Are you confused as to when to apply heat or ice / cold? Knowing which one to use properly can speed up your recovery process, while choosing the wrong one can delay it. Choosing between the two often comes down to what stage of healing you are in: Acute or Chronic.

Acute injuries are sudden, sharp, traumatic injuries that occur immediately (or within hours) and cause pain (possibly severe pain). Most often acute injuries result from some sort of impact or trauma such as a fall, sprain, or collision and it’s pretty obvious what caused the injury. Common signs of an acute injury are: pain, tenderness, redness, skin that is warm to the touch, swelling and inflammation. If you have swelling, you have an acute injury.

Cold therapy with ice is the best immediate treatment for acute injuries because it reduces swelling and pain. Ice is a vaso-constrictor (it causes the blood vessels to narrow) and it limits internal bleeding at the injury site. Apply ice (wrapped in a thin towel for comfort) to the affected area for 10 to 15 minutes at a time, using the CBAN rule. CBAN stands for Cold, Burning, Aching and Numbness. It is ok to feel the C, B and A – but always remove the cold therapy if you experience Numbness, even if this occurs prior to 10-15 minutes! Numbness implies tissue damage such as frost nip. Allow the skin temperature to return to normal before icing a second or third time. You can ice an acute injury several times a day for up to three days.

After a workout, ice is the better choice on a chronic injury.

Cold precautions:

• with insensitive skin or in the presence of poor circulation
• elderly people, young children, and people with diabetes must be very careful with cold treatments
• on the left shoulder if you have a heart condition
• around the front or side of the neck

If you have any questions about cold therapy, ask your health care practitioner for advice.

Chronic injuries develop slowly and is persistent and long-lasting.

Heat treatment (or thermotherapy) relieves stiffness and chronic aches, facilitates relaxation, and stimulates circulation. It works by increasing tissue temperatures and blood flow, thereby drawing extra nutrients into the area to assist in the recovery and healing process.

Heat treatments should be used for chronic injuries or injuries that have no inflammation or swelling. Heat applied to chronic conditions helps relax and loosen tissues, and to stimulated blood flow to the area. Chronic injuries can be subtle and slow to develop. They sometimes come and go, and may cause dull pain or soreness. They are often the result of overuse, but sometimes develop when an acute injury is not properly treated and doesn’t heal.

Safely apply heat to an injury 15 to 20 minutes at a time and use enough layers between your skin and the heating source to prevent burns. Check skin frequently for redness.

When to use:

• sore, stiff, nagging muscle or joint pain
• with chronic pain or overuse injuries before exercise to increase the elasticity of joint connective tissues and to stimulate blood flow
• relax tight muscles or muscle spasms

Heat precautions:

• do not apply heat after exercise
• do not apply on an acute injury
• do not use heat over swollen tissues or redness
• do not use heat before vigorous exercise – muscles may be too relaxed for peak performance and safety