Ice or Heat?

Not sure if you should use ice or heat for your injury? You’re not alone.

There is so much confusion around when to use ice and when to use heat. This is a very common question we are asked in our clinic. Both ice and heat are wonderful to aid healing when used correctly however, they can also be detrimental if used incorrectly.


Ice is for acute (recent) injuries and is used for calming red, hot, swollen, inflamed injuries.

Inflammation is an important and necessary part of the healing process when it comes to damaged tissues (injuries). Unfortunately, though, the inflammatory process is painful and ice helps dull the pain associated with this inflammation and swelling.

Examples of when to use ice:

    • any kind of acute sprain or strain (eg ankle, knee, wrist)
    • acute muscle tears (eg hamstring, quadriceps)
    • suspected fracture
    • when a joint is swollen &/or hot &/or red
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Heat is used for muscles and chronic pain injuries (more than 3months)

Heat is great for muscle spasms and trigger points which are common causes of back and neck pain. Heat helps to take the edge off the pain as well as soothes the nervous system and helps with stress. It is therefore very useful for chronic pain as stress can often make chronic pain worse.

Examples of when to use heat

        • back or neck ache or sharp pain (not associated with trauma – eg motor vehicle accident or a fall)
        • sharp pain in the top of your shoulders/shoulder blades (not associated with trauma)
        • muscle spasm or trigger point (commonly calf muscle, hamstring)
        • chronic muscle pain (eg an old hamstring tear from last season at footy).
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The following case studies are common conditions we see regularly in the clinic. They are not meant to be medical advice or replace assessment, treatment and advice from your doctor or physiotherapist.

Case Study 1

Karen is an office worker and spends up to 8 hours a day on her computer. She notices a sharp stabbing pain in the top of her shoulder, close to her neck and reports that seems to get worse the longer she is at her computer and usually at the end of the day. She reports feeling improvement if she has better posture when sitting at her desk, or if she takes regular breaks to move her arms and shoulders around. She remembers this pain started about 6months ago when she increased her hours from part time to full time at work. Karen’s physiotherapist said she has tightness in her muscles and is helping her with this as well as improving her poor posture at work.

Ice or Heat?

  • Karen’s pain is chronic (more than 3months)
  • It also sounds like her posture is contributing to her pain
  • It sounds like Karen has a trigger point or tightness building up in her muscle
  • Therefore Karen should use heat.

Case Study 2

Glenda is a spritely 62-year-old woman. She loves to garden and you will find her pottering in her garden bright and early every morning. She has lived in her home for the last 35 years and takes pride in having the most beautiful, fragrant roses. Yesterday morning while watering, she tripped over the hose, rolling her ankle and landing on her wrist. Although it gave her quite a fright, she didn’t think she fractured anything. She visited her GP later in the day who confirmed no fractures. By that evening, both her ankle and wrist were swollen and she could see that there was some slight bruising on the outside of her ankle. She didn’t like to think what it would look like by the following morning.

Ice or Heat?

  • This is an acute (recent) injury
  • There is obvious swelling in both her ankle and wrist
  • She has bruising to her ankle
  • Therefore Glenda should use ice to both her ankle and wrist

Case Study 3

Luke played under 18s club footy today. He was tackled many times but he remembers one tackle in particular. He was going for the footy when another player accidentally stepped on his foot, tripping him up and causing Luke to fall to the ground. He doesn’t remember knocking his knee but thinks he may have twisted it. There isn’t any swelling or bruising but it does twinge a bit when he walks. He hasn’t had a chance to get to the GP or physio yet. He said he’ll wait to see how it pulls up Monday.

Ice or Heat?

  • Although there is no swelling or bruising to Luke’s knee, this is considered a traumatic injury
  • Luke injured his knee only a few hours ago, therefore it is an acute (recent) injury
  • Therefore he should use ice.

Remember that ice and heat are helpful to reduce symptoms but do not always resolve the injury fully. It is best to consult your physio or GP for their expert assessment, advice and treatment.