Ice vs. Heat: An Ongoing Debate

You just started a new workout program and everything aches. You'd like nothing better than to soak in a warm bath to soothe those muscles. Is that the right thing to do?

You were out for a walk, stepped in a hole, and twisted your ankle and now it's bruised and swollen. Do you use ice or put a heating pad on it?

This is one of the most common questions I receive. It's also one of the more common things that people do incorrectly. It does make sense...heat on something for a long time makes it feel good. Ice becomes uncomfortable after having it on for a few minutes. So heat should be better, right?

As it turns out, ice is universally better for acute injuries and even some chronic ones. Ice serves as a natural anti-inflammatory and functions to constrict the blood vessels, thereby reducing the blood flow to the injured area. Blood carries in it factors responsible for inflammation. Having less of these present minimizes the swelling, bruising, and pain associated with inflammation. The sooner you apply an ice pack to a sprain or strain, the sooner it can do its job reducing pain and swelling. For chronic problems such as low back pain or muscle spasms, ice whenever the symptoms start up.

You do need to take some precautions with ice, though. Never put ice directly on the injury...always wrap it in a towel first. Only keep ice on for 20 minutes and then take a break for at least 40 minutes. After 20 minutes, you lose the efficacy and can damage the soft tissues.

Heat does have its place, also. Heat increases blood flow and restore movement to injured tissue. Heat can also help pain and stiffness in joints, such as the resulting pain from osteoarthritis. Heat shouldn't be used on a new injury, however, since the increase in blood flow will cause an increase in swelling and pain and can cause more harm than good. When you apply heat, use it for 20 to 30 minutes and then take a break.

If you have diabetes, please remember that your sensation may be diminished in your hands and feet. You should check the heat of the pad with an area that has full sensation, such as your elbow. You also need to make sure that you only apply cold for the recommended period of time and stop if you notice any change in color to the area.

With any injury, a never-fail way to treat yourself is with RICE: Rest, Ice, Compression, and Elevation. If it's not feeling better then make sure you call your local physician.


Dr. Andrew Schneider is a podiatrist in Houston, TX and is the medical director of Tanglewood Foot Specialists. He treats all injuries and conditions of the foot and ankle. For more information and many informative videos, visit and his blog at
Dr. Andrew Schneider
Dr. Andrew Schneider is a podiatrist and foot surgeon at Tanglewood Foot Specialists in Houston, TX.