Ice or Heat for Treating Sprains & Strains

Apr 13, 2021

Wade Weisnicht

by Wade Weisnicht
PT, DPT | South Chandler

When sprains, muscle strains, inflammation, and general pain come at you, knowing exactly when to use ice or heat can significantly shorten your recovery time. So what do you choose, ice or heat?

This is a common question asked by patients of their physical therapists during initial evaluations. Many times, the patient has tried one or the other but was unsure which option would benefit them the most. Knowing the benefits of each along with knowing the proper duration for each can help patients manage injuries from the start and speed up the recovery process.

When Ice Should Be Used:

Ankle sprains, acute or chronic pain, acute or subacute inflammation, bursitis, muscle spasms, abnormal tone, tendonitis, musculoskeletal trauma, myofascial trigger, tenosynovitis.

How Applying Ice Works for an Injury

Ice helps decrease the local temperature of the tissue, which results in decreased blood flow, edema, and muscle tone. It is also shown to slow metabolic rate and nerve conduction velocity. It can also help increase the body’s pain threshold. Ice should be applied for 15-20 minutes at a time. You should give your tissue adequate time to return to normal temperature between icing sessions. Exactly how long and how often a patient should ice an injury depends on a variety of factors that a physical therapist can assess, but generally, for the first 72 hours after an injury, it can be iced at least 3 times per day. After 72 hours, some people will respond better to heat, and they can try using heat to alleviate pain and promote healing. Some potential reasons ice might NOT be a great option for you include cold intolerance, cold urticaria, cryoglobulinemia, infection, over regenerating peripheral nerves, or any form of vascularization problems (such as PVD or Raynaud’s).

When Heat Should Be Used:

Subacute or chronic inflammatory conditions like neck or back pain, abnormal tone, decreased range of motion, muscle guarding, muscle spasms, myofascial trigger points, subacute or chronic pain,

How Applying Heat Works for an Injury

Heat helps increase local temperature to the injured tissue resulting in the following:

  • Increased blood flow to the area
  • Increased capillary permeability
  • Increased collagen extensibility
  • Increased metabolic rate
  • Increased muscle elasticity
  • Increased nerve conduction velocity
  • Increased pain threshold

Hot packs should be applied for 15‐20 minutes at a time. When applying heat, be sure to protect yourself from direct contact with the heating source by wrapping it with a towel to prevent burns, stay hydrated, and make sure not to fall asleep on a heating pad. Generally, heat should be applied 1-3 times a day – however, if heat is added too early in the healing process it can perpetuate the inflammation cycle and be harmful to the body. Possible reasons you should NOT use heat following an injury include acute muscle trauma, arterial disease, bleeding or hemorrhage, over the cancerous area, peripheral vascular disease, or thrombophlebitis.

5 Easy-To-Remember Rules for Ice or Heat When Treating an Injury

Ice and heat packs for treating injuries

  • If the injury is new and has occurred within the last 3 days = Ice
  • If there is noticeable swelling = Ice
  • If you have no significant swelling and decreased range of motion = Heat
  • If you have increased muscle tightness, spasms, or trouble relaxing muscles = Heat
  • If you have had pain for an extended period of time with no range of motion loss and significant swelling = Ice first, then Heat

Ultimately, the decision to use heat or ice is up to you. Your body might respond differently to heat or ice, so try different variations of both treatments to determine which ones you find most effective. If you have recently been injured and are dealing with pain, a physical therapist can evaluate you and help you to determine an appropriate course of action for treatment. Contact your local Foothills Sports Medicine’s Physical Therapy clinic today if you have questions about pain management!

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