Icing or heating injuries or painful joints can provide pain relief. But it’s important to understand when to use which type of ‘thermal therapy’. More data now exists to say there is a right and a wrong way.
R.I.C.E. (Rest, Ice, Compression, Elevation) — it’s the standard treatment we’ve heard since childhood, right?
But would you be surprised to hear that the man behind that method is now saying he believes it to be completely wrong if you’re using ice to recover from a workout or many injuries?!
For years, I’ve always assumed that when injured ice was the go-to. However, after putting ice on my knee repeatedly one summer I was told “STOP THAT”.
In that particular case my muscles were tight and each time I iced them, I made them tighter.
In my case, once I started to apply heat the muscle relaxed and I could start doing assisted stretching, which is part of what helped to quickly resolve what I had been battling for months.
This made me wonder when I should actually be using ice vs heat and what else I might not know about managing injuries.
Sometimes the classic home remedy of using heat or ice for injuries and chronic conditions such as knee pain is what’s best to do. But it’s definitely tricky and confusing to know when to use what and what effect it has on our body.
So, in this article, I’ll cover all of it so you can learn when to use ice or heat for injuries as well as painful joints, and we’ll also look at more specific thermal therapy methods such as cryotherapy and contrast therapy.
What are Heat and Ice Therapy?
It’s simple and exactly what it sounds like.
Ice therapy and heat therapy (thermal therapy, medically) mean to apply something cold or hot to an affected area. This then affects how your body responds to pain, stiffness, inflammation, and swelling
Depending on the type of injury you’ve had, the treatment will change.
Some conditions and situations require icing, while others require heating. This can make it confusing at times, especially if you don’t know which one to use for what situation.
So, let’s dig into it more and make it super simple for you.
Ice Vs Heat for Injuries?
After lots of research and talking to different PTs, I found that the science is changing on the old RICE beliefs as more doctors are looking to ideas of active stretching and using heat.
Mostly I say find what works for you, but you should understand why more people are now saying to stay away from ice.
When you’re choosing between ice or heat, it mainly depends on what type of problem you’re dealing with. Both ice and heat therapy may decrease the transmission of pain signals to the brain, which can also help with pain relief.
But as you’ll learn, there’s a valid reason why doctors are now saying to stay away from icing, and it has a lot to do with the recovery process.
Here are some guidelines based on my discussions.
When to Use Ice Therapy for Injuries and Pain
The general rule is to use ice therapy for acute injuries to help with pain management.
An acute injury is one that comes on suddenly, such as a twisted ankle or a pulled tendon. It is usually accompanied by pain in a specific location often with swelling, inflammation, or the sensation of feeling ‘heat’ in the area.
Ice can assist in both numbing some of the initial pain effects and reducing swelling by constricting the blood vessels, it does not speed healing it is just a short-term action to stop pain and inflammation.
Timing of Ice
The impact of icing is the greatest when used immediately after an injury, as it reduces blood flow to the area which can then decrease swelling and inflammation.
It’s best for fresh, new injuries and so icing is recommended within the first 24 to 72 hours of getting injuries. It works well for swelling, redness, and pulled muscles.
You should never ice an area for more than 20 minutes at a time. It’s considered best practice to ice for 10 minutes, and then remove the ice pack for 10 and ice again.
It’s incredibly important to note though that the only real benefit is numbing pain, as it does not promote recovery.
Icing is one of the few cases where even the mental benefits you might get from believing that it’s promoting recovery, might be undone by what is actually happening in the body.
When it comes to running, you should never ice a muscle prior to a run since it causes muscle tightness which may lead to injury.
Homemade Cold Pack Ideas
If you don’t have a fancy gel pack in your freezer, no worries. It’s super easy to make your own cold compress.
Dampen a towel with cold water. Fold it and put it in a Ziploc bag but place the bag in the freezer for 15 minutes. Next, remove the bag from the freezer and place it on the affected area.
This is also a trick we use for running in the heat. That cold towel during your run, will help to lower body temperature and thus lower heart rate.
Ice Pack or Cold Compress
Put ice in a Ziploc bag and partially fill it with water. Seal it properly after squeezing the air out of it. Now wrap the bag with a damp towel and place it on the affected area.
Alternatively, you can wrap a bag of frozen vegetables with a damp towel and place it on the affected area.
When to Use Heat Therapy for Injuries and Pain
The general rule is to use heat therapy for chronic injuries, to assist with pain and facilitate recovery.
Chronic injuries are those that have been going on longer than a week and tend to consist of things like tight muscles (IT Band Syndrome, runner’s knee, lower back pain), arthritis, aches, or muscle spasms.
It’s usually something that has been lingering or going on for a while and is actually made worse by the application of ice.
Heat therapy should be used for lingering injuries because it increases blood flow to the area, which helps blood vessels dilate, which draws in more oxygen and nutrients, and helps with healing.
This can be especially soothing for stiff joints and chronic conditions such as arthritis. It assists in relaxing tight muscles for additional stretching and increases blood to an area which is good to do before an activity.
Heat an area for no more than 20 minutes at a time or you could risk burning your skin. Heating also has the advantage of providing relief as it feels more soothing and comforting than icing.
This is my favorite heating pad for runners’ knees and they make others specific to other body parts. You can also buy a hot water bottle instead. Other options for moist heat include hot showers, saunas, steam baths, and hot baths.
If you’re looking for some homemade options for heat therapy, note that they might not be as effective or convenient as the heating pad I mentioned above.
But since I’m here to give you all options, here are some ideas for homemade heating pads:
Homemade Heating Pad Ideas
Warm water washcloth
Dampen a towel in warm (not scalding) water and writhe it out before placing it on the affected area. Dampen it again and repeat the process when it cools down.
Epsom Salt Bath
This is my personal favorite. The warm bath is going to help relax your muscles. And you’ll be getting the benefits of magnesium for healing.
Towel in dryer
Place a towel in the dryer for a few minutes and place it on the affected area. It’s never going to be super warm, but it’s something!
Microwaved moist towel
Another option is to dampen and writhe a towel and place it on a microwave-safe container or dish in the microwave for 15 – 20 seconds. Make sure that it’s not too hot before placing it on the affected area.
Safety Precautions for Heating Pads
Whenever you’re using any type of heating pad or device, it’s important to protect your skin from coming in direct contact with it to avoid burns. This is especially important if you have any nerve damage, such as from diabetes or any other health condition.
Hyperice has created a new wrap that does both icing and heat, which many love. It also allows you to do contrast therapy, which we’ll talk about below.
We’ve looked at heat or ice for injuries and pain, but what if the pain is in your joints?
As runners, this can be a common issue, especially knee pain. So, let’s look at that before learning how thermal therapy can help with recovery.
Heat or Ice for Joint Pain?
Thermal therapy can be incredibly useful for joint pain, but which type to use depends on how the pain started and at what stage the injury is.
A simple and common example of this for runners could be knee pain.
Should I ice or heat knee pain?
Knee injury and pain can occur in several different ways including a sprain that impacts the ligaments, a strain that affects the tendons, cartilage tear, or runner’s knee.
- The first step is to identify what type of injury it is and to check the area for inflammation or swelling.
- If there is swelling in your knee, start by icing for 48 to 72 hours until the swelling reduces.
- Once the swelling is gone, you can start using heat to help regain mobility and assist in the healing process.
If you have chronic joint stiffness and tightness, heat therapy can help relax these painful joints. Always ensure there is no swelling before applying heat to any affected area as it can exacerbate the swelling further.
Now that we understand how to deal with joint pain, the next question is how does cold therapy work in the world of recovery? Are things different than when we’re looking at an injury?
Ice Bath vs Epsom Salt Bath for Recovery?
When it comes to post run recovery, you might actually be doing more to delay your progress as a runner than to speed it up. That’s right this a recovery method that you should probably stop using ASAP!!
“The fact that icing feels so excruciating almost surely adds to whatever effectiveness the technique might have.
Scientist call this an active placebo effect – our natural inclination to believe that if a treatment is painful, it must be very effective.” – a well stated thought from Christie Aschwanden in Good to Go.featured runner from The Local Elite.
Ice Bath After Running?
As noted above this may not be the great recovery tool that you previously believed.
Jumping in an ice bath will stop inflammation, but also postpone the healing process. What this means for you as a runner is this:
- inflammation from the run is how your body knows where it needs to get stronger
- inflammation is your body’s signal to send in everything it needs to repair
- by dampening that you are lowering the body’s response to rebuild
- by dampening it you are also slowing down the recovery process
- once the icing stops then the body is going to have to restart the recovery process
- studies have shown cold treatments reduce gains is muscle mass and strength
- it does reduce pain by causing numbness and reducing blood flow to extremities (hence the mental feeling that you’ve done something good)
I’ve been reading so much more about this and truly we’ve all had this particular piece of advice wrong for so very long. We’re so afraid of inflammation that we’re actually trying to tamp down the good stuff that provides growth.
Does that mean that my long beloved warm Epsom Salt Bath or hot tub might be a better solution???
Perhaps because my muscles get a massive dose of magnesium known to aid recovery and I mentally get a moment for my cortisol to drop, which is going to help me recover.
In fact, it turns out the biggest benefit to nearly all recovery methods is forcing you to pause, slow down, and mentally relax.
For me that means my bath is a win.
Is there anytime an ice bath is good?
If you’re a major league baseball player, football player or track athlete who needs to compete again within say 24-48 hours then an ice bath could be worth your time.
We also know when you are extremely hot and need to bring core temperature down it can do a lot.
At that point you are postponing the recovery process of your body, so that you can try to delay soreness and continue to compete at that high level.
But during your marathon training, you gotta stop doing it after long runs.
Does Cryotherapy Work for Recovery?
Wait if all of this is true, then why the sudden huge spike in Cryotherapy??
And can Cryotherapy actually provide all of the benefits that it claims: weight loss, energy, faster recovery from injuries??
Because I’m never one to give you half an answer, I did my research and I agreed to go use a Cryotherapy chamber for 30 days straight during some of my highest mileage training in years.
I can say with 100% certainty it’s more enjoyable than an ice bath, but studies are actually showing that one of the few benefits of an ice bath might be the compressive effect of the water.
What about the reported mood boost of cryotherapy?
A 2007 study did show that cold showers could help with depression through an increase in dopamine.
Unfortunately, that mood boost declines as your body starts to realize that it can survive this crazy temperature drop. So it may work if you go in randomly, but not all the time.
What about the reported calorie burn of cryo chambers?
While things like Coolsculpting are able to show some results, cryotherapy is NOT burning 800 calories per session.
Shivering in a true hypothermic state burns 100 calories in 15 minutes and you’re no where near reaching this state. Plus unless you are in a fully enclosed chamber, you aren’t cooling the brown fat which is around your collarbone.
Is Cryotherapy Good for Healing?
“Anything that reduces your immune response will also delay muscle healing,” Physician Gabe Mirkin says.
“The message is that the cytokines of inflammation are blocked by icing — that’s been shown in several studies.”
The one potential area where I could see it being useful is running with arthritis. In that state, you have constant inflammation and if this provides some relief then I say go for it.
What about Contrast Therapy?
Tim Ferriss and Ben Greenfield, two of my go to podcasts for new biohacks, have talked about this numerous times, which of course lead me to do some additional research.
Contrast Therapy is going back and forth from cold to warm in the same treatment session. You can often find warm and cold pools at treatment centers (like the one I profiled here) or you can set it up to do at home using buckets or a tub.
Why does an ice bath then hot tub work?
Again, I’m not positive this is a standard recovery treatment to jump on, but potentially one to consider for injuries.
One example, is when swelling limits range of motion, contrast therapy along with active range of motion appears to reduce swelling. The sharp sensory contrast between heat and cold appears to reduce pain.
Both of which are going to help us progress back to physical therapy or simply get moving, rather than being stuck on the couch!
Or maybe just the heat alone based on my own experience loosening the muscles, allowing me to relax and my body to then put it’s energy towards recovery.
How to do contract therapy?
I think Jahn Tang does a fabulous job describing how to best use it, so I’m not going to describe it as well.
Read more on handling our running aches:
- Dealing with the most common running injuries
- Running pain vs. discomfort
- CBD Oil to promote recovery
- Is your pain all in your head?
- How to mentally recover from an injury?
- Why runners need to avoid pain meds?
Do you always reach for ice?
What’s your method for attempting to keep it on?
Other ways to connect with Amanda
Instagram for ongoing motivation: RunToTheFinish
Facebook for all the chatter: RunToTheFinish
Pinterest for more running tips: RunToTheFinish