Ice versus Heat which should I use?

There is a lot of confusion whether ice or heat should be applied to an injury – in fact it is one of the most common questions I am asked.

Applying ice or heat is a cheap, easy option for many common painful problems.

In a nutshell ice is for recent injuries and heat is for more chronic problems, stiff joints or aching muscles. 


Ice should be applied to acute injuries (within the last 48 hours) as it helps to calm down the damaged tissues that are inflamed, red, hot and swollen.                                                     Ice causes the blood vessels to constrict (narrow) therefore limiting blood flow to the injury site, reducing swelling and limiting internal bleeding. Following an injury, inflammation starts the healing process, however this can also be incredibly painful! Ice provides natural pain relief by numbing the area.

Ice should be should be applied immediately to the area for 10-15 minutes and repeated every 2-3 hours for 24 to 48 hours.


Heat can be a great help in relieving more chronic injuries including muscle aches and stiffness.                                                                                                                                                 Heat causes the blood vessels to dilate (widen) encouraging more blood flow to the injury site, which brings fresh oxygen and nutrients to stimulate the healing process.             Chronic pain often involves a lot of tension and anxiety for which heat can be calming. Heat has a soothing effect, which helps to relieve tight muscles and make the tissues suppler, easing stiffness.

Safety points:

Always wrap an ice pack in a tea towel and regularly move the pack to avoid freeze burns. If you have a heart condition don’t use ice packs on the left shoulder and don’t place them around the front or side of the neck.

Heat should not be applied to an injury for no longer than 30minutes at a time and like the ice should be constantly moved to avoid burning the skin.

Never apply heat where swelling is involved. Swelling is caused by internal bleeding and heat draws more blood to the area worsening the swelling.


Quick quiz: Would you apply ice or heat in these situations?

  1. You are pulling up weeds in the garden and as you go to stand up you feel a sudden sharp pain in your back. What would you use?
  2. During the middle of a netball match you jump to get the ball and as you land roll over on your ankle. What would you use?
  3. You’re walking the dog and your back is feeling stiff and the muscles feel tight. What would you use?
  4. Six months ago you hurt your shoulder and had it fixed with some osteopathy treatments. A few days ago performing a shoulder press the pain returns. What would you use?


  1. Ice. With this type of injury it is likely you have injured your disc or facet joints, which will begin an inflammatory response for which ice is beneficial.
  2. Ice. You have likely sprained the ligaments in the ankle, which will quickly cause rapid swelling. Ice will help reduce the swelling and pain.
  3. Heat. This sounds like a niggling long-term injury so heat will help the blood flow and relax the muscles.
  4. Ice. This is an acute flare up of an old injury – most probably a tendinopathy, where the tendon is irritated and inflamed. Ice will help reduce the inflammation and numb the pain.

What about alternating between the two?

Just to confuse you there are some situations where alternating between ice and heat can be greatly beneficial. Some injuries will have a combination of inflammation and muscle tension, which will benefit from the two. Apply heat for 5 minutes, rest 3 minutes then ice for 5 minutes and repeat this process 3 times.                                                                         The flushing effect on the blood flow from constricting and dilating the blood vessels can help the healing process.

These are the general guidelines for ice and heat, which are quick, easy, and cheap modalities to help manage your injuries. However, if they’re not enough to get you moving pain free you know where to find me.

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