What Is Better to Put on a Pulled Hamstring: Ice or Heat?

When you have a pulled hamstring, you want relief and you want it fast. But it's hard to remember whether you're supposed to use ice or heat for hamstring pain. The answer depends on when your hamstring injury occurred. If it's very recent, ice is your best choice; if it happened a while ago, heat can bring relief.

Use ice at first and then heat. (Image: Dirima/iStock/GettyImages)

Tip

For a pulled hamstring, ice or heat will provide relief, but ice is best in the first 72 hours after the injury.

Pulled Hamstring Injury

A pulled hamstring muscle occurs when the muscle fibers are overstretched or subjected to a force too strong for the muscle to withstand, according to Harvard Health Publishing. Depending on the severity of the injury, a few muscle fibers may be torn or the entire muscle might tear in half.

For more mild strains, there may be some pain, slight swelling and muscle tightness. With more serious strains, the pain will be greater with more swelling and possible bruising, muscle spasms and muscle weakness. If there is a complete tear, you may lose muscle function.

Ice for Acute Injuries

Whether the tear is mild, moderate or severe, the first goal of treatment in the acute phase is to reduce pain and control swelling. Ice is the best way to do this. It also helps reduce bruising and prevent muscle spasms, according to the Southern California Orthopedic Institute.

How to Apply Ice

You may use an ice pack designed for the purpose, or a bag of ice or frozen vegetables. You can create a hamstring ice wrap using an elastic bandage. However, don't place ice directly on an injury to avoid ice burns.

Apply the ice pack for about 10 to 20 minutes, and no more than 30 minutes at a time, every hour if possible. If the injury site becomes bright pink or red, remove the ice pack. Continue icing the injury for 48 to 72 hours or as long as your doctor has suggested.

Heat for Healing Injuries

Once you are out of the acute phase and the swelling, pain and bruising have subsided, you can begin to use heat therapy. Heat helps loosen and relax the muscles and stimulates blood flow to the injured hamstring to promote healing.

This is why you shouldn't use heat on an acute injury; swelling is caused by an increased flow of blood to the area, so you don't want to stimulate more blood flow by applying heat.

How to Apply Heat

You can use a heating pad, a microwaveable gel pack or a hot, wet towel to supply heat. According to WVU Medicine, moist heat tends to be more effective.

As with ice, don't leave the heat source on the injured muscle for an extended period of time — about 15 minutes is enough. Remove it, allow some time to pass, then reapply it.

Treatments for a Hamstring Injury

Ice is part of the gold standard treatment for muscle strains — RICE — which stands for rest, ice, compression and elevation. Along with ice therapy you can further reduce pain, swelling and other symptoms by doing the following:

  • Rest the muscle. Avoid any sports or other strenuous activity and stay off the affected leg as much as possible.
  • Wrap an elastic bandage around the thigh. This helps reduce swelling and provide support to weakened musculature. Wrap it snugly, but not so tightly that it affects proper circulation.
  • Elevate the leg to or above the level of the heart to draw blood and other fluids away from the injury site.

Continue these treatment measures for 48 to 72 hours, or for however long your doctor has advised. You can also take over-the-counter anti-inflammatory pain medications; however, make sure they do not interact with any medications you are currently taking.

Next Home Treatment Steps

Once you are out of the acute phase, you can begin to restore flexibility to the muscle. Gentle hamstring stretches, such as a seated or standing forward fold, will lengthen the tight and shortened muscle.

Applying heat before the stretch can make stretching easier and improve your range of motion; just be sure not to overstretch. Go to the point where you feel a mild stretch, hold for 15 to 30 seconds, then release. Repeat the stretch three times, a few times a day.

Massaging the hamstring muscle either with your fingers or with a foam roller can also help release and relax the tight muscle. Gently knead the muscle with your fingertips, but avoid being overly aggressive.

Using a foam roller, roll up and down your leg until you feel tender points, then stop and hold on those points for about 2 minutes each. Use a lower-density foam roller and don't apply too much pressure at first. You may feel mild discomfort, but if you feel pain, back off and try again in a few days.

Returning to Activity

Resuming your regular level of activity should be gradual. You can start with some easy strengthening exercises, such as supine hamstring curls, heel digs, standing hip extensions and bridges. Just do these with your own body weight.

When you're ready, you can work some other more challenging exercises into your routine, such as squats and lunges. Use your bodyweight at first, then add resistance as you feel stronger.

To restore lost stability to your hamstrings, do balance exercises. Stand on one foot for up to 30 seconds, and repeat several times. When that is no longer a challenge, try closing your eyes.

When to See Your Doctor

If you heard a popping sound or sensation at the time of injury, this signifies a complete tear, which requires immediate medical attention. You may use the RICE treatment protocol until you are able to see the doctor, but do not attempt to treat a severe injury at home.

If your mild or moderate injury does not respond to home treatment and you still have significant pain and swelling after a few days, contact your doctor. The injury may be worse than you thought, or there may be another underlying problem causing your symptoms.

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