By Brad Williamson BSc. (Physiotherapy) (Dist.) APAM


Confused as to whether or not ice or heat is right for your injury? Be confused no more! Let us fill you in on everything you need to know! 

Have you found yourself in this scenario before; you or a friend has sustained an injury, let’s say a sprained ankle or pulled a muscle, it’s painful, swollen and angry looking. You know that injuries of this sort benefit from ice or heat, but which one?


Well wonder no more! This article aims to un-muddy the waters of acute injury management so that you have the tools to optimally manage the next injury you see. This article pertains to musculoskeletal injuries, usually sustained through sporting endeavours, and is not necessarily applicable to more serious injuries. In such a case, medical help should be sought.


However, if one sustains an acute sporting injury that does not necessitate immediate medical attention then ICE is the weapon of choice. This is because upon sustaining an injury, the affected tissues are damaged to a certain extent. The response to this cellular damage is inflammation, a rapid cascade of chemical release and cellular signalling that produce five cardinal signs; pain, swelling, heat, redness and loss of function. Sound familiar?

Ice assists in reducing pain and swelling to a degree across the first 48 hours post-injury

Research demonstrates that application of ice assists in reducing pain associated with inflammation and can reduce swelling to a degree, although this is contentious(1). It also impacts the redness and heat by mitigating blood flow to the area although these elements of inflammation are usually of less concern.


To be most effective ice should be crushed in a wet flannel and applied to the affected area as this allows maximum cooling. In all cases actual ice, whether in a plastic bag or wet flannel, is preferable to gel ice packs as they tend to warm much faster. Once the ice is prepared it should be applied periodically in 20 minute bursts over the first 48 hours. It is important to remove the ice for periods and ensure there is a layer of tissue or flannel over the skin to prevent ice burns.

Apply ice for 20 minute periods across the first 48 hours

So, when does heat come into the picture? Heat is more effective in the later stages of an injury where muscle tightness, spasm and stiffness are the primary complaints. Heat is not recommended in the presence of inflammation as it may exacerbate the inflammatory process. Depending on the injury your physiotherapist will advise you as to the best exercises to perform after using your heat pack to lengthen muscles and loosen joints.

Wheat packs are a great way of applying heat therapy with most requiring between 1-2 minutes in the microwave, although be sure to follow the instructions on your particular heat pack. Again, it is important to protect the skin by leaving a thin layer of fabric between the skin and heat source. With heat therapy ‘more is more’, the research recommends continuous heat application (8 hours) for pain relief in chronic low back pain (2). So, don’t be afraid to make the heat pack your new best friend for a while!

I hope this quick write-up clears up any confusion out there about when to use which modality and allows you to get your recovery started the right way. With any injury it is important for prompt recovery and long-term health to be professionally assessed and treated, so if you or a friend has sustained such an injury book in today to ensure your recovery is 100%!



1. Bleakley C, McDonough S, MacAuley D. The Use of Ice in the Treatment of Acute Soft-Tissue Injury: A Systematic Review of Randomized Controlled Trials. 2004. ACSM; Vol32:(1). 

2. French, S. D., Cameron, M., Walker, B. F., Reggars, J. W. & Esterman, A. J. Superficial heat or cold for low back pain. Cochrane Database of Systemic Reviews, Issue 2. Art. No.: CD004750