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When To Apply Ice And Heat: A Shoulder Injury Treatment Guide

Shoulder surgeons and physiotherapists look at injuries while playing sports or due to everyday activities. Here Dr Chandra Shekar B advises on the popular topic of when to apply Ice or Heat on Injuries. When is the right time? What’s the difference between the two?

Knowing the difference between an acute injury and a chronic illness can help you know when it’s time for Ice or heat.

Let us see!

How to treat sprains, strains and stiffness by use of ice or heat?

Knowing exactly when to apply hot or Ice packs can shorten recovery time and help with chronic pain and stiffness. Treatment of injuries can be complex, and not all sports injuries or conditions require rigorous Ice or heat therapy. In general, ice therapy is better for injuries such as sprains and strains, whereas heat therapy is usually better for treating chronic illnesses.

The RICE method is useful immediately after sprains or strains and can also help with severe swelling or pain after strenuous activity or exercise. Heat is best for tense muscles, sore muscles, and the stiffness and pain associated with arthritis. Heat can also be used after an acute injury to increase blood flow once the swelling has subsided. Remember, applying heat too quickly after an acute injury can increase swelling. After a sudden injury, ice therapy should be used for the first 24 to 72 hours. The patient can then turn to heat therapy to increase blood flow to the area.

Of course, there are exceptions to this basic rule, and some injuries may respond more appropriately to a combination of ice and heat therapy. A recent study found that Ice and heat therapy effectively reduced damaged muscle tissue after strength training. Still, cold therapy was more effective in treating pain immediately after exercise and up to 24 hours later.

Every injury requires different treatment, and there are situations when Ice or heat may not be suitable for certain injuries or conditions. For example, applying a hot compress to a recent injury can stimulate blood flow to the area and increase the risk of swelling. Using Ice for back pain associated with muscle stiffness can only exacerbate the annoying stiffness. 

Ice therapy

  • Effects of Ice: Reduces blood flow, metabolic activity, inflammation, and tingling of the skin.
  • Ice Benefits: Reduces pain, swelling, inflammation, and muscle spasms. Best used after exercise or after activities that trigger pain.
  • Ice Risk: Long term use may cause frostbite.
  • Methods of application of cold therapy: Ice pack, ice bath/ice whirlpool, ice massage. 

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When to not use Ice

  • Just before physical activity
  • When the icing area goes numb
  • When pain or swelling affects a nerve (such as the ulnar nerve “)
  • If the athlete has sympathetic dysfunction that is an abnormality in the nerves that control blood flow and sweat gland activity
  • If the athlete has vascular disease 
  • When there is an irritation with the skin (for example, an open wound, a wound that doesn’t heal, the skin is stretchy, blistered, burned, or thin)
  • If the athlete has hypersensitivity to cold, including cold-induced urticaria (hives)

How long can Ice be used

  • Two to three times a day (minimum); up to once an hour.
  • The duration varies depending on the technique, typically 20 to 30 minutes per session. 

Ice can still be used in medicine as long as there are pain, swelling, inflammation, or cramps.

How to do ice therapy

Effective cold therapy involves several daily treatments, up to 20 minutes each. Remember, it is not recommended to Ice a sprained, strained, or injured ankle that lasts more than 20 minutes. Some people may only need one treatment per day, while more severe sprains and strains may require multiple ice therapy uses each day. To prevent sunburn, people should place a layer of material between the skin and the ice pack or ice product. Wrapping an ice pack or ice pack in a towel to prevent direct skin contact usually works.

Use of heat

  • Heat Effect: Increase blood flow, metabolic activity, and inflammation.
  • Thermal Benefits: Improves Soft Tissue Compliance; relieves pain and cramps. Heat is most helpful for warming stiff or soft scar tissue before stretching or exercising. Heat can also help relieve pain or cramps associated with neck or back injuries.
  • Heat Risk: Can increase swelling and inflammation; Using it for too long or at too high a temperature can cause burns.
  • Heat application method: Hot compress, hydro-collator, Whirlpool.

When not to use heat

  • After physical activity
  • When the area is numb
  • When there are open wounds or burns
  • Immediately after an acute injury
  • When the body temperature increases due to fever or heat stress

What types of injuries do you need to cause heat?

Pain or chronic conditions usually require heat therapy. Chronic pain indicates that the body has not fully recovered, and the pain often returns. Some of the common chronic conditions are:

  • Muscle aches or pains
  • Stiff joints
  • Arthritis
  • Long/repeated injury

Heat therapy is the opposite of cold therapy. Unlike cold therapy’s ability to constrict blood vessels, heat can dilate our blood vessels and relax our muscles. The application of heat has a calming effect.

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How to do heat therapy

Many products on the market penetrate deep fabrics for efficient heat treatment. Whether dry or humid heat is more suitable depends on the conditions. A heating pad is an example of a dry heat source, whereas a warm bath is popular humid heat therapy. Studies show that humid heat can outperform dry heat when it comes to penetration into deeper tissues. Therefore, humid heat can be more effective in treating thicker muscle tissue such as the quadriceps. It is important to use comfortable heat during heat therapy to minimize the risk of burns. Regarding soaking in a hot bathtub, we do not recommend soaking in temperatures above 104 degrees Fahrenheit. A heating pad or heating compress should be wrapped in a towel or cloth to avoid direct skin contact.

Although heating pads and packages are ideal for larger areas such as the lower back, smaller joints may require other heating products for optimal maintenance. For example, those with arthritis pain can completely immerse the joints in a paraffin bath. Although mild pain can benefit from short treatments of 15 to 20 minutes per day, moderate symptoms may require long-term treatment. People with chronic muscle pain can get great results if they soak in warm water for an hour or two.


Science has yet to prove the effectiveness of hot and cold therapies, but the risk of side effects, when used at certain points on the body, is usually small. People with chronic pain or less serious injuries can try and find what works best for them.

With specialized training to treat shoulder injuries problems, Dr Chandra Skehar is an expert in this field. He works with other doctors to rehabilitate patients and help them overcome mobility limitations and previous pain. If you experience pain or swelling at home that won’t go away with the appropriate ice or heat therapy method, call us at 9959588389.

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