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A Common Inquiry: Ice or Heat for Injuries?

Many individuals often wonder whether they should apply ice or heat to an injury. Although this may appear to be a straightforward question, the response can vary depending on factors such as the injury's nature, the patient's underlying conditions, and other considerations. Let's explore the rationale behind our recommendations.

Embracing Inflammation: A Beneficial Response

Surprisingly, inflammation can be advantageous in some cases! Studies have demonstrated that when muscle fibers sustain damage, as with an acute injury or a strain/sprain, inflammatory cells (macrophages) rush to the affected area. These cells work to eliminate damaged tissue and encourage muscle fiber regeneration. For an educated general public and practitioners, it's essential to understand this complex process to make informed decisions on injury treatment.

Macrophages: Key Players in the Healing Process

Macrophages are always present in your bloodstream, ready to act when needed. Upon injury, the body releases histamines, increasing blood flow to the affected area and delivering more macrophages to help. These cells digest the damaged tissue through a process called phagocytosis, and fluid then fills the vacated space, resulting in inflammation and swelling.

Approximately 24 hours later, non-phagocytosing macrophages release Insulin-like Growth Factor (IGF-1) in the area, promoting the formation of new tissue (precursor cells). These cells eventually merge to replace the damaged tissue, enabling healing and regeneration (see 3D illustration of macrophage cell).

The inflammatory process is crucial for healing to take place, as it relies on fluid movement in and out of the injured tissue. Any obstruction of this movement can slow down the healing process, emphasizing the importance of understanding the body's complex responses to injury.


Acute & Chronic Inflammation

It is important to differentiate between normal (Acute Inflammation) and run- away or abnormal inflammation (Chronic Inflammation).

Acute vs. Chronic Inflammation: Understanding the Difference

Acute inflammation occurs immediately after an injury, resulting from trauma, strain, sprain, infection, or even intense physical activity. This short-lived inflammation aids in speeding up the healing process, and its presence is a positive sign that the body has entered a heightened state of recovery.

In contrast, chronic inflammation involves the body attacking its own tissues, leading to various autoimmune conditions like rheumatoid arthritis, hay fever, asthma, and celiac disease, among others. This uncontrolled, prolonged inflammation can be detrimental; it has even been linked to heart disease. Chronic inflammation increases myostatin production, which hampers the regeneration of new tissue.

If you suspect chronic inflammation, testing is advised. Standard blood tests, such as C-reactive protein (CRP) and erythrocyte sedimentation rate, can provide valuable information to your doctor regarding potential inflammatory conditions.

The specific type of inflammation you're experiencing will undoubtedly influence our recommendations for using ice or heat as part of your treatment.


Using Ice

The Role of Ice and Heat in Injury Treatment: Striking a Balance

Ice is a valuable resource for pain reduction and swelling control following an acute injury or surgery. However, it can also impede new muscle tissue regeneration by suppressing inflammation and, consequently, slowing down the healing process.

Swelling-induced pain (nociceptive pain) results from increased pressure on nerve endings. Alleviating pain is crucial, as it can impact sleep, exercise adherence, and overall functioning. Using ice to control inflammation is a delicate balancing act, as it can also delay healing.

For severe pain, we recommend icing within the first 72 hours after an acute injury. If you don't experience significant swelling or acute pain, it's better not to use ice.

That said, we don't advise applying heat to an injured area immediately after an injury. While heat therapy can improve blood flow, it may also exacerbate inflammation and increase pain. A moderate level of inflammation is necessary for healing, but excessive inflammation can be counterproductive.


When to Avoid Ice Therapy

Refrain from using cold therapy if the person:

  1. Is unconscious, unable to communicate, or lacks sensation in the injured area. Surprisingly, ice has been used on unconscious individuals before.

  2. Exhibits rash or blister formation when exposed to cold temperatures.

  3. Suffers from circulatory problems.

  4. Has Raynaud's Disease, rheumatoid arthritis, gouty arthritis, or kidney malfunctions.


How to Ice!

Optimizing Cold Therapy: Tips for Effective Icing

Now that you understand when to use ice and when to avoid it, here are some suggestions for maximizing the benefits of cold therapy while minimizing potential drawbacks:

  1. Elevate the injured area, ideally above the heart, to decrease swelling and encourage blood flow away from the injury, using gravity to assist.

  2. Apply ice every two to three hours, ensuring the area has warmed up and is no longer numb between applications.

  3. To prevent frostbite, avoid placing the ice pack directly on your skin. Instead, use a thin towel as a barrier.

Icing with an Ice Pack: Guidelines for Safe Application

  1. Place a thin cloth over the injured area to prevent direct contact between the ice pack and your skin.

  2. Apply the ice pack to the affected area.

  3. Keep the ice pack in place until the area feels numb.

  4. Expect to first experience cold, followed by a burning sensation, then aching, and finally numbness. If numbness doesn't occur, you may need to ice longer. However, limit icing to a maximum of 15-20 minutes to avoid frostbite.

  5. Allow at least one hour between icing sessions to ensure your tissues have ample time to warm up.

Ice Massage: An Alternative Approach to Icing

Ice massage can be a highly effective alternative to traditional icing in many instances. To use this method:

  1. Fill small paper cups with water and freeze them.

  2. Peel back the top of the cup to expose the ice.

  3. Hold the paper-covered bottom part of the cup as a handle.

  4. Massage the ice over the injured area using small circular motions, letting the ice melt and using a towel to catch the dripping water. To avoid tissue damage, limit ice massage sessions to 7-9 minutes.

  5. Expect to experience col



The Right Time for Heat Therapy

While heat therapy may feel more comforting than ice, using it too soon after an acute injury or trauma can lead to complications and prolong recovery time.

Heat therapy should only be applied after the acute inflammatory response has subsided.

Avoid using heat within the first 72 hours of an acute injury, particularly when tissue damage and swelling are present. Applying heat to soft tissues (muscles, ligaments, and tendons) during active inflammation may exacerbate the injury. In most cases, cold therapy offers more effective and appropriate relief during the first 72 hours.

For non-acute injuries, heat therapy can be used almost immediately.

Benefits of Heat

Using Heat Therapy After Inflammation Subsides

Once inflammation has diminished, heat therapy can be applied to the affected area to enhance flexibility, alleviate muscle cramps, reduce arthritic symptoms, and accelerate healing by increasing blood flow.

Heat therapy's strength lies in its ability to penetrate deeply and improve circulatory and neurological function. Enhanced circulation delivers oxygen and nutrients to the area while removing waste products. Heat also stimulates sensory receptors in the skin, which can decrease pain signal transmission to the brain, reducing muscle spasms and acute pain episodes.

Heat Application: For minor, superficial injuries, apply heat therapy for 10 to 20 minutes. For chronic injuries, heat therapy may need to be applied for 20 to 35 minutes.



Heat Therapy: Finding the Right Fit

The efficacy of heat therapy differs between individuals. Each person should experiment to determine the most suitable heat therapy for their condition. We recommend two primary types of heat therapy: moist heat and dry heat.

Moist Heat: Moist heat therapy encompasses hot baths, heated whirlpools, hot packs, or hot moist towels. Many users report better depth of penetration with moist heat.

The Moist Towel Treatment

  1. Dampen an old, clean towel (note that towels may discolor during this process).

  2. Heat the moist towel in a microwave for one minute. Check the temperature and heat for another 30 seconds to a minute if necessary.

  3. Carefully remove the moist towel (avoid steam burns) and wrap it with a dry towel (to prevent burns and retain heat). Apply the wrapped towel to the affected area until the muscles relax.

  4. Apply the heat for 10 to 20 minutes.

Epsom Salt Bath

Soaking in an Epsom salt bath is highly beneficial for the body. Epsom salts (magnesium sulfate) are rich in magnesium, which helps alleviate muscle cramps, ease joint pain, and enhance circulation. Keep in mind that Epsom salt baths are a form of heat therapy, so all rules applicable to heat therapy also apply to Epsom salt baths.

To prepare an Epsom salt bath, mix 2 cups of Epsom salts in hot water. Immerse yourself in the bath and let the Epsom salts work their magic.

Using Epsom Salts Locally

  1. To soothe sore feet, fill a bucket with hot water, add one cup of Epsom salts, and soak your feet.

  2. For localized treatment, dip a washcloth in water mixed with Epsom salts and wrap it around the affected area, such as a foot, hand, or shoulder.

  3. Alternatively, soak a cloth in Epsom salt water, wring it out, and place it over a sore or painful area. Wrap a tensor bandage or towel around the area to retain heat and hold the Epsom-salt-soaked cloth in place.

When used at the appropriate time, heat therapy can be highly effective!


Dry Heat Therapy

Dry heat therapy options include dry saunas, electric heating pads, and heat lamps. These can be highly effective forms of heat therapy, but they may also lead to dehydration. Be sure to drink plenty of fluids when using dry heat therapy.

Apply heat for 10 to 20 minutes only. Exercise caution when using saunas to prevent dehydration. Prolonged sauna sessions may increase the risk of dehydration and result in side effects such as a drop in blood pressure or loss of consciousness.



Dr. Abelson is committed to running an evidence-based practice (EBP) incorporating the most up-to-date research evidence. He combines his clinical expertise with each patient's specific values and needs to deliver effective and patient-centred personalized care.

As the Motion Specific Release (MSR) Treatment Systems developer, Dr. Abelson operates a clinical practice in Calgary, Alberta, under Kinetic Health. He has authored ten publications to date and continues offering online courses and his live programs to healthcare professionals seeking to expand their knowledge and skills in treating musculoskeletal conditions. By staying current with the latest research and offering innovative treatment options, Dr. Abelson is dedicated to helping his patients achieve optimal health and wellness.



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