Cold Therapy vs Heat Therapy: Which is Better?

October 19, 2011

By Dr. Trina Rowe, DPT, SCS, CSCS at the Bauerfeind Performance Center

When To Apply Heat or Ice to Injuries

It’s the age old question relating to injuries: “Should I apply heat or ice?”  I’m actually surprised at the confusion surrounding this issue. The answer is almost always ice. Heat can actually be detrimental to tissue healing in many cases. To clarify specific issues surrounding this topic, I’ll discuss the appropriate application of both modalities here.

Sports injuries are the result of trauma to your tissue. It could be externally applied by a collision with an opponent or inanimate object. It can also occur independent of an outside source—such as when you role your ankle or twist your knee while changing directions.

Trauma to your tissue sets off a physiologic process known as inflammation. As part of the inflammatory process, your body sends specialized cells and proteins to seal off the injured area, destroy damaged tissue and keep out bacteria. This can become problematic as, left unchecked, inflammation can destroy healthy tissue and create a bigger problem than you started with. To prevent this, it is crucial that you minimize inflammation as soon as possible.

Application of ice, more properly known as cryotherapy, decreases the temperature of injured tissue. This helps diminish pain, slow down muscle metabolism, and minimize muscle spasm. As a result—and here’s the key—the inflammatory process is decreased which aides in tissue recovery after trauma. Introduction of heat to the area will have the opposite effect. It increased blood flow to the area and can actually accelerate the inflammatory process in acute injuries. Therefore, any time there is an acute injury with swelling or inflammation present, heat is not appropriate.

Instructions for Applying Ice to Injuries

The basis for application of cryotherapy is different depending on the acuity of the injury in question. Ice applied right after the injury occurs reduces muscle metabolism and decreases the degree of tissue damage due to inflammation. Later, when the injury is in its sub-acute phase, the primary purpose of cryotherapy is to relieve pain to help facilitate exercise and activity tolerance.

Hopefully, by now I’ve convinced you to ice your acute or sub-acute injury. Mode and duration of cryotherapy application is important. Large, flexible gel ice packs that can surround the joint provide superior skin cooling effects when compared to rigid ice packs. Research articles recommend anywhere from 10-20 minutes 2-4 times a day up to 30-45 min every two hours. I typically suggest that more severe injuries and post-operative patients apply ice more frequently but for the average injury 10-20 minutes 2 times a day, especially after activity, is adequate.

When to use Heat Therapy

Despite its lack of applicability to acute injuries, heat is not without utility in treating certain types of injuries. Heat can be applied for chronic issues such as muscle or joint stiffness or soreness. Heat can also help relax muscles or decrease muscle spasms. In these cases, it is best applied before exercise to promote blood flow and prepare tissue for use. Heating pads or hot packs are good ways to heat tissue but I recommend moist heat for maximum efficacy. Try using a hot, wet towel to wrap the area in question. Safely apply heat for 15-20 minutes at a time and make sure that you have several layers between your skin and the heating source to avoid burns. Heat should not be applied after exercise. Even with chronic injuries, ice is the better choice after activity.

Cryotherapy and heat therapy both have useful applications when dealing with injury. Make sure you select the correct modality for your injury and always apply it safely. Cold temperatures can burn your skin just as easily as hot temperatures if not applied properly. If you develop a fever or your injury does not improve after a reasonable time, be sure to see your physician to rule out something more serious.

About the Author: Dr. Trina Rowe is Doctor of Physical Therapy (DPT), a Sports Clinical Specialist (SCS) and a Certified Strength and Conditioning Specialist (CSCS). Trina is part of the physical therapy staff at the Bauerfeind Performance Center in Santa Monica, CA. Visit the Bauerfeind Performance Center or contact us at to receive expert advice on injury prevention and recovery, active wellness and raising your potential.

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  • Larry

    Ice may not be the answer.  Check this out:
    For years, people have been told to freeze torn, bruised or sprained muscles to reduce the swelling.But now for the first time, researchers have found that it could slow down the healing as it prevents the release of a key repair hormone.This discovery turns the conventional wisdom that swelling must be controlled in order to encourage healing and prevent pain.It could also lead to new therapies for acute muscle injuries that lead to inflammation.The study, published in the Federation of American Societies for Experimental Biology journal, suggests muscle inflammation after acute injury is essential to repair.Professor Lan Zhou and colleagues at the Neuroinflammation Research Centre at the Cleveland Clinic in Ohio discovered inflamed cells produce a high level of a hormone called insulin-like growth factor-1 (IGF-1) which significantly increases the rate of muscle regeneration.During the study, scientists studied two groups of mice. The first group was genetically altered so they could not form an inflammatory response to injury.The second group was normal.All mice were then injected with barium chloride to cause muscle injury.The first group of mice did not heal, but the bodies of the second group repaired the injury.When they studied the muscle tissue they saw the healthy mice produced a high level of IGF-1 in their inflamed tissue.Prof Zhou, said: “We hope that our findings stimulate further research to dissect different roles played by tissue inflammation in clinical settings, so we can utilise the positive effects and control the negative effects of tissue inflammation.”This discovery could change how much patient monitoring is required when potent anti-inflammatory drugs are prescribed over a long period.Gerald Weissmann, editor of the Federation of American Societies for Experimental Biology journal, said: “For wounds to heal we need controlled inflammation, not too much, and not too little.”It’s been known for a long time that excess anti-inflammatory medication, such as cortisone, slows wound healing.”This study goes a long way to telling us why – insulin-like growth factor and other materials released by inflammatory cells helps wound to heal.

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