can then transition over to heat to help with any additional stiffness and loosen things up in a way that can help you start moving again and recovering.”

That leads us to our next question. What injuries are best treated by heat?

Heat helps soothe joints and relax muscles, and is used to treat chronic pain that doesn’t result from a specific injury. Heat reduces muscle aching and stiffness, and works by improving circulation and blood flow to a particular area. It can also increase muscle flexibility and promote the healing of damaged tissue.

Some good examples of conditions that may benefit from heat-based therapy are chronic muscle strains, delayed onset muscle soreness (DOMS) and overworked muscles, but Cloud says he often sees heat being a treatment method of choice for those with arthritis.

“I have some patients who have arthritis, for example, who prefer icing their joints because their joints feel hot and painful, and that brings them comfort. But I also have many arthritis patients who prefer heating their joints to help loosen up the stiffness and alleviate pain that way,” he explains. “When we get into these chronic, or long-standing conditions, using heat or ice or interchanging the two will really be up to personal preference.”

Cloud recommends moist heat — from steamed towels or heating packs — for the same duration as ice: 10-20 minutes on, 20+ minutes off.

How can I discern which method will work best for me?

“What method you find most effective at treating your symptoms and pain is going to be purely preferential after that acute inflammatory phase,” Cloud explains. “I have some patients who prefer ice and some who prefer heat. And I have some patients that toggle between the two. The simplest guide you can follow is if it’s a new injury where pain and swelling are the primary concern, ice is probably going to be your best bet. Whereas, if you have an older, chronic issue where stiffness is your primary concern, heat will be your best friend.”

Are there any precautions I should take when using ice or heat?

Ice and heat are relatively safe treatment methods. However, Cloud says there are some precautions to be mindful of to make sure you’re not doing more harm than good:

  • Make sure there is a barrier between your skin and the cold or heat device to prevent burns, skin damage or reactions.
  • Limit each session to 10-20 minutes.
  • Leave the ice or heat device off for at least 20-40 minutes before repeating.

“You should be mindful of any excessive use, especially when it comes to ice,” Cloud adds. “Some studies have shown you can actually delay your healing by excessively using ice, or even excessive resting. We know that ice and heat are great for pain, and they’re both extremely safe treatments, but we just want to make sure we’re not overdoing it.”

If you find that you’re having to rely on ice, heat, or rest to function, it may be time to see your doctor for an evaluation.

OK, when should I see a physician for questions about injuries?

“If you have a concern because you’ve done something serious and you want to get the injury checked out, I encourage you to do so, no matter if you feel like you’re jumping the gun,” Cloud says. “If you’re able to bear weight on the affected limb, not having any bony tenderness, and just having that tenderness in those muscles or tendons, it’s totally okay to keep an eye on it and self-treat the first couple of days. However, if you’re not seeing any improvement in pain, swelling, etc. in a few days’ time, it’s a good idea to see your physician.”

Regardless of whether the injury is acute or chronic, it’s important for patients to consult a sports medicine physician to get answers and advice about the injury. A physician can also diagnose a patient to ensure that more serious issues like fractures aren’t the source of the pain.

Each case is different, but to complement heat or ice treatment, Cloud says he will often recommend activity modification to allow the injury to heal, and consideration of the following, physical therapy, pharmaceuticals, injections, and regenerative medicine, to help ensure the patient is back to his or her normal self.

If at-home treatments seem to keep falling short of alleviating your pain, it may be time to see a specialist. For more information about Texas Health Sports Medicine or to find a sports medicine physician, visit TexasHealth.org/SportsMedicine.

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