Note: This is the first in a series of posts that I am developing. In this post, we discuss (and include the thoughts of other sports medicine experts) when athletes and sports medicine providers should use heat or ice. In future posts, we will address e-stim, ultrasound, dry needling, kinesio taping, and more.
One of the questions I get from athletes, parents, and exercise enthusiasts centers on the perpetual debate about the use of heat or ice. “Should I use ice after practice or exercise?” “Can I use heat to warm up my muscles?” “Is heat harmful to injury healing?” While there is no universal consensus on heat or ice for every possible scenario and which is best for each, there seem to be some general principles. Rather than trying to explain them in my own words, I asked several people who work in sports medicine – athletic trainers, physical therapists, and massage therapists – for their thoughts.
Steven Kleinman, PT, MPT, in Riverdale, New Jersey:
“After an initial injury, always ice and elevate to decrease swelling. When I am asked a general question of which is better to use, I usually respond, ‘If you feel tight or stiff, use heat or try a hot shower and see if the hot water makes it feel better. If you are sore or have pain or swelling, use ice to decrease inflammation.’”
Ann Wendel, PT, ATC, CMTPT in Alexandria, Virginia:
“In general terms, use ice for a muscle/joint injury that is warm to touch, swollen, recent (in the past week or so), or a result of a heavy workout. Use heat for a muscle/joint that is stiff, achy, chronic (more than a few weeks old), or arthritic in nature.”
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Lindsey Clarke, ATC, CMT in Charleston, South Carolina:
“As an athletic trainer working in an outreach capacity, I would say I use ice more regularly than heat. While we do have access to limited training room facilities, we are usually working more in a first responder/emergency care type of situation. Having said that, when dealing with acute injuries, heat is never indicated, as it will exacerbate any localized inflammatory response and actually make swelling worse. Ice is a cheap, effective, widely accessible tool I have in my belt for response to acute injury, soreness, swelling, etc.
As a whole, I find ice to be more effective because of its immediate role in injury treatment. Any athlete, from weekend warrior to elite, needs to form a good relationship with ice to aid in recovery from training, help combat any acute injury or inflammation, or maintenance of a nagging condition. Like heat, ice provides an analgesic effect, but it also provides a marked physiological response in regards to addressing the injured area.”
Bobby Weisenberger, ATC, PES in Charleston, South Carolina
“At the Charleston Battery we use a great deal of heat and ice. We use heat packs and hot whirlpools prior to training and games to warm up the muscles and ready them for the workload. At the end of training and after any acute injury we use ice packs and cold whirlpools to reduce swelling and aid with muscle recovery.”
Michael Barr, PT, DPT, MSR in Charleston, South Carolina:
“This is a very common question with many misconceptions about the use of heat and ice. The old adage of icing for 2-3 days after an injury and then switching to heat is no longer the suggested plan of care. Ice should be used post completion, practice or exercising for joint and/or muscular soreness. Ice is also the most beneficial modality that you can use following an injury.
Ice should never be used prior to a physical event or activity. I would suggest using heat prior to physical activity for muscular tightness in addition to completing a proper warm-up.
If something is painful, which is usually due to acute inflammation, ice is your best course of treatment. For the most part, you do not want to add something hot to a site that is actively inflamed. Heating an inflamed or swollen joint can actually cause an increase in swelling and delay the healing process. Yes, there are always exceptions to these suggestions, but those should be under the guidance of a medical practitioner.”