Which to Use When: Ice or Heat?

Armen Hareyan's picture

Knee pain after running? Wake up with a backache? Twist an ankle?

When aches, pain, strains or swelling take place due to an injury or chronic condition, what is the best course of action: ice or heat? Many people automatically assume heat will ease their discomfort. Think again.

Ice and heat have opposite effects when dealing with inflammation and pain. Both are useful when applied at the correct stage of an injury. Ice constricts blood vessels and decreases blood flow to an injured area, therefore reducing inflammation. It also numbs pain. Heat increases local blood circulation and relaxes tight muscles. When is it appropriate to use each?

The Acute Injury Stage:
Immediately after an injury occurs, inflammation and swelling takes place due to damaged soft tissues and broken blood vessels which leak blood into the affected area. This is considered the acute stage of an injury and lasts about 48 to 72 hours. Pain, stiffness, bruising and tissue tenderness are symptoms of the acute stage. Ice should always be used immediately following an injury because it constricts blood vessels, which will lessen swelling, as well as numb pain and control bleeding. Apply ice no more than 20 minutes at a time. Always protect skin from tissue damage by using a cover over the ice pack. Allow the skin to return to normal temperature before reapplying ice. Heat should not be used during the acute stage. It will increase blood leakage, which increases swelling and possibly pain. Most professionals agree that icing an acute injury will facilitate healing. Applying heat may actually slow healing during the first 72 hours after an injury takes place.

The Chronic Injury Stage:
This is normally the point at which inflammation decreases, approximately 72 hours after the injury. Pain and stiffness may still be present. At this point, both ice and heat can be used to assist in healing. Use ice to control pain and to help with inflammation that might occur after working the injured area, such as a sore knee after running. Use heat to relieve muscle tightness or joint stiffness. Heat is also helpful before a workout to increase blood flow to the injury and warm up the affected area. When applying heat, use moist warmth. Never use a heating device that is too hot nor sleep on a heating pad, which may result in burns. Apply heat only for 20-minute intervals, using the same general guidelines as ice.

An Easy Guide for Ice and Heat:

When to Use Ice:

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During Acute Stage (48 to 72 hours immediately after an injury)

To decrease swelling and inflammation.
To numb pain.
To decrease muscle spasms.
To treat an acute burn.

During Chronic Stage (after inflammation subsides, usually 4 or 5 days after injury)

To manage pain and possible swelling.
After an activity or workout involving an overuse injury to decrease pain and swelling.
To treat joint swelling due to inflammatory arthritis.

When to Use Heat:
During Chronic Stage (after inflammation subsides, usually 4 or 5 days after injury)

To warm up stiff joints and aid in joint mobility.
To decrease chronic muscle spasms.
To aid in stretching tight muscles.
Before an activity or workout involving an overuse injury to warm up the affected area.

Disclaimer: This information is not intended as a substitute for professional medical treatment or consultation. Always consult with your physician in the event of a serious injury.


Louise Roach is the editor of on-line health and fitness newsletter, NewsFlash*SnowPack. She has been instrumental in the development of SnowPack, a patented cold therapy that exhibits the same qualities as ice. Her injury prevention and treatment articles have been published on health and fitness websites.



You have never had to get up and go to work the next day and use your injured limb. Try this, Apply Asprin paste to any injury that is not bleeding, externally or internally, then wrap it with an ace bandage, Apply ice to anything muscle related for 20 minutes, then off for 20 minutes and then back on for three hours. Bruises: Apply asprin paste topically to bruise, then apply heat. Lots of heat. Keep the bruise body part ABOVE your heart. Do not do this if the bruise is still growing.
If the bruise is on my lower back, I am unable to keep above my heart. Any suggestions? The bruise is from a fall.