Heat V Ice: Which Should You Use for Acute Injuries?

The Acute Injury Management Strategy Rivalry

We get asked all the time by our patients whether they should be using ice or heat for their injuries. Sometimes it’s hard to know whether you should be using ice or heat and we understand why some people don’t feel confident making the choice. Acute injuries are stressful and painful enough, and we want you and the people around you to feel confident choosing between ice and heat.

Injuries are painful, but the acute management isn’t complex.

It’s especially helpful to use these strategies in the time between the injury and your physiotherapy appointment…

We’re here to help! Our physiotherapists are sharing their knowledge of heat vs ice for acute injuries.

Firstly, you might be wondering what we mean when we refer to an ‘acute injury’.

An acute injury is an injury that is sudden and unexpected. Usually the acute injury occurs in response to an accident or trauma.

This can include a broken bone while taking a hanger in a footy game, or a sprained ankle when going for a game-winning interception in netball. Both devastating and painful acute injuries.

After these types of acute injuries, we want to get on the front foot (no pun intended!) and introduce injury management straight away. What we don’t want is to ignore the problem. We want to manage the acute injury to reduce pain, swelling & inflammation.

It’s important to note that heat and ice alone will not fix or treat an acute injury. Advice from a physiotherapist on how to manage and treat the injury is most important for a speedy and effective recovery.

Usually, after an acute injury people use either heat or ice. They are two very common strategies people reach for almost straight after an injury occurs. Both can be effective strategies, depending on the injury. For example, ice to reduce swelling is a great idea and is helpful. Whereas using heat for swelling can do more harm than good.

That’s why it’s important to be confident in choosing between heat and ice!

When should you choose heat therapy?

Heat works by increasing blood flow to the body part where it is applied. Therefore its primary mechanism is to reduce acute pain.

In the majority of acute injuries, heat is not the strategy you should be reaching for. Heat is mostly used for conditions like arthritis, or presentations that are chronic. However, heat and heat packs have been found to reduce pain in presentations like acute lower back pain or delayed onset muscle soreness. Or, if you’re experiencing muscle cramps, stiffness or spasms, heat might help to relax the surrounding muscles. Heat bags or heating creams can be helpful here.

When using heat for an injury, the heat aid can be applied to the affected area and left until the heat wears off. If the pain continues it is safe to re-apply heat as needed, pending the heat is not too extreme.

Most importantly, you need to remember that heat INCREASES blood flow. Therefore if the goal is to reduce swelling or inflammation, step away from the heat bag! Any heat that is applied to an injury with related swelling and inflammation will worsen the problem and won’t alleviate any pain.

It’s important to remember that the pain relief that heat provides is temporary, and it is not working to ‘fix’ you. It is good for the immediate pain relief your back or muscles are desperately needing. But if the pain continues you need to consult your physiotherapist for ongoing pain management strategies and treatment. Heat is your recovery aid, not recovery plan.

What are the best heat aids to use?

There are a number of topical heat creams in the market, including deep heat. Most of them are quite similar and are generally safe to use.

Here at PhysioWest, our favourite heat aid is hands down our Wili Heat Bags!

In a range of colours and styles, there is a heat bag to suit everyone. Plus, they’re hand made right here in Adelaide. We stock their neck wrap, rectangle and hand warmer heat bags in both of our clinics.

They are not your average heat bag. The Wili Heat Bags use a more modern approach to microwave heat bags, using heat-able lupins rather than wheat. This means a longer-lasting heat, no condensation with absolutely no smell!

We often recommend a heat bag for our clients with chronic pain or conditions, muscle soreness or stiffness, or our chronic cramp sufferers.

Plus… they can also be used as a cold pack!

When should you choose ice therapy?

Ice is the most common and usually the best strategy for acute injuries. This is because most acute injuries involve inflammation and swelling. It is best to use ice for any injury that is like a sprain, strain in nature. Ice can help reduce the initial swelling and inflammation and prevent any further damage to the body part.

Ice can and should be used immediately after an injury. You should continue to apply ice intermittently immediately after injury and up to 72 hours after.

However, you shouldn’t use ice 24/7 after an acute injury. The affected area needs a break from the cold, so too much ice can be harmful. For example, too much ice can decrease blood flow to the area (short-term good for swelling, long-term a hindrance to recovery).

What is the best method for applying ice?

  1. Ice can be applied immediately after injury. The sooner, the better!
  2. It may be helpful to keep the ice moving around – no body wants a dead foot or ice blisters due to extreme cold…
  3. If possible, try to elevate while icing. This may help the reduction of swelling after the injury
  4. Use the 20 on, 20 off method! Don’t apply ice for any longer than 20 minutes at a time, it can be damaging to the area where ice is applied. Make sure that the area has time to heat up a bit before re-applying to maintain a safe therapy strategy
  5. Repeat steps 3 and 4 over the 72 hours post-injury

As with any injury, it needs time to heal. Our bodies are super clever and just need a little bit of peace and time to recover. After any acute injury it is important to rest, keep the weight and load off, and give it a few days.

Any strenuous activity, weight bearing activities, and movement should be kept to a minimum in the days after an acute injury. You should be aiming to see your physiotherapist a few days after your injury. They have the knowledge and the skills to develop a plan for your injury short and long term, so that you get better AND stay better.

Also, as with heat therapy, the ice will not fix the injury or promote healing. Beyond reducing swelling and inflammation, there are no healing benefits. It is important that you consult your physiotherapist after an injury to make sure that the healing process is on the right track.

Remember, there is a difference between helping an injury and being beneficial to healing. Acute injury management is often about alleviating pain and reducing swelling, but it has nothing to do with the actual healing of an injury.

Physiotherapists are super important in the acute stage of the injury. They can help diagnose the problem and create a plan moving forward. They will help you get back out on the field or the court, and stay there too!


If you have an acute or a chronic injury, come and see one of our expert physiotherapists! They are keen to help educate clients on their ideal recovery journey, so that the healing process runs smoothly.

To book an appointment, click on the link below or in the top right corner. Alternatively, give our lovely client services team a call on 8352 3582! We can’t wait to chat about getting you better.



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