Whether you're a professional athlete or a weekend warrior, workout injuries can happen to anyone. And if you've ever experienced a sprain, strain or other kind of pain from physical activity, you've likely heard the acronym RICE.
It stands for Rest, Ice, Compression and Elevation (sometimes there's also an S for Stability), and it's the most popular recommendation for treating acute sports injuries.
But what about heat? Whether you use heat or ice (or a combination of the two) depends on how long it's been since the initial injury. Injuries that respond well to cold and/or heat therapy include:
The Two Phases of Workout Injuries and Recovery
Acute Phase of Injury: This is the first 24 to 48 hours following your injury. During this period, you'll often experience sharp, shooting pain followed by swelling. This is the body's way of protecting the injured area against further damage, forcing you to reduce pressure on the injured body part.
Recovery Phase: This follows the acute phase and can last from a few days to a few weeks. During the recovery phase, you'll often notice continued swelling, reduced range of motion and tissue soreness. If you've sprained your ankle or knee, you'll have trouble putting weight on the affected leg.
When to Use Ice for Workout Injuries
The key to treating sports injuries is acting quickly. The sooner you start treating your injury, the faster you'll recover. "[Ice] is particularly effective for the first 48 to 74 hours after an injury," says Steven Struhl, MD, a board-certified orthopedic surgeon at NYU Langone Orthopedic Hospital. "It reduces swelling, slows blood flow, minimizes edema, and reduces pain." But you should avoid applying heat during this period, he says.
Cold compresses can consist of:
- Commercially made cold wraps
- Reusable gel packs
- Freezer bags filled with ice cubes
- Bags of frozen peas
- Ice cups
- Coolant sprays
- Ice massage
- Ice baths
Begin by wrapping the cold pack around the injured area using the attached straps or an elastic bandage and elevate the body part. You can also treat small, nagging workout injuries by rubbing ice directly on the skin.
For most other situations, avoid applying cold treatments like gel packs or freezer bags directly on the skin. Instead, wrap them in a hand towel to avoid causing freezer burns or tissue hypothermia.
"Fingers, toes and Achilles tendons are more likely to experience frostbite due to superficial soft tissue," says Kathy Weber, an orthopedic physician assistant at University of California San Diego Health. "But I have seen patients with frostbite on other areas if they apply the ice too long or fall asleep with the ice pack on."
To avoid frostbite, apply the cold packs for no more than 20 minutes at a time, three to five times a day. Never apply ice to the injured area before exercising. While cold can be a safe approach to treating acute sports injuries, it's not without its risks.
Additionally, avoid cold therapy for treating arthritic joints, as pain can increase with cold (arthritic joints tend to like to be warm), says Weber. "At the same time, I advise patients to listen to their bodies. If their injury prefers heat over ice or vice versa, they should do what feels best."
When to Use Heat for Workout Injuries
Following the first 48 hours of injury, switch from cold compresses to heat applications. "[It] increases blood flow, improves elasticity and enhances metabolism, and therefore is helpful in alleviating morning stiffness, muscle spasms and muscle soreness from activity overuse," says Dr. Struhl. He says it's particularly helpful for neck and back pain.
Heat applications are available in dry and wet heat varieties, but wet heat is more effective, Dr. Struhl says. You can apply heat to the injured area by using:
- Heating pads
- Commercial heat wraps
- Heated gel packs
- Hot, damp towels inside freezer bags
- Hot-water bottles
- Saunas and whirlpools
- Paraffin wax baths
- Professional heat therapy and ultrasound treatments
Depending on the injury, you'll use local, regional or whole-body treatments. Local heat therapy is most effective for small areas like an injured knee. Regional treatments are used for widespread injuries and stiffness like shoulder joints or hips. Lower-back injuries requiring whole-body treatments respond best to saunas or immersion in heated baths or taking a hot shower.
The easiest way to apply heat at home is by using dry heat with a heating pad or dry heat packs. Dry heat promotes blood circulation and speeds recovery. It also sends oxygen and nutrients to the injury, helping it to heal faster. It relaxes the muscles and reduces pain and cramping.
When to Alternate Between Heat and Ice
Somewhat related to both cold and heat therapy is contrast therapy — alternating between cold and heat applications during a single therapeutic session. "Despite its popularity and anecdotal success stories, there are currently no high-quality scientific studies that support its use," says Dr. Struhl.
- Plantar fasciitis
- Shin splints
- Carpal tunnel syndrome
- Tennis elbow
- Achilles tendinitis
- Iliotibial band syndrome
- Patellofemoral syndrome
The theory behind alternating cold and heat therapy is that it "exercises" injured muscles without you having to endure the pain of initiating movement. Repetitive cycling between cold and heat also modifies the body's pain gate mechanism, reducing pain signals to the brain. The reduction of pain can be a welcome relief if you're suffering from long-term, chronic athletic injuries. Contrast therapy uses:
- Immersion in sinks, buckets or tubs
- Wrapping with heating pads, ice packs or soaked towels
- Pouring or spraying a stream from a faucet, container, removable shower head or hose
Contrast therapy is usually administered by certified athletic trainers and involves six brief, alternating periods of cold and heat:
- 2 minutes of heating (comfortably hot)
- 1 minute of cooling (cool, not cold)
- 2 minutes of heating (hotter)
- 1 minute of cooling (colder)
- 2 minutes of heating (as hot you can handle)
- 1 minute of cooling (as cold you can handle)
"I specifically advocate contrast therapy for patients with chronic regional pain syndrome, a condition in which nerves are hyperactive and the alternating of hot and cold can symptomatically calm the nerve pain," says Weber. "For other more common musculoskeletal injuries, theoretically, contrast therapy could increase blood flow and healing."
Whether you use heat, cold or contrast therapy, there are a few things to keep in mind. First, avoid using cold and heat therapies in the following cases:
- Broken skin
- Deep vein thrombosis
- Multiple sclerosis
- Raynaud's syndrome
- Peripheral vascular disease
- Open wound
- Severe cognitive impairment
- Areas with recent radiation treatment
If you have a history of heart disease, hypertension or are pregnant, check with your doctor before starting cold or heat therapy.
When to See a Doctor
Many, if not all, sports injuries can be successfully treated at home using cold and heat therapy. "See a doctor if there is significant swelling and/or bruising in the area, severe pain or significant compromise of joint function such as not being able to lift your arm (shoulder) or limping and difficulty walking (knee)," Dr. Struhl says.
- Tingling or paralysis of the area
- Deformed and/or broken bones
- Severe joint swelling and pain
- Mental disorientation or confusion
- Irregular breathing and/or pulse
If you experience any of these symptoms, call 911 immediately or have a family member transport you to an emergency room or hospital. And if you haven't noticed any improvement in the pain two to three weeks after being injured despite your at-home treatment efforts, that could indicate a more serious injury, says Dr. Struhl. Make an appointment to see your physician or orthopedic specialist.
- Soft Tissue Injury? What are the Healing Phases? Physioworks -
- National Institute of Arthritis and Musculoskeletal and Skin Diseases -
- Marshfield Health System: Treating Pain with Heat or Cold Compress:
- Cleveland Clinic Health Essentials: Should You Use Ice or Heat for Pain?
- Johns Hopkins Medicine: Cryotherapy (Cold Therapy) for Pain Management -
- Journal of Athletic Training: Cold- and Hot-Pack Contrast Therapy: Subcutaneous and Intramuscular Temperature Change:
- Pain Science: Contrast Hydrotherapy: Exercising tissues with quick changes in temperature, to help with pain and injury rehab (especially repetitive strain injuries)