Should You Heat Or Ice Your Injury?

I was discussing heat vs. ice with my Pilates ladies this morning. When you suffer an injury do you know which therapy is best? As with most things the answer is not black and white.

For years I encouraged my clients to ice. Ice your sore shoulder, ice your bum knee, ice your back after your massage. Why? The R.I.C.E. manta – rest, ice, compression, elevation – had been drilled into my head.

I have recently been suffering from a tight hip (left piriformis and sacral tendon if you must know) and have been applying heat via my grain filled cloth bag (I call it a bucky) several times a day. Rarely do I ice an injury nowadays. Why? First of all it is winter here in Portland and it has been really cold and unusually snowy. I can not imaging putting ice on my body in this weather. Second my condition is one of tightness, so applying heat encourages my tight muscles to relax.

If you ask a Chinese medicine practitioner or acupuncturist about heat vs. ice they are likely to tell you that pain equals blocked chi (energy) and heat moves the chi. When treating an injury this is what we want, movement, not stagnation.

So when is it appropriate to ice? When you have an acute injury that involves swelling, or feels “hot” ice may help relieve swelling and bring temporary pain relief. A perfect example of this, one of my ladies twisted her ankle playing soccer on Monday. She iced her ankle and within 48 hours her pain had subsided. Ice temporarily numbs the area, provides pain relief, and reduces swelling.

We could have a long discussion about how swelling is your body’s natural response to an injury and weather or not it is wise to jump in and stop this. This clinic for example eschews ice entirely for treatment of ligament and tendon injuries and suggests a M.E.A.T. treatment protocol instead.

Here is a basic guide.


  • Acute injuries – twisted ankle
  • Swelling – jaw pain after oral surgery
  • Headaches – place a bag of ice in a pillowcase and rest it over your eyes


  • Chronic injuries – tight shoulder from that college skiing incident
  • Tight muscles – especially low back, hips, hamstrings
  • Tight tendons – like the Achilles
  • Before exercise – warm shower or bath before your strength or cardio session

Be careful to not overdo it – 20 minutes at a time will provide relief without irritating the tissue, and always place a cloth or pillowcase between your skin and the hot or cold object.


Anne McCranie is a Portland, Oregon based Licensed Massage Therapist and Personal Trainer. Please see your healthcare provider for specific medical advice.