Workout Injuries: Which Is Better Heat or Cold Treatment?

Doesn’t matter if you’re a professional athlete or a weekend warrior, workout injuries can happen to anybody. And if you’ve ever experienced a sprain, strain or other kind of pain from physical activity, you’ve likely heard the acronym RICE. Which means Rest, Ice, Compression and Elevation. (sometimes there’s also an S for Stability), and it’s the most popular recommendation for treating acute sports injuries.

What about heat? Whether you use heat or ice (or a combination of both) depends on how long it’s been since the initial injury. Injuries that respond well to Cold and/or Heat treatments include:

Muscle strains
Runner’s knee and other overuse injuries
Repetitive-motion injuries
Lower-back pain
Stress fractures
Joint sprains
Tendinitis
Shin splints
IT band syndrome
Patellofemoral syndrome
Delayed onset muscles soreness (DOMS)
Acute arthritis pain
Ankle injuries
Rotator cuff injury

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Treating injury using cold or heat, depends on the injury phase. The majority of sports injuries go through at least two distinct phases; the initial (acute) phase, and the recovery phase (sometimes called the repair, remodeling or chronic phase).

First 24 to 48 hrs following your injury is called the acute phase of injury. During this period, you’ll often experience sharp, shooting pain followed by swelling. This is the body’s way of protecting the injured area against further damage, forcing you to reduce pressure on the injured body part.

The Second which is recovery phase follows the acute phase and can last from a few days to a few weeks. During the recovery phase, you’ll often notice continued swelling, reduced range of motion and tissue soreness. If you’ve sprained your ankle or knee, you’ll have trouble putting weight on the affected leg.

Workout Injuries

The crucial step to treating sports injuries is acting quickly. The earlier you start treating your injury, the faster you’ll recover. Apply cold compresses during the first 24 to 48 hrs following injury. Cold compresses can consist of:

Bags of frozen peas
Ice cups
Coolant sprays
Ice massage
Ice baths
Commercially made cold wraps
Reusable gel packs
Freezer bags filled with ice cubes

Start by wrapping the cold pack around the injured area using the attached straps or an elastic bandage and elevate the body part. You can also treat small, nagging injuries by rubbing ice directly on the skin.

For most other situations, avoid applying cold treatments like gel packs or freezer bags directly on the skin. Instead, wrap them in a hand towel to avoid causing freezer burns or tissue hypothermia.

Apply the cold packs for up to 20 mins at a time, three to five times a day. Never apply ice to the injured area before exercising. While cold can be a safe approach to treating acute sports injuries, it’s not without its risks.

Fingers, toes and Achilles tendons are more likely to experience frostbite due to superficial soft tissue, says Paul Ryan, an orthopedic physician assistant at University of California San Diego Health. “But I have seen patients with frostbite on other areas if they apply the ice too long or fall asleep with the ice pack on.”

Lastly, avoid cold therapy for treating arthritic joints, as pain can increase with cold (arthritic joints tend to like to be warm), says Paul. “At the same time, I advise patients to listen to their bodies. If their injury prefers heat over ice or vice versa, they should do what feels best.”

Following the first 48 hours of injury, switch from cold compresses to heat applications. Heat applications are available in dry and moist heat varieties. You can apply heat to the injured area by using:

Hot-water bottles
Saunas and whirlpools
Paraffin wax baths
Professional heat therapy and ultrasound treatments
Heating pads
Commercial heat wraps
Heated gel packs
Hot, damp towels inside freezer bags

Depending on the injury, you’ll use local, regional or whole-body treatments. Local heat Therapy is most effective for small areas like an injured knee. Regional Treatment are used for widespread injuries and stiffness like shoulder joints or hips. Lower-back injuries requiring whole-body treatments respond best to saunas or immersion in heated baths or taking a hot shower.

The simplest way to apply heat at home is by using dry heat with a heating pad or dry heat packs. Dry heat promotes blood circulation and speeds recovery. It also sends oxygen and nutrients to the injury, helping it to heal faster. It relaxes the muscles and reduces pain and cramping.

Apply heat packs for 20 mins or more on the affected area. Have in mind that the effects from moist heat only last two hours, while dry heat applications can last more than 8 hrs.

Something related to both cold and heat therapy is contrast therapy; alternating between cold and heat applications during a single therapeutic session. Although contrast therapy has been used for thousands of years, it’s still somewhat controversial.

This is primarily used by serious athletes who believe it fasten healing process, which helps them get back in the game sooner. Many therapists believe it’s effective for treating;

Tennis elbow
Achilles tendinitis
Iliotibial band syndrome
Patellofemoral syndrome
Plantar fascistic
Shin splints
Carpal tunnel syndrome

The reason behind alternating cold and heat therapy is that it exercises injured muscles without you having to endure the pain of initiating movement. Repetitive cycling between cold and heat also modifies the body’s pain gate mechanism, reducing pain signals to the brain. The reduction of pain can be a welcome relief if you’re suffering from long-term, chronic athletic injuries. Contrast therapy uses:

Wrapping with heating pads, ice packs or soaked towels
Immersion in sinks, buckets or tubs
Pouring or spraying a stream from a faucet, container, removable shower head or hose

Contrast therapy is usually administered by certified athletic trainers and involves six brief, alternating periods of cold and heat.

2 minutes of heating (comfortably hot)
1 minute of cooling (cool, not cold)
2 minutes of heating (hotter)
1 minute of cooling (colder)
2 minutes of heating (as hot you can handle)
1 minute of cooling (as cold you can handle)

I specifically advocate contrast therapy for patients with chronic regional pain syndrome, a condition in which nerves are hyperactive and the alternating of hot and cold can symptomatically calm the nerve pain, says Paul. “For other more common musculoskeletal injuries, theoretically, contrast therapy could increase blood flow and healing.”

Whether you use heat, cold or contrast therapy, there are a few things to keep in mind. First, avoid using cold and heat therapies in the following cases:

Dermatitis
Deep vein thrombosis
Diabetes
Multiple sclerosis
Broken skin
Open wound
Severe cognitive impairment
Areas with recent radiation treatment
Raynaud’s syndrome
Peripheral vascular disease

If you have a history of heart disease, hypertension or is pregnant, check with your doctor before starting cold or heat therapy.

Many, if not all, sports injuries can be successfully treated at home using cold and heat therapy. However, there are exceptions cases where you should seek immediate medical attention. They include: