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Ice or a Heat Pack?

Updated: Feb 14

We want relief, and we want to heal and recover. So when should we pull out the ice, and when should we turn up the heat?

The very short, very sincere answer is that we should do the one that feels good. Seriously, if it doesn't feel good then it won't bring relief. If the brain detects the ice or heat as a threat, it reacts by signalling discomfort or pain. We might not understand why the body is objecting to the treatment, but we should listen to it or risk an increase in spasms, inflammation or pain.

That said, a better answer to the "which one" question would be useful!

Knowing which conditions respond best to which treatment can save experimenting, which saves time. And in this case, time is pain.

Read on for the current advice on ice, followed by the equivalent info for heat.

When to Ice an Injury

There has been a debunking and a rebunking. (Is that a word?)

First there was RICE: Rest, Ice, Compression, Elevation.

RICE taught millions of people that if you sprain your wrist, you RICE it. Twist an ankle, same thing.

And then we worked out that the compression was doing more to reduce swelling than the ice was... and maybe ice wasn't doing much for healing... and OMG ice isn't curing anything, what a rip-off, dump it!

Except there's one little thing that caused the experts to gradually circle back around. Ice doesn't actually promote healing, but the evidence actually says that it doesn't effect healing at all. It doesn't reduce healing, or slow it (when used sensibly, of course). And in the meantime, it reduces pain.

Just to state the obvious: the average person with a sprained ankle would like to have less pain in their ankle.

Ice can help with that. It's no morphine, but 'cryotherapy' can deliver minor pain relief without effecting healing.

Thank goodness - especially if you missed the memo about shunning it - we can all use ice again. It's cheap, easy to get and easy to use, and safer than some of the other options.

Phew. Pass the frozen peas.

Ice This:

Ice is mostly for fresh injuries, but can also be useful for those ongoing (chronic) conditions that tend to flare up. Those are often the ones that feel hot to touch.

Common injuries that might respond helpfully to ice:

  • muscle tears or strains (first 3 days)

  • ligament tears or strains (first 3 days)

  • new bruises

  • tendonitis

  • a flare-up of arthritis

  • carpel tunnel syndrome

  • plantar fasciitis

  • pelvic floor (perineum) after childbirth

When to Be Wary of Ice:

A person or a body area that has decreased sensation is not suitable for ice, because there is potential for an 'ice burn' if you can't detect the onset of numbness and therefore know when to take a break from the treatment.

If the problem is stiffness or tension, ice is likely to make it worse. It's also likely to make symptoms worse if it's uncomfortable or unwanted, so never insist on ice as the best treatment for someone who says they don't like it.

Open wounds are usually not iced, for reasons of hygiene and to avoid potentially interfering with the body's natural inflammatory/immune reactions.

Too much cold, or ice applied for too long, can damage body tissues. It should be removed once it has created some numbness, because it's job is done. Once the tissues have returned close to normal temperature, ice can be re-applied.

How to Apply Ice:

This naturally varies depending on the injury, the body part being iced, and other factors. Ice is always applied for a limited time, then removed for a recovery time. The possibilities are many!

Here are two possible icing regimes:

Option A: Apply ice for 10 minutes, remove for 20 minutes, repeat. Use a cover on the ice to protect the skin, making it safer to use for this long. Best for when the cold needs time to penetrate deeper - hips, shoulders, or the deeper layers of thick muscles as on the butt or thigh.

Option B: Use a chunk of ice to massage the area directly (no cover on ice) for 1 to 3 minutes. Stop when numb to a light touch. (Areas with thin tissue over bone will numb faster.) Repeat as often as desired, as long as tissues recover to a normal temperature in between. Best for small limbs or thin tissues - hands, feet, knees and elbows.

Treating With Heat

The information here relates to applying physical heat, like a hot-pack, wheat bag or clever electrical heat wrap. It doesn't apply to 'heat' ointments like Deep Heat or Tiger Balm. They are a completely different type of treatment. Not evil, just not what this information relates to.

Heat, like ice, is used for relieving pain. But the action is different, the type of pain it works best on is different, and it has a broader range of effects than the simple numbing property of ice.

Warmth, as long as it's used appropriately, is nice. It's comfortable. It assists relaxation of tense sore muscles, and also works to lessen the tension issues we might have in the nervous systems and in our generally stressful lives.

Heat This:

Common injuries that might respond well to heat treatment include:

  • Low back pain

  • Neck pain

  • Muscle knots and trigger points

  • Muscle cramps and spasms (including menstrual cramps)

  • Grumbling arthritis pain (not flare-ups)

  • Restless Leg Syndrome

  • Fibromyalgia

  • Body aches from fatigue, stress etc (Oh yes that's real)

  • Possibly useful for DOMS (post-exercise muscle pain) but the jury is still out

When to be Wary of Heat

As with ice, it is important that the area being treated has good sensation - the person needs to be able to feel if the treatment is too hot, and be able to remove the heat so that no burning happens.

Heat should not be used on new injuries, burns, or on anything inflamed, swollen or already hot. Adding heat to a swollen sprained ankle is likely to make it SWELL MORE. This is painful, and will make recover slower.

Be wary of using heat treatment in a hot environment. The body needs to be able to cool itself to avoid illnesses like heat exhaustion.

If your body says no, listen to it. If the heat doesn't feel comforting, it's not working anyway.

How to Apply Heat

There are many ways to apply heat! From hot water bottles to standing under a warm shower, many people already have a favourite method.

We must avoid overwhelming the body with too much heat (eg getting sick from having a hot shower on a hot day) or burning the skin with too much direct heat (eg when one end of a hot pack slips out of its cover and presses against the skin).

But once we have safety and common sense covered, the world of heat is pretty open. We can apply it for long periods of time. There are professional appliances designed to warm lower backs for hours at a time!

With safety and common sense in play, you can apply heat for as long as it is comforting, and as often as it is comforting.

In Summary

Ice is for minor pain relief for fresh injuries and inflammations. If something feels hot, cooling it down may bring relief. It should be used for short intervals.

Heat is for comforting relief of longer-term aches, knots and tension in our muscles and our minds. It can be left on for much longer than ice. (How happy is a cat on a hot water bottle?)

The best choice for treatment is the one that feels best. There is no point (and possibly some damage) using either ice or heat if it feels uncomfortable.

Images on cover photo: Hot tap by Kirsten Marie Ebbesen, ice cubes by Victoria Wendish.

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