David was halfway through a pickup basketball game when he landed awkwardly. A sharp pain hit his ankle fast, and it swelled within minutes. A friend handed him a bag of frozen peas while another suggested heating.
David just sat there confused and hurting, wondering: “Which one’s right?“
It’s the long-debated injury question: Heat or ice?
If you’ve ever found yourself staring at the freezer or microwave, unsure of what to grab, know you’re not alone. Let’s break it down, once and for all.
First Things First: What’s an Acute Injury?
Before we talk about temperature, let’s talk timing. An acute injury happens suddenly, like a rolled ankle, twisted knee, or a muscle strain during a lift. There’s usually immediate pain, swelling, and some degree of tissue damage. We aim to calm things down and support healing without worsening the condition.
This is where temperature therapy can help, but only if you choose the right one.
Ice: Your Go-To for Fresh Injuries
Let’s start with cold. Ice (or anything cold) is your go-to in the early phase of injury, when everything is hot, swollen, and painful.
When to Use Ice:
- Within the first 48 to 72 hours after the injury
- When you see swelling, redness, or heat at the site
- If the area feels tender, inflamed, or bruised
Why It Works:
Cold therapy, also known as cryotherapy, slows blood flow, helping reduce swelling and inflammation. It also numbs the nerves, making the pain more manageable.
How to Use It:
- Apply ice for 15 to 20 minutes maximum
- Use a towel or cloth as a barrier between the ice and your skin
- Repeat every 2–3 hours during the first couple of days
Don’t overdo it as icing for too long will slow healing or irritate your skin.
Heat: Your Best Friend for Stiffness and Tension
Heat feels great, but it’s not for brand-new injuries. It can help you move better and heal faster when things feel tight, sore, or stiff.
When to Use Heat:
- After the acute phase, 72+ hours later, when the swelling has settled
- For tight muscles, stiff joints, or chronic pain
- When the pain feels dull and sore, not sharp or hot
Why It Works:
Heat increases blood flow, bringing oxygen and nutrients that help tissue repair. It also relaxes muscles, reduces stiffness, and makes movement easier.
How to Use It:
- Apply a heating pad, warm compress, or sock in a hot bath
- Use for 15–20 minutes at a time
- Never use heat on a fresh, swollen, or inflamed area
Reminder: If it’s still inflamed, skip the heat; ice is your safer bet.
I asked Lalitha, a physiotherapist who does sports physiotherapy in Calgary who said “We often see patients delay recovery by misusing heat or ice. The key is timing—ice early to reduce inflammation, then switch to heat to ease stiffness and promote healing”.
The Grey Zone: What If It’s Sore and Swollen?
This is where people get tripped up. Maybe you’ve got a muscle that feels tight but also tender. Or your joint is sore in the morning but swells after walking.
Here’s a quick cheat sheet:
- If the pain is sharp and recent, start with ice
- If the pain is dull and lingers, heat might help
- If you’re not sure, ice is safer for new pain
And of course, ask a physiotherapist if you’re unsure. A trained eye can make all the difference.
What About Contrast Therapy?
You might’ve heard of hot-cold alternation (contrast therapy). It’s real and works well in chronic issues, post-workout recovery, or stubborn swelling.
For example:
- 3 minutes heat
- 1 minute ice
- Repeat 3–5 times
But it’s not usually recommended for fresh injuries. Stick with one temperature until you’re out of the acute phase.
When to See a Physio (a.k.a. Don’t DIY Everything)
Ice and heat are useful tools, but they’re not the full solution.
If you have pain that doesn’t improve in a few days, swelling that won’t go down, trouble bearing weight, or are unsure what’s going on, it’s time to book a session. A physio can pinpoint the issue, guide your recovery, and help prevent it from returning.
“For a new injury (within the first 48–72 hours), ice is usually recommended to reduce swelling, inflammation, and pain by constricting blood vessels. Heat is better used later, once swelling has gone down, to relax muscles and improve blood flow during recovery,” says Alejandra, a physio from Stay Active Rehab.
Final Thoughts
David stuck with ice for the first few days. Once the swelling had settled, he used heat before rehab exercises to loosen things up. Within two weeks, he returned to the court, stronger, smarter, and with no pain.
Bottom line: Use ice to calm things down. Use heat to loosen things up. And when you’re unsure, reach out to someone trained to help your body improve.
Recovery is about doing the right thing at the right time and not guesswork, ensuring you can heal better, faster, and stronger.
