When To Use Ice or Heat?

By Jim Harrison, PT

When Should I use Ice or Heat for an Injury? 

Therapists and athletic trainers are asked constantly ice or heat, when patients are recovering from their injury and/or surgery. The answer is: “It depends on the circumstances.” There is no real best answer except to say that the appropriate modality is selected based on what the therapist/trainer/individual is trying to accomplish. To better clarify, it is first worthwhile to understand the physiological responses to the applications of the therapeutic heat or cold.  If you would like to learn more about ways to reduce swelling, please go to this ARTICLE.

Physiological Responses of Cold or Ice Treatments

  • To Decrease swelling
  • Decrease pain
  • To decrease spasms
  • Decrease inflammation
  • Less comfortable
  • Decrease metabolism
  • Decrease flexibility

Physiological Responses of HEAT

  • Increase swelling
  • Decrease pain
  • To decrease spasm
  • Increase inflammation
  • Increase flexibility
  • More comfortable

Now that the physiological responses have been presented, we now can apply this to the decision-making process to determine which is the right modality – correct? Well, not quite. There are certain conditions that many individuals suffer that preclude the use of therapeutic heat or cold.


  • Decreased heat or pain sensation
  • Impaired skin circulation
  • Malignancy
  • Neurological impairment
  • Poor thermal regulation
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Heat Application

Okay, so now we know who we should and should not apply heat or ice to. Now we can proceed, right? Not quite yet! There is a question of methodology. In other words, when should they be applied, how long should they be applied, how frequently should they be applied, and how should they be applied.

WHEN to use Cold 

  • Cold if the individual is tolerant of the discomfort of ice application
  • Cold for acute situations – within the first 24-48 hours after injury
  • Use Cold for pain
  • Cold for spasm
  • Cold for inflammation
  • Use Cold for swelling

WHEN to use Heat

  • Heat if comfort is a concern and inflammation and swelling is not a concern
  • Heat for more chronic situations or after the acute phase of injury is over
  • Use heat for pain if the inflammation and swelling is not a concern
  • Heat for spasm if inflammation and swelling is not a concern
  • Heat for increasing soft tissue flexibility

Application Time

  • Cold- 15-20 minutes
  • Heat- 15-20 minute

Frequency of Application

  • Cold- multiple applications are okay as long as there is allowed a minimum of 30 minutes is allowed between applications
  • Heat- multiple applications are okay as long as there is allowed a minimum of 30 minutes is allowed between applications

Application Types for the Home User

  • Bag of ice
  • Reusable ice packs
  • Cracked ice in a washcloth
  • Electric hot pack
  • Re-heatable hot packs

Tips for Ice and Heat

  • Do not let raw ice or a plastic bag with ice directly contact the skin – enclose in a cloth or pillowcase
  • Check your skin after any cold or heat application
  • The skin will normally turn a pinkish color with heat or cold
  • Heat applications should be comfortably warm
  • With cold in acute situations employ the R-I-C-E principle:
    1. Rest– remove yourself from the injurious situation and rest
    2. Ice– use the appropriate cold application method
    3. Compression– use a compression wrap (“Ace” wrap) under the cold pack
    4. Elevation– elevate the part above the heart for the duration of the cold application.
Ice bag for the R.I.C.E Protocol for Injuries

When to use ice or heat for an injury

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