Fire v Ice - Temperature Treatments for Injury Recovery Part 1

Part 1 - Cryotherapy

I am frequently asked about the use of hot and cold in the self treatment of injury.  Is hot better than cold? Are ice baths effective? Should I treat pre or post exercise? How long should I treat for? As this is quite a large topic I've split this article into three parts.  The first is all about cryotherapy - cold treatment.  Part 2 will be on thermotherapy - heat treatment, and Part 3 will be on contrast therapy - alternating heat and cold. 

Temperature treatments are a free and easy form of self treatment and can be an effective part of rehabilitation and recovery from injury.  Although there is little scientific evidence as to the effectiveness of temperature treatments for injury recovery, they are frequently prescribed by sports doctors and therapists and many patients and athletes report having beneficial effects.  

Generally speaking ice is used for acute injuries and heat is used for muscles.  It is important to use temperature treatments correctly otherwise they can make injuries worse! I explain why below... 



Cold treatment is used in the acute phase of trauma injury.  For instance, a fall or an accident in sports or in training. A sports doctor or Physio will need to assess the injury.  If there is swelling, tenderness and pain with movement then cold treatment will be used and is often combined with compression, elevation and cessation of any activity that may further aggravate the injury.


The theory of cold treatment 

When tissues or structures are damaged or torn, internal bleeding and swelling occurs which causes increased pressure of the surrounding tissues - this is the normal and much needed first stage of healing. Cold is effective to stop internal bleeding and reduce further swelling and pressure.  The blood will clot and form scar tissue.  The aim of using cold treatment at this early stage is to reduce the amount of scar tissue formation. A large build up of scar tissue often results in a longer recovery.  Cold treatment also has a pain relieving affect. 


Modalities of cryotherapy

Cold compresses are ideal as they provide cooling and compression can can be applied to an elevated limb. Ice, cryotherapy, cold gel or chemical packs and cooling sprays are all alternatives if a cold compress is not avian label.  


How to apply

A Physio or sports doctor will advise on the duration and frequency of cold treatments in each individual case.  A general rule is application of cold treatment for 10-20 minutes every hour for the first 24-72 hours*. 


When NOT to use ice

Do not use ice on muscle spasms as it will make it worse. You may want to ice an injury such as low back pain or neck pain but if this injury has a spasmodic nature or the area contains a lot of tension and trigger points (muscle knots) you may find it makes the area more painful.  Heat would be better in this instance. Contraindications to cold treatments are Raynaud's Phenomenon and cold urticaria


Ice baths

Ice baths are used by elite athletes post competition and after particularly intense training sessions.  As someone who is always cold, I can imagine ice baths are the worst part of being an athlete - unless you are Andy Murray and you get to take in the Wimbledon trophy with you. As he said himself, it definitely takes the edge off! The theory behind ice baths is that they help constrict blood vessels, restrict swelling and tissue breakdown and help flush out toxic by products of exercise. Many athletes use ice baths and report experiencing less or no delayed onset muscle soreness the following day. However, there is very little scientific evidence to support this theory at present.  I would not recommend an ice bath as a method of injury recovery.  Although if you are a competitive or recreational athlete speak to your coach about whether this would be of benefit to your training. 


For any further questions on icing and injury recovery please do email me at Part 2 for how to use heat for healing and recovery of injuries comes out in 2 weeks! Sign up to our mailing list to get our articles sent directly to your in box. 

* Sports Injuries Their Prevention and Treatment 3rd Edition. Lars Peterson & Per Renström