Ice vs. Heat: Which Is Best For Injuries?

When you’re sidelined by a sprain, strain, muscle spasm or bruise, you want to find fast relief. Many of us have heard of RICE (Rest, Ice, Compression and Elevation) to reduce inflammation after an initial injury, but in the days ahead, is ice or heat better for your injury?

Franciscan Health Sports Medicine specialists explain when to use the RICE method for your injury, when to use ice or heat for a longer-term injury, and when to seek medical care for your injury. Understanding the differences between these two treatments and when to best use them can impact your healing process, helping you manage pain effectively and recover more quickly.

Is Ice Or Heat Better For An Injury?

Whether to choose heat or ice to help relieve a longer-term injury often depends on how long it has been since the injury happened.

"From a literature point of view, they're both very helpful," said Franciscan Physician Network sports medicine doctor Thomas Schmittdiel, MD, who practices in Michigan City, Ind. "It's a lot of times it's patient preference, but my old adage is if you're worried about swelling or if it just happened within the last one to two days, I think ice is more your friend. But if it's more of a muscle strain and more of a longer-term injury, heat helps promote muscle relaxation and blood flow, which is really important for healing. So I think heat's probably your friend.

"So I would say a good baseline rule is if it's in the first two days, I would try ice and then after that make sure we're doing a lot of stretching, a lot of heat."

What Is The RICE Method For Treating Injuries?

RICE is an initial first-aid treatment for common sports injuries. The RICE method is a simple self-care technique to help reduce swelling and ease pain in the first day or two after an injury happens.

RICE stands for Rest, Ice, Compression and Elevation.

Rest your injury

Start by resting the injured area. Don't move any parts of your body that hurt for at least 48 hours.

Ice your injury

Apply an ice pack (a bag of frozen vegetables will do) to the injured area. This helps reduce swelling and thereby also decreases pain and speeds healing. Cover the ice pack with a wet cloth and apply for 10 to 30 minutes at a time, up to eight times a day for 48 to 72 hours after the injury.

For most acute injuries—such as a sprain or strain—ice is preferred over heat initially. Applying cold reduces the metabolic rate in the affected area, helps narrow blood vessels, preventing blood from accumulating at the injury site and causing too much inflammation and swelling that can delay healing.

Icing an injury for the first 48 to 72 hours reduces the amount of secondary tissue damage and can also ease pain. Apply ice for 20 minutes, once an hour, which gives the skin a chance to recover from each application of ice and prevents frostbite or damage to the skin.

Compress your injured body part

Compress or wrap the injured area with an elastic or ACE bandage. This also helps to reduce swelling. Don't wrap so tightly that blood flow is cut off or the area becomes more painful.

Elevate your injured area

Elevate your injured area above the level of the heart when possible. Elevating the injury above the heart will decrease the blood flow to the area, decreasing post-injury swelling, and aid the recovery process. You may need to lie down and prop up a leg or arm. It may be necessary to use a chair, bed, or pillows to prop the affected limb or area and achieve the correct elevation.

"If it is acute, rest is probably a little bit better in the sense that it just happened. You're swollen, get the ice going, the compression is to help get the swelling down. The elevation is to help decrease the swelling as well," said Matthew Rachwalski, DO, a Franciscan Physician Network sports medicine doctor in Michigan City.

If this RICE treatment doesn't work after a couple of days, consult your health-care provider. Also, if you suspect a fracture or dislocation or if you're experiencing severe pain, see your doctor immediately.

Why Is Ice No Longer Recommended After 48 To 72 Hours For Some Injuries?

Recent research suggests that while ice is effective immediately following an injury, prolonged use beyond 24 to 48 hours might hinder the healing process by impeding blood flow. It's essential to transition to heat therapy after this period to promote healing.

When Should I Use Heat For Pain Relief?

Heat is the best way to treat ongoing muscle aches and pains, or to loosen tense and sore areas before physical activity.

Heat can help when you're dealing with chronic or recurring pain, stiffness or soreness. Applying heat can increase blood flow, relax muscles and soothe discomfort in cases like chronic joint pain or muscle spasms.

What Is The 20/20/20 Rule For Ice And Heat?

The rule suggests applying ice for 20 minutes, resting the area for 20 minutes, and then reapplying if necessary. Similarly, heat can be applied for 20 minutes, ensuring not to overheat the area.

Is Heat Or Cold Better For Joint Injury?

Immediately after a joint injury, cold therapy is better for reducing swelling. However, for ongoing joint pain or arthritic conditions, heat therapy may be more beneficial to alleviate stiffness and promote blood circulation.

When Should You Not Use A Heat Pack For Pain?

Avoid heat if you have swelling or bruising, as heat can increase inflammation in the affected area. Heat is also not advisable for injuries in the first 72 hours as it can exacerbate swelling.

Does Heat Speed Up Healing?

Heat may speed up healing after the initial swelling stage by increasing blood flow, which helps in the healing and recovery of tissue.

Is It Better To Put Ice Or Heat On A Pulled Muscle?

Initially, ice the pulled muscle to reduce swelling. After about 48 hours, transition to heat to promote relaxation and blood flow to the affected area.

Can You Over-Ice An Injury?

Yes, over-icing can lead to frostbite or nerve damage. It's essential to ice in short intervals with breaks in between.

When To Seek Medical Care

If self-care treatments don't improve your symptoms after a few days, or if you're experiencing severe pain, swelling or bruising, see a Franciscan Health sports medicine specialist. They can provide a comprehensive evaluation and recommend appropriate treatments for your condition.