Ice or heat: Which is the best initial treatment for a muscle strain?
Whether to apply heat or cold is a common question that we are asked at Embody Movement. What may not feel particularly helpful for the pain initially can actually assist the recovery of injury in the long term.
Ice to reduce inflammation
Ice is often used for inflammatory injuries because it helps to reduce the blood flow to the affected region. Inflammation is the body’s initial response to injury (the first 72 hours following an injury). It is a normal response, designed to protect the injured area and start the healing process.
Signs of inflammation include: redness, swelling, palpable heat, and pain when touched. Inflammation normally presents as a pain or an ache that increases with rest (especially first thing in the morning or at night) and reduces with movement or a hot shower. Therefore, ice should be used for a minimum of 72 hours following injury AND until you have no ache or pain at night or upon waking in the morning.
In addition to ice treatment, further measures to reduce inflammation are indicated in the first 72 hours following injury. These may include: rest from aggravating activities, elevation of the injured part above the level of your heart and the use of a compression bandage.
During this period, avoid heat treatment, alcohol and massage (to the injured area), all of which increase blood flow and subsequent inflammation.
Heat to increase blood flow
Heat does the opposite of ice in that heat treatment increases blood flow to the affected region. This is beneficial after the inflammatory phase of an injury, since more blood flow means more nutrients and oxygen are transported to damaged tissue, therefore speeding healing. Heat can also help to reduce pain and muscle spasm as well as reduce muscle tightness and joint stiffness.
If used during the inflammatory phase (the first three days), heat treatment may increase inflammation and swelling, and can subsequently prolong injury recovery.
Heat can create muscle relaxation, pain reduction and improve tissue flexibility, and so is appropriate for stiff joints and tight muscles that have not been acutely injured.
So what do you use and when? Here’s what I tell my clients:
ICE as soon as possible after an acute injury
ICE after an activity or exercise session that leaves you with swelling, redness, palpable heat to an area or a “throbbing, achy pain”
HEAT for stiff (NOT inflamed) joints or muscles before an activity to loosen them up and make the activity more enjoyable
HEAT for tight and painful joints or muscles not acutely injured (where there are no signs of inflammation)
HEAT for tight muscles to make them more responsive to stretching.
Now…how much, how long, how often? Here are my tips:
15 minutes of heating or icing is often enough – beyond this, you cannot change the temperature of the tissue any further or send the heat/ice any further into the tissue.
Put a barrier between you and the heat/ice – 4 towel layers is recommended to avoid ice/heat burns to the skin.
Cycle on-off periods of the heat or ice – wait at least 15-20 minutes between applications. Continual heating/icing can cause surface skin damage.
The number of times per day to heat/ice will depend on the nature of the injury, goals of treatment and will vary from client to client
The use of ice or heat can be very beneficial to the body when used appropriately. Consult your local physiotherapist if the decision is still unclear.
First published 10 September, 2018, revised and updated 30 May 2024.