Hot or Cold?

Can anyone tell me how long you should apply ice to an injury before switching over to heat? I've got an undiagnosed knee problem - mainly because I can't decide exactly where it hurts, but have found conflicting advice on icing & applying heat.


  • I think it's 20 minutes icing - I seem to remember reading that somewhere. I do that, but don't do the heat thing.

    I'm sure someone with far more knowledge than me will arrive shortly...!
  • I've always been told to apply it as hot or as cold as you can stand (without getting frostbite or burns) & to change when it doesn't feel as hot/cold.

    Failing that, 1-3 minutes each starting hot, finishing with cold for approx 10 minutes duration in total.

    How do you get the hot & cold? I prefer a bucket of ice water & the shower head set to hot but I always feel guilty at wasting so much water & dominating the (shared) bathroom so I usually resort to a bag of peas & hot water bottle sitting in front of the telly.

    As to whether it will help, nearly everyone who's tried it swears by it but it depends what the problem is. I have a nerve problem that seems to be aggravated by heat so I'm not using it at present.
  • I have one of those microwave wheat-filled bags which you can get quite hot, & a gel pack which freezes.
    The pain I have is on the inside of my kneecap, possibly where the inner quad muscle joins. Ran a race a couple of weeks ago with some very steep, lengthy downhill sections and its been sore ever since.
  • 15-20 mins of icing every few hours for the first 24 hours, then switch to massage and warmth. That's what i usually do, anyway.
  • A word of warning about the microwave wheat packs (which are very nice, though don't work for injuries for me the way ice does). We left ours in a warm cupboard when we went away, and when we came back the room was full of thousands of little corn weevils that had hatched out from it.

  • I've always worked on the premise that ice is only really beneficial for the first 36 hours after an injury, to prevent immediate swelling as much as possible, and also just after each run in the case of ongoing problems like shin pain.

    Both the physios I've used in the last couple of years said that ice wouldn't make any difference for an injury that was more than a few days old, and that the best way to encourage healing after that was heat, as it it increases the blood flow to the injured area which speeds up the healing process.

    Not 100% sure this is correct, just what I've been told.

    P.S. image at the thought of the corn weevils...

    • Ice 15-20 mins for the first 48-72hrs (or until acute pain has subsided to more of a dull ache) - this is to limit inflammation, ease spasm and relieve pain
    • hot & cold for the next 6 days - cycles of 2 mins each at temperatures not too much above & below normal body temperature; hot & cold tap water temperature would be plenty - the injury site may still be fragile but you're wanting to accelerate the repair process. The heat will draw blood and therefore necessary repair cells to the injury whilst the cold will counter any new inflammation
    • If needed after this period heat should suffice - this is when massage can be used

    Beware of using heat or massage too early into the injury as both of these can aggravate the problem.

    Also - further to runs-with-dogs final paragraph - continued icing would slow down the healing process as bloodflow to the injury is restricted

  • I agree with runs-with-dogs and ajax.  I would just add - make sure to finish on cold when doing contrast bathing, especially in first few days.

  • Yes RT you're right although towards the end of hot/cold (last 2 days) treatment I finish on hot.

    Another purpose of hot/cold is to start phasing out cold treatment in favour of hot, so the first 4 days I start & finish on cold whilst days 5 & 6 start & finish with hot.

    My timings are very user friendly too but I've found when I've describe the timings I actually use, the client often doesn't find it easy to follow. 

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