Sports injuries happen to athletes of all levels, from professionals to weekend pickleball players — or people out for their morning stroll. And even a minor sprain or strain can keep you from the activities you love.
In my sports medicine clinic, patients often ask if it's better to use cold therapy or heat therapy after an injury. My answer? You should use both. But it's important to get the order right. Here’s how each type of therapy can help you recover — and exactly how to use them.
Ice vs. heat: Which is better for healing?
Ice and heat are both helpful for treating sports injuries, and ice always comes before heat.
Sprains, twists, and strains cause inflammation and swelling. Ice takes the initial swelling down while providing a short-term numbing effect. Heat, on the other hand, can make swelling worse. However, it does a great job at helping an injury heal once the early swelling has eased up.
When to use cold therapy
It’s a good idea to start icing a sports injury as soon as you can, even if you plan to seek medical care. Covering the area with cold will cause your blood vessels to constrict, which slows circulation to the injury. The result is less inflammation, swelling, and pain.
What to use: You can buy or make an ice pack to keep in your freezer. But if you don’t have one handy, don’t worry: A bag of frozen vegetables works just as well — or better. You can mold the bag around your entire injury, which isn’t always easy to do with an ice pack.
How to use it: For the best results, ice the area for 20 to 30 minutes at least four times a day. Try to keep this up for 48 to 72 hours after your injury. Wrap your ice pack in a kitchen towel to protect your skin.
During this time, I recommend patients follow the PRICE principle:
- P – Protect the area from further injury. Protect it with a splint, pad, or crutches if needed.
- R – Restrict activity. Stop doing what caused your injury, and try not to use the affected area.
- I – Ice the area. You know what to do!
- C – Apply compression. Use an elastic bandage when you’re not icing. The gentle pressure can help with swelling.
- E – Elevate the injured area. Keep your foot or ankle propped up as much as possible, for instance. It’ll also help keep swelling down.
When to use heat therapy
Once your swelling has gone down — about 48 to 72 hours after your injury — it’s time to consider heat therapy.
Heat will cause the blood vessels around your injury to widen, boosting blood flow. That sends more fresh oxygen and nutrients to your tissues. As a result, the area will heal faster.
What to use: A heating pad or hot water bottle wrapped in a towel can get the job done. In a pinch, you can also fill a sock with uncooked rice and warm it in the microwave. Or try soaking in a hot bath or shower. Remove the heat source if your skin starts to feel uncomfortably hot.
How to use it: You can apply heat for 15 to 20 minutes at least once per day. If you’re using it more than once per day, take an hour-long break in between heating sessions.
Keep in mind that heat isn’t right for everyone. You shouldn’t use it if you have diabetes, an open wound, or stitches, as it can increase bleeding. Check with your healthcare provider if you have questions about your specific injury.
How to combine heat and cold therapy
After swelling has gone down, many people like alternating between heat and ice.
I tell my patients that heat can be nice in the morning or before physical therapy or exercise to reduce stiffness. That’s also true for chronic injuries or conditions like arthritis or fibromyalgia.
Ice is helpful in the evening. It can take down swelling and pain that have built up over the course of the day.
What about topical treatments?
Creams, sprays, and patches can give you a feeling of heat or cold on your skin. But they aren’t the same as heat or cold therapy. They often use ingredients such as menthol (which feels cold) and capsaicin (which feels warm). These substances stimulate the nerves, which can help block pain signals, but they don’t really help with inflammation.
When to see a specialist
Mild sports injuries often heal themselves with some TLC at home. But if the pain is severe or isn’t getting better after a few days, you should have it checked out. The sports medicine specialists at Temple are here to care for all types of sports injuries. Call 800-TEMPLE-MED (800-836-7536) or request an appointment online.
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