Ice vs. Heat

Now that you know the effects of cold and heat on the human body, here is the answer to the ever-popular question, “Should I ice it or use heat?”

Guidelines for Ice Application

Length of treatment: maximum of 20 minutes
Amount of time between treatments: minimum of 20 minutes between applications
Stage of Healing: all

Ice can/should be used extensively in the first stage of healing after an acute injury (first 48-72 hours), since it reduces the amount of secondary tissue death caused by hypoxia as well as reducing swelling. Ice can also be used to decrease pain and limit exercise-related swelling in the other stages of healing by icing after rehabilitation sessions and other physical activity.

Ice limits future swelling through lowering the rate of cellular metabolism and causing vasoconstriction. Ice does not reduce or eliminate pre-existing swelling.

It is possible to have a cold reaction (sometimes called a “cold allergy”) associated with cryotherapy. If the body part being subjected to the cold application starts to itch or gets an intense burning sensation after the initial CoBAN period has ended, stop the treatment immediately and seek medical attention.

If you are using something other than ice as an ice bag (frozen vegetables, freezer gel pack, etc.), use something between the bag and your skin. It is possible to get frostbite or other cold-related tissue damage from using these types of cold packs directly on your skin and/or for too long.

Guidelines for Heat Application

Length of treatment: maximum of 20 minutes
Amount of time between treatments: (20 minutes)

This doesn’t really apply to using heat, like it does with ice. In the first stage of healing after an acute injury, your injury usually prevents you from being able to do much more than ice. This is partially why people tend to go overboard on the ice and end up causing even more damage. But, once you’ve progressed to being able to use heat, you are most likely doing rehabilitation exercises and modified activity, so you won’t be as likely to want to heat all day every day. The most important thing to remember is that your skin can become burned if you are heating all day, so you need to follow the 20 minute time limit for each individual treatment session.

Stage of Healing: Stages 2 and 3 following an acute injury

When an acute injury occurs, avoid using heat for the first 2-3 days immediately after injury. Because heat application increases blood flow and dilates the blood vessels, it increases swelling. Because excessive swelling associated with an acute injury can impede proper healing and extend the time you are out from activity, heat should not be applied until the injury has progressed into the subacute phase (when the body’s not producing as much swelling and has started to work on getting rid of the swelling that’s present).

The effects of heat don’t last very long, so you need to go directly from using a heating pad to your warm-up and rehabilitation/rehearsal/workout in order for the thermotherapy to be effective. Take this literally – you need to remove the heating pad and start your warm-up instead of heating at home, driving 10 minutes to the studio or gym, taking 10 minutes to change clothes, hanging out and talking with your friends for 5 minutes, and THEN starting your warm-up. In this situation, using the heating pad may feel good when you’re doing it, but it won’t help protect you from further injury, improve your flexibility, or facilitate the healing or rehabilitation processes.

It is possible to be burned by heat packs or heating pads. Be sure to follow all manufacturer instructions when using a product at home (especially the kind of liquid- or gel-filled packs that can be microwaved). If you are using an electric heating pad (or something else that continues to generate heat while you are using it), be sure to set a timer for your treatment and make certain you don’t fall asleep with the heating pad on you or you may wake up to some nasty tissue burns.

Final Word

As a general rule, if you are outside the 3 days immediately after an acute injury, heat before and ice after. This means that you can use heat to supplement (not substitute for) your warm-up before rehearsal, exercise, or a performance and then use ice after your physical activity is over.