Almost all of us, at some point, will strain or irritate a muscle or ligament. The resulting pain can have a big impact on your daily life.
To ease that pain, is it better to use ice or heat?
What is Inflammation?
Inflammation and pain is the body’s natural reaction to an injury. As much as it might hurt, swollen and inflamed tissue contains the components of healing that your body uses to repair itself after an injury.
When an area on your body is inflamed, fluid (“water on a joint”) and/or irritation cause pressure in the area. It’s this pressure that causes you to feel pain.
A good example is an ankle sprain. The ankle swells when it’s sprained because the body sends inflammation and increased fluid to the wounded area. Inflammation can also result from irritation in an area of the body’s tissue, such as a hangnail.
Depending on the nature and severity of the injury, in orthopedics, we treat inflammation using anti-inflammatory medication, elevation of injury, massage, cortisone injections, compression and rest.
Does heat make inflammation worse?
Ice (cryotherapy) beats heat (thermotherapy) for treating pain and inflammation in most circumstances. Although heat initially feels warm and cozy, ice helps decrease pain and inflammation in the long run.
Ice constricts, or narrows, blood vessels. Constricting blood vessels inhibits the body from allowing inflammation in the iced area. Heat dilates, or widens blood vessels, allowing more inflammation to flow to an injured or painful area.
As a general rule of thumb, ice should be used if you have recently injured an area or had surgery or a procedure. Medical studies agree that 20 minutes of icing is most effective. You should ice with a cold compress or ice pack that is the temperature of a melting ice cube.
Some people have cold allergies, which cause ice to burn the skin. Put at least a thin towel between the ice and skin to avoid burned skin.
Greater than 20 minutes of icing can cause reactive vasodilation, or widening, of the vessels as the body tries to make sure the tissues get the blood supply they need. Studies have also shown 30 to 40 minutes in between icing sessions are needed to counter this reaction. The suggested time for icing is 20 minutes on and at least 30 minutes off.
Although many articles and studies may say that heat should be used for injuries and pain that have lingered for longer than six weeks, this is not necessarily the case.
For conditions such as chronic tendonitis and osteoarthritis, the body thinks that it can heal the worn or injured area. The body continues to go through a cycle of increased inflammation even though it cannot heal these conditions on its own.
Icing for 20 minutes several times a day can work as well as, if not better than, oral medications and injections. By controlling inflammation, symptoms often resolve or improve and pain subsides.
About Applying Heat
Heat does have its role. Heat works best in larger muscle groups. As an example, heat helps to ease back muscle spasms – as long as the spasms are not caused by a new fall or injury.
Moist heat or heat pads work best when used for 15 minutes on at a time and at least 30 minutes off.
Rules to Remember:
If an injury has occurred to any body part within three days, ice is preferred -- 20 minutes on and 30 to 40 minutes off.
Pain to the back, neck and large muscle groups like quads, hamstrings and calves will respond well to heat after three days of injury.
Use ice for pain in joints such as knees, elbows and shoulders.
Keep It Local
Do not apply ice or heat to large areas of the body if only one joint or body part is the focus. As an example, a full-body ice bath should not be used to treat an ankle sprain.
The body cannot sustain the vasodilation, or decrease of blood flow, to such a large area. This type of treatment will not help the injured body part, so do not waste your time in a really cold bath.
Ice & Heat Together
As a more advanced treatment, use ice AND heat. To achieve therapeutic results, you must do this in a very specific way. The key is to ice for 20 minutes, causing the vessels to narrow, and then heat for 15 minutes, causing the vessels to dilate. This acts as a pumping mechanism to the inflammation, pushing it away from the injured area.
Most importantly, end the treatment cycle on ice (unless you’re treating a chronic back spasm). By ending on ice, the vessels will be narrowed and will help keep inflammation from re-entering the area.
Heat and ice can be used on all injuries or sore body parts at any time and can provide significant pain relief.
Ice is definitely not as comfortable as heat, and ice will sometimes ache or burn for the first five to seven minutes of the 20-minute session. If used appropriately, it can help tremendously with most aches and pains.
I always like to say, “An icing a day keeps the orthopedic doctor away.”
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September 11, 2023
To confirm, the method is ice then immediately apply heat then immediately apply ice? Making sure there isn't time in between icing and hearing.
- Agnes
Reply From:OrthoCarolina
September 12, 2023
There are no strict rules regarding the perfect timing and frequency for switching between heat and ice. A common approach that works for many people involves applying each for approximately 15-20 minutes. However, it's important to consider your personal preferences and how your body responds when determining the best approach for you. Feel free to adjust your routine according to your specific needs and requirements.
August 22, 2023
I have a question about the ice heat ice therapy. Is the time in between when using this method or is it 20 ice immediately followed by 15 heat immediately followed by 29 ice.
Also how many times a day should this method be done?
Thanks in advance
- Stacey
Reply From:OrthoCarolina
August 23, 2023
The ideal duration and frequency of alternating between heat and ice don't have strict guidelines. Many people find that applying each for about 15-20 minutes is a popular method. Your individual preference and how your body reacts are important factors in determining the most effective approach for you. Don't hesitate to make changes according to your needs.
September 13, 2022
I’m experiencing increased discomfort in my knees. I was confused about how to use both ice and heat. I’m going to ice them more and see how it helps! Thanks
- Tahnett
September 02, 2022
I noticed my knee was tender from over use while roller skating. I had a heat pack on while reading your article. I have now applied ice and it feels better already. So glad I found this information. Really very useful info! I will also try ice on my back the next time I have any issues!
- Nifty
Reply From:OrthoCarolina
September 06, 2022
Sorry to hear about your injury but glad that you found this content helpful and were able to find relief!
August 11, 2022
I hit the top of my foot pretty hard the pain wasn't to bad for few days. put a ice pack on it about the 4th day the next day the pain and swelling increase so much did I do something wrong by putting ice pack what should I do try heat I'm not shore don't wanna make worse
- Josh
Reply From:OrthoCarolina
September 06, 2022
We recommend seeing an orthopedic specialist if the pain and swelling is continuing after multiple days.
July 26, 2022
Fall while running this morning. Hit knee on the pavement. This information is so well written. Thank you!
- Liz McNeel
July 20, 2022
I understand it says start with heat, then ice, but then when it says "end with ice" to narrow the vessels, how long should that last ice session be? Thank you in advance!
- Kaitlyn
Reply From:OrthoCarolina
September 06, 2022
Great question! The last ice session should be the same length as the previous - you are just ending on ice vs ending on heat. Hope that helps clarify!
July 13, 2022
This is one of the more comprehensive articles on how and when to use ice and heat. I have 2 herniated disks and have been searching for a good ice heat method. If there's any additional information you can provide for someone who is suffering from severe sciatica due to a herniated disk flare up
- Hafiz Akhtar
Reply From:OrthoCarolina
July 13, 2022
Hi Hafiz, we are so sorry to hear of your severe sciatica and herniated disk flare. We would absolutely recommend consulting with an orthopedic specialist for further guidance here especially if the pain is severe and keeping you from doing daily activities.
July 09, 2022
Twisted my knee in a skiing mishap 3 days ago. Done Rest Ice Compression Elevation since. Looked up what to do after 72 hours and found your very helpful article. Looks like I might try your ICE/HEAT advice today. Thank you.
- Fiona Gregory
Reply From:OrthoCarolina
July 11, 2022
Hi Fiona, we are so sorry to hear about your knee! Hopefully the rest of you skiing trip was fun though. We are so glad you found this article so helpful and hope it provides you with some pain relief. Don't forget, if your swelling does not subside or it is overly painful to walk, it may be a good indicator to visit your local Orthopedic Specialist.
June 13, 2022
Clear and helpful instructions. Thank you!
- Dmytro
Reply From:OrthoCarolina
June 13, 2022
We are very glad you found them helpful!
May 05, 2022
Thanks so much! Loved the clear and simply put instruction as well as the download sheet! Will come very in handy!
- Eryn Noble
Reply From:OrthoCarolina
May 05, 2022
Glad you found this helpful Eryn!
May 01, 2022
Thank you for that. I love it that (with the exception of an acute injury) anytime I ask PA’s who take care of my knee or back should I use heat or ice the answer is always yes. It always makes me smile.
Orthocarolina is awesome.
- Steven Singer
April 17, 2022
Thanks for the information! I wondered what the affects of icing a knee longer than 20 minutes would be. Thanks for supplying the answer plus lots of other helpful information!
- Lynn Gaspari
Reply From:OrthoCarolina
April 18, 2022
Glad this was helpful, Lynn!
April 17, 2022
This was very helpful. Here I thought after being an avid reader and athlete for the last 40+ years I knew exactly how ice and heat work for injuries, I did not. I wish I would of read this 3 weeks ago when I injured my back. Thank you for the info.
-Tracey
- Tracey
Reply From:OrthoCarolina
April 18, 2022
We are so sorry to hear you hurt your back, Tracey! Now you know some pro tips on ice and heat for the brain bank. Hope your back is feeling better now!
March 19, 2022
wow this helped loads with my ligament tear, thanks!!
- sana
Reply From:OrthoCarolina
April 01, 2022
Hi Sana. Thank you for your comment. We are so glad to hear that this helped with your ligament tear!
February 18, 2022
very good advice,for this article i shall use
- HEMED MUSSA
January 12, 2022
PA-C Wheeler,
I echo the other comments. This is refreshingly succinct and thorough. Thank You.
- Jack
January 11, 2022
Thanks for this insightful article! It’s really helpful and I appreciate it :)
- Shakti
December 15, 2021
Thanks for such a thorough explanation of heat versus ice.
- Milton
October 20, 2021
My chiro advised icing and applying ice then heat. Thank you for the great explanation.
- Jenn
October 15, 2021
You have explained the use of ice and heat, singly and in combination better than a number of sites I read before finding you. A much appreciated and magnificent job. Thank you heartedly.
- Richard Ince
September 28, 2021
Most informative and very helpful . Thank you soo much .
- Rose
June 29, 2021
Thanks very much I learn the difference between ice and heat for pain
- Pat
Reply From:OrthoCarolina
June 29, 2021
Thanks Pat.
June 29, 2021
This was great! I now have a very clear understanding on how to treat my injuries, thank you so much!
- Anthony
Reply From:OrthoCarolina
June 29, 2021
You are very welcome Anthony, thank you for the note.
May 02, 2021
I am very thankful that I found this article! I've had knee replacement surgery and suffered a lot of pain. I was told by therapist that icing was my best friend, but what I didn't know was that 20 minutes on and 30 to 40 minutes off is the best cycle of using ice. I tried it and it worked much better! Thank you for the knowledge!
- William Rutledge
Reply From:OrthoCarolina
May 02, 2021
Thanks William!
March 20, 2021
Thank you for letting me know in plain language about the icing and the Heat I was always getting confused about
the two.
- Judy
Reply From:OrthoCarolina
March 22, 2021
Thanks Judy!
March 15, 2021
Thank you so much for clearing up the confusion I have had on icing and heat for my back. You explained this so clearly!!
- Marlene
Reply From:OrthoCarolina
March 15, 2021
Very welcome Marlene
December 23, 2020
Interesting read, thanks!
- Alex
August 28, 2020
Thank you so much,this is very details,I only use heat method before but now I will try the heat and ice method on my clients that has Arthritis.
- Folashade,massage therapist
Reply From:OrthoCarolina
August 28, 2020
Thank you for reading.
April 18, 2020
Thank you for an in depth explanation.
- Ray
Reply From:OrthoCarolina
August 28, 2020
Very welcome Ray.
February 15, 2020
Thank you for confirming. I’ve had inflammation to both knees with sharp pain. I think I was icing too often and too long. After reading this article I got it now.
- Linda I
Reply From:OrthoCarolina
February 15, 2020
Very welcome Linda.
December 19, 2019
My husband had a cortisone shot into his arthritic shoulder. I was puttng heat on it and did not know about icing for twenty minutes and heat for fifteen minutes, etc. Excellent article to clear up the confusion we had. Thank you!
- Joan Carmichael
Reply From:OrthoCarolina
December 19, 2019
Great to hear, thanks Joan.
November 27, 2019
thank you for sharing the amazing article and tips. It helps me a lot, in relieving my knee pain.
- lisa
October 30, 2019
I twisted my knee 4-6 weeks ago and I’m still having problems. This is the best and most thorough explanation I have been able to find. Thank you
- Karon Canterbury
Reply From:OrthoCarolina
October 30, 2019
Thanks Karon.
October 12, 2019
Very good, clear and thorough explanation. Thanks.
- Alicia
Reply From:OrthoCarolina
October 12, 2019
Thank you Alicia.
July 13, 2018
Before Dr. Howe did my hip replacement surgery, I had used ice on that joint daily which was the right choice. Now that the hip joint pain is gone I have been noticing other minor aches and pains more and often ask the "Ice or Heat?"question when treating them. After reading your article I feel I will make the correct choice every time now. Thank you for explaining things so well!
For acute orthopedic injuries after scheduled clinic and urgent care hours, please utilize the HURT! App, in partnership with OrthoCarolina, for fast free access to orthopedic advice with a response time of ~4 minutes. Download here.
November 16, 2023