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Ice vs. Heat: Which is Better for Musculoskeletal Injuries?

When you have injured your back, (or you can substitute shoulder, knee, elbow, ankle, or other joints of your body), what you want first is pain relief and then you want it to heal quickly. There is often confusion over which therapy is better. Both are relatively inexpensive and easy to use. So when should you use one or the other or even both?

Working with professional athletes and private patients for over three decades and consulting the research, several things can be used as general guidelines.

Warning: Each therapy can carry risks associated with them and you should never attempt to self-treat your injury without the advice of a doctor or competent health professional. This article is for general information only and not direct advice from this doctor for your particular condition. The risks will be discussed at the end of this post.

Injuries can be from macrotrauma, such as falling off a ladder, rolling an ankle or lifting too much weight, which can cause sudden pain, or soon after. Microtrauma, results from small , repetitive movements over a long period of time, such as someone who constantly scans items to purchase in a market or sits at a computer for hours typing without moving.

Both can result in pain and inflammation. In general, to calm the injury down, there is an acute period from 0-72 hours following the trauma, where ice should be applied to the injured area. This is done for a maximum of 20 minutes and then off for one hour. Then you may reapply as often as necessary to control the pain. Never fall asleep on ice and always have a cloth between your skin and the ice pack.

Ice can be uncomfortable because it is cold. First you feel cold, then burning, then aching and finally numbness, which is the most important stage.This is where it might finally feel better. The importance of cold or cryotherapy is to reduce the circulation of the inflammatory exudates which cause more swelling and more tissue damage. It can also reduce muscle spasms as well as pain.

Heat is generally used for chronic conditions, such as those injuries that have been there for months or years. Moist heat, such as a warm wet compress is generally preferred over dry heat, such as a heating pad. However, this may be a personal preference. You should use heat to relax stiff muscles and joints. Heat causes an increase in blood flow, which can be soothing and relaxing. Heat therapy is most effective when used for around 20 minutes. When using a hot compress, a hot water bottle or other heating source, wrap it with a towel so that it does not come in direct contact with your skin.

What about the Subacute Phase, the time between acute and chronic? Opinions vary widely, depending on which source you look up. Many doctors, trainers and therapists, recommend both ice and heat. If your condition remains painful and you still see swelling, then you may want to continue with the ice. If there is stiffness and pain, but no swelling, often you can use the contrast method, by applying heat to the area for 15-20 minutes and then following it up with ice for the same period of time. This may prove to be effective and provide relief for both the short and long term.


  1. Sprain/Strain:

    1. Acute: Ice

    2. Subacute: Ice/Heat

    3. Chronic: Heat

  2. Arthritis: (Degenerative): Moist heat for chronic stiffness

  3. Arthritis (Inflammatory): Ice may be used to numb pain

  4. Chronic Back Pain: Heat in the form of a Jacuzzi bath.


Don’t use ice if you have:

  1. Poor circulation

  2. Fibromyalgia

  3. Previously frost bitten areas

  4. Vascular diseases

  5. Inability to feel cold on your skin

Don’t use heat if you have:

  1. Acute inflammation

  2. An infection over the injured area

  3. Broken skin over the injured area

  4. Deep vein thrombosis

  5. Dermatitis

  6. Diabetes

  7. Neuropathies

  8. Multiple sclerosis

  9. Sunburned areas

  10. Inability to feel heat on your skin

Also young children, elderly people, pregnant people, or those with diseases should only proceed with ice or heat therapy under the advice of a doctor.

Ice and heat generally should be used as part of an overall rehabilitation plan, which has been set forth by your medical professional.

As always, use common sense, be well and take care of yourself and the others you love!

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