Ice, Heat or Both?

by Hamid L. Sadri, DC, CCSP, ICSSD, CSCS, CKTP, CES, PES

Ice or Heat – When, Why, and How

Burning ice cubes on black backgroundOur patients at 1st Choice Sports Rehab Center often ask us whether they should use ice or heat for their particular conditions. When deciding on which of these thermal modalities to use, here are some rules and guidelines, which if followed, will reduce the risk of adverse effects or further injury and provide for the most effective way of using these therapies.

Among the many different physiological effects that ice and heat have on a tissue, there are basically 2 that make the most difference. These are vasoconstriction and vasodialation. Simply put, ice results in a narrowing of the local blood vessels (vasoconstriction), while heat will increase the vessels’ diameter (vasodilation). It is because of this main difference that the use of these modalities will vary. While both help to reduce pain, they should be used at the right time and in the correct manner or adverse results may occur.

The general rule is that if the injury is acute (72 hours or less) or if there is inflammation in the tissue, then ice is the treatment of choice. By the same token, if there is no inflammation and if the condition is in a subacute or chronic stage (3 days to several weeks after an injury), then heat may prove to be more beneficial.

When applying ice, one should take caution NOT to apply the ice pack directly to the skin as there would be a risk of frostbite. There should always be one layer of a damp towel or T-shirt placed between the ice pack and the skin.The proper way to use ice therapy is to multiple, back-to-back applications by applying the ice pack for 20 minutes, leaving off for one hour, and reapplying it again. Best results are obtained when this is repeated at least 3-4 immediately after an injury. To prevent tissue damage, it is important to be sure that the tissue temperature has returned to normal before applying ice to the area again. When using ice therapy you can expect the tissue to feel cold, followed by a burning sensation that will in a short time turn into an ache and will finally begin to feel numb. The main benefit of this will be a reduction in pain, spasm and swelling.

When using heat, once again, prolonged exposure should be avoided. The therapeutic benefit of heat is best achieved by 30 minute applications with an hour in between to allow the tissue temperature to normalize. Heat therapy should never be used in bed as the risk of burns increase if one falls sleep during application resulting in prolonged exposure. The benefit is increased circulation along with reduction of pain and spasm. Since ice reduces blood flow to the tissue, it is important to remember NOT to use ice when a condition has reached a sub-acute or chronic state. This will result in a slowing of the healing process as the tissue is deprived of oxygen and nutrients.

There is a third method of application called “contrast therapy” and it is considered to be superior to using ice or heat alone. This is once again used after the acute inflammation has subsided and its benefit is in its ability to rapidly flush the tissue with blood. Heat will bring in increased blood flow and with it comes increased oxygen and nutrients and ice will cause the blood to rapidly leave the tissue and take the waste and pain producing elements away. This will aid in increasing tissue repair and hence improve speed of recovery. When using contrast therapy, heat is applied first and last and ice is alternated. The time application ratio is usually 3 to one (3 minutes of heat followed immediately with one minute of ice). This should be repeated for approximately 20 minutes and repeated every hour. Following these simple guidelines will help in better outcomes when managing your injuries and will reduce the risk of adverse effects.

Always remember,….when in doubt, use ice.

Dr. Sadri has been practicing in Decatur, GA for 26 years and specializes in athletic injuries and rehab. The clinic, 1st Choice Sports Rehab Center, was named “The Best Sports Injury Center in the Southeast” by Competitor Magazine. To subscribe to our newsletter click here. To schedule an evaluation, call 404-377-0011.

Decatur Office

2545 Lawrenceville Hwy

Suite 100

Decatur, GA 30033


fax 770-939-9353

Johns Creek Office

9810-B Medlock Bridge Rd

Suite 104

Johns Creek, GA 30097


fax 770-939-9353