Updated: Mar 25, 2021
Ice is an extremely controversial topic in sports medicine and acute injury rehabilitation. The way physiotherapist treat injuries is continually changing based on the most up to date research. Due to this, it’s no wonder there is confusion around whether ice is good, bad or indifferent for injuries.
First of all, do not use heat on acute injuries because that extra heat can increase inflammation by the vasodilatation of blood vessels (A widening of blood vessels, usually near the surface of skin, leading to increased blood flow with flushing or warmth) and delay proper healing.
Although icing and heating an injured area is not a one-way street; the two complement each other and often work hand in hand when it comes to recovering from an injury. Doing both while in recovery and upcoming participation may help avoid injury in the future.
Icing an injury typically takes place immediately after the injury occurs. Using a cold compress or ice pack on a strained muscle can decrease inflammation and numb pain in the area. Icing is effective at reducing pain and swelling because of the vasoconstriction (narrowing – constriction of blood vessels by small muscles in their walls. When blood vessels constrict, blood flow is slowed or blocked) of blood vesseles and decreases circulation to the area.
When someone twist their ankle during a game or fall on shoulder, most of sports physiotherapist instinctively grab an ice pack. When we see professional athletes get injured, they’re wrapped in ice before they’ve even made it off the field. Immediate application of ice will cut down on long-term swelling and potentially lessen recovery time.
Minor injuries, such as mild sprains and strains, can often be initially treated at home using PRICE therapy for two or three days.
PRICE stands for protection, rest, ice, compression and elevation.
Protection – protect the affected area from further injury – for example, by using a support.
Rest – avoid exercise and reduce your daily physical activity. Using crutches or a walking stick may help if you can’t put weight on your ankle or knee. A sling may help if you’ve injured your shoulder.
Ice – apply an ice pack to the affected area for 15-20 minutes every two to three hours. A bag of frozen peas, or similar, will work well. Wrap the ice pack in a towel so that it doesn’t directly touch your skin and cause an ice burn.
Compression – use elastic compression bandages during the day to limit swelling.
Elevation – keep the injured body part raised above the level of your heart whenever possible. This may also help reduce swelling.
Where to use Ice
Muscle strains and sprains
Muscle strains and sprains usually benefit from a combo of both ice and heat when they occur. Whether you’ve pulled a muscle in your calf or back doing lifting work or sprained your ankle playing football/basketball, it’s best to start either off with ice to ease inflammation (including swelling, redness or tenderness of the injury) and numb the pain. Only after the inflammation resolves is it a good idea to switch to heat; this can help relieve any muscle stiffness at the injury site.
Tendinitis is a painful inflammation issue that affects the tendons, the connective tissues between your muscles and bones. A common cause is repetitive activities so tendons in your elbow, knee, shoulder, hip and even your Achilles tendon are common sites. Besides the usual measures to alleviate the pain — rest, pausing of activities that cause pains, OTC pain relievers — ice is the preferred method here as it can ease the inflammation and help numb the pain.
While similar to tendinitis in that there’s tendon pain, tendinosis is distinct because of the cause: a chronic, long-term condition caused by a degenerating tendon. Because this condition involves irritation and stiffness in tendons attached to joints, heat is best for relieving stiffness in the joints, but only after the inflammation resolves.
How to safely apply ice and heat
You can apply ice and heat in lots of ways. Our experts generally recommend up to 20 minutes on and 20 minutes off:
Ice packs: Frozen peas or corn, ice cubes in a baggie or frozen gel pack. You can ice beyond 48 hours, until swelling, tenderness or inflammation are gone.
Ice massage: Freeze water in a Dixie cup, peel back the top, and massage the tender area until it’s numb. (Best for targeted icing after injury or for areas too awkward for ice packs, like the elbow or heel).
Cold masks: Place a cold mask, available at drugstores, over your eyes or lay a towel soaked in cold water over your forehead and temples.
Moist heat: Enjoy a bath, shower, hot tub or whirlpool using warm, not hot, water (92-100°).
Heat wraps: Drape a heat wrap, available at drugstores, around your neck like a scarf (great for work or travel).
Heating pads: To avoid burns, remove heating pads if the area becomes uncomfortably warm.
The PRICE method for treating acute sprains and strains includes rest, ice, compression, and elevation. This is most effective for injuries within 48 hours. With minor injuries, the PRICE method can reduce pain and swelling, and return you to your activities as soon as possible. With more severe injuries, however, it’s important to consult your doctor before self-treating.
Certainly, the best treatment is prevention. Making sure to stretch when applicable, taking time to warm up and cool down, and resting an injury until it is healed enough to resume sports, are all effective ways to reduce the chance you might need to use the PRICE method in the first place.