How to tell whether to use heat or ice on an injury

Using ice and heat properly has many benefits, including reduced swelling and discomfort, and faster recovery from injury. Make no mistake, ice and heat work. I have seen many elite athletes reduce the worst impacts of bad injuries by applying ice and heat properly, and everybody can benefit from these methods.

A big misconception is being too devoted to one over the other – for example, always reaching for the ice pack when there is discomfort, no matter what the circumstances, thinking “only ice works for me, heat doesn’t do anything”, and vice-versa. Often ice will do the trick, but there are situations where heat is the better option.

The most common mistake I see in using heat and ice is to overdo it by applying treatment for too long. People commonly end up with ice burns by applying the ice directly to the skin. Using a light towel helps. And, of course, using heat too long will also burn the skin.

If you are not sure which situations require ice, and which require heat, there are some simple guidelines:

  • When there is swelling, and the injury is hot to touch, and it’s within 24-48 hours of injury – use ICE.
  • When there is swelling but the injury is not hot to touch – use HEAT
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In short, hot to touch = ICE; cool to touch = HEAT.

Many injuries need a combination of both. For example, you roll an ankle, which is now painful, swollen and hot to touch. In this situation, ice will help in the first 24-48 hours.

After that time, if the swelling is still there, but the injury is no longer hot to touch, heat becomes the best option.

The next key is getting the application right so you don’t overdo it. As a rule:

  • Use ice or heat only for 10-20 minutes at a time, every two hours
  • That’s a maximum 20 minutes at a time for ice or heat, no more
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Any more than this and you may cause more harm than good.

Compression helps

Compression garments used in conjunction with ice or heat, can quicken recovery time. These are form-fitting garments of varying degrees of compression, which can be worn on various parts of the body.

Compression helps to reduce swelling and discomfort in the affected area, and is now mainstream practice across sports physiotherapy worldwide.

If nothing’s working

If after 48 hours of using ice and heat there is no decrease in swelling, and no relief from pain, then your injury may be chronic. In this case you need to see a professional such as a physiotherapist or your GP.

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