Heat or Ice?

Heat or Ice?
by Zach Roberts, PT, DPT, ATC 

What should be used for recovery and minor injuries?

 How they work: 

            Heat: When applied superficially, an increase in skin temperature leads to an increase in blood flow to help cool the affected area. This increase in blood flow helps promote healing to affected soft tissue by bringing nutrients to the area and clearing out damaged tissue. An increase in tissue temperature causes muscle relaxation and reduced muscle spasms as well as reducing pain through an analgesic effect. 

            Ice: When applied superficially, a reduction in skin temperature causes reduced blood flow through arteriole constriction. This reduced blood flow effect minimizes acute circulatory and inflammatory effects that follow initial injury and tissue trauma. A reduction in tissue temperature leads to less oxidative demand and tissue metabolism to reduce further injury from initial tissue trauma including long training runs. Application of superficial cold therapy has a strong analgesic effect through reduction of nerve conduction and a numbing sensation to free nerve ending. Ice can also reduce spasm by breaking the pain spasm cycle.   



- increase blood flow

- reduce pain

- reduce muscle spasms

- increase nerve conduction

- increase soft tissue extensibility

- increases cellular metabolism


- reduce blood flow

- reduces acute inflammatory responses

- minimize oxidative stress

- reduce pain

- slow nerve conduction

- reduce immediate post injury swelling

- minimize post injury edema

- decreases cellular metabolism

- facilitate early exercise



- can prolong inflammatory response if used too early in injury

- can increase swelling and result in tissue damage if used with first 24-48 hrs of injury


- can increase soft tissue stiffness

- can delay healing if applied to chronic soft tissue injuries with poor blood supply (tendons/connective tissue)

- reduce mobility/soft tissue extensibility(short term effect)

- reduces circulation


*There is no current evidence that supports the use of contrast therapy(use of hot and cold intermittently) that shows any greater benefits than choosing one or the other. 

Contraindications (not all inclusive): 


- impaired sensation

- open wounds

- acute injury

- heat illness

- impaired circulation


- impaired circulation (diabetics)

- impaired sensation

- open wounds

- cold allergies

- Raynauds


When and how should each be used? 

            Heat: Should be used for chronic or overuse injuries as an adjunct with preventative exercises such as stretching, foam rolling, dynamic warm ups/cool downs etc… It is most effective when applied for a minimum of 10 min in a relaxed setting. It is vital to utilize appropriate layering to avoid any type of superficial burns. This can be monitored by checking the skin frequently and ensuring the skin maintains a pink complexion, and to let pain be your guide. Heat should not be utilized for any acute injury or chronic injury that becomes acute causing increased swelling/fluid retention. 

            Cold: Should be used for acute injuries. Research shows that ice is most effective when applied immediately post injury or post intense workout and for the next 8 hours. It may also have benefits up to 48 hrs in reducing inflammatory processes and acute swelling. Ice should be used post intense exercise as it has been shown to significantly reduce DOMS (delayed onset muscle soreness) and may benefit in recovery. Ice is very effective at reducing pain. Ice should be applied for a minimum of 20 min but no more than 45 min as this increases the risk of frostbite. As with heat proper layering should be followed to avoid frost bite or other cold related injuries. Again frequently monitor skin appearance and check capillary refill by pressing on the skin and monitoring the time it takes the skin to return to pink (average return to normal <5 sec). 

* As a general rule of thumb ice should be used for intense pain and swelling as well as for immediate recovery from intense workouts; while heat is most effect for aching, dull, and sore pain. If any severe pain is present, always follow up with a medical professional i.e. Physical Therapist or Orthopedic Physician for evaluation of the cause of severe or persistent pain.

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