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Some Like It Hot: Ice vs. Heat for Sports Injuries

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Like many marathoners, triathletes, and recreational athletes, I’m no stranger to sports injuries. Rotator cuff problems, knee aches and pains, and tendonitis aren’t anything new and I’ve largely learned to cope with a small amount of pain. I know I’m supposed to ice my injuries after a workout, but, especially during the winter months, when sitting in a chair with a an ice pack on my ankle for twenty minutes is a slow form of torture, I always wonder, why can’t I use heat on this baby? 


There are real differences between using ice or heat for sports injuries and chronic pain and adhering to the right regimen can help you heal faster, reduce pain, and get back in the game a lot faster. 


Ice, Ice, Baby
In general, there are two types of sport injuries: acute and chronic. Acute injuries are sudden, caused by a fall, trauma, twist, or sharp movement—think of a sprained ankle. Chronic injuries build up over time and are usually due to overuse of a ligament, tendon, or group of muscles. 


Acute injuries that involve swelling and inflammation necessitate ice treatment. Ice is a vasoconstrictor, meaning it decreases blood flow to the area. This is beneficial for reducing swelling, which can decrease the flow of chemicals that can cause inflammation. Numbing effects can decrease pain and ice can slow the nerve transmission of pain. Reducing the swelling is critical for a quick recovery, as swelling can inhibit the healing process. 


When an acute injury happens, icing the affected body part immediately is key. Most athletes are familiar with the R.I.C.E plan, which is rest, ice, compression, and elevation (often anti-inflammatories are used as well). When an acute injury happens, you should apply ice for fifteen to twenty minutes, making sure to protect the skin with a cloth or rag. A bag of ice works fine, but frozen vegetables or fruit are also convenient and reusable. When icing, elevate the injured body part above the heart, if you can. Rest helps the injury heal and compression can also help immobilize and reduce the swelling. 




Generally, you should apply ice three to four times a day, for around twenty minutes at a time, for the first three days of an injury. However, this varies greatly, depending on the severity of an injury and how long the inflammation lasts. You can use ice for chronic injuries as well, especially after playing the sport that aggravates the injury. For chronic injuries like rotator cuff problems or knee pain, ice can help prevent swelling, inflammation, and pain that can accompany the activity and should be used immediately after. 


Heat Is Neat
Heat generally does the opposite of cold, meaning that it is a vasodilator, increasing the blood flow to the injured area, warming it, and causing increased localized metabolism. This is beneficial for healing, because the increased blood flow can remove waste materials and reduce swelling, but you don’t want to apply heat during an active inflammation, because it can increase the number of cells injured. 


Heat is applied in much the same way as ice, with periods of fifteen to twenty minutes at a time. A warm bath or heating pad are usual routes of heat therapy. In general, you should use heat for muscle aches, stiff joints, and tight muscles, but not for acute injuries like ankle sprains or any other injury that has active inflammation. How can you tell if there’s inflammation happening? Usually the area will be warm to the touch. In addition, if the area is still sensitive, swelling is increasing, and the pain limits range of motion, stick with ice. 


Heat treatments can also help loosen up an injured area and relax a tense spot, making them a great treatment for muscle spasms. You can also use heat before activity, to help loosen up the affected area and increase range of motion.


Of course, neither heat nor ice alone will heal an injury—they’re always used in combination with other tools, like strengthening, rest, stretching, and a gradual return to activity. Unfortunately, being sidelined with an injury makes that twenty minutes with an ice pack seem to last forever, even when you know it’s for your own good.


Updated September 6, 2010

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