How to Treat a Sports Injury: Heat or Ice?

Traditionally, the recommended method for treating sprains and strains from exercise has been the RICE approach – rest, ice, compression, and elevation. While the RICE method is still recommended and widely used, some sports medicine doctors, even the person who coined the acronym RICE, have begun shifting their advice. In some cases, movement can be more helpful than rest, particularly for overuse injuries, and icing may not always be the most effective treatment.

Dr. Gabe Mirkin, a retired sports medicine physician who coined the term RICE in 1978, now suggests early movement, as long as it does not cause pain. “The most important rule is to listen to your body because you feel pain when you’re doing something wrong,” Dr. Mirkin said. “The reason injuries are so common is that people think they can work through pain.”

New approaches are called “M.E.T.H.” – movement, elevation, traction, and heat – or “P.O.L.I.C.E.”, which stands for protection, optimal loading, ice, compression, and elevation.

When to Use Heat vs. Ice

Although many clinics and healthcare providers, including Britain’s National Health Service, recommend applying ice to an injury for 20 minutes every two to three hours after injury, scientific studies about the effectiveness of ice have not been conclusive.

Dr. Julie Han, a sports medicine physician at NYU Langone Health, stated that there is no right or wrong answer as to whether one should use heat or ice, and emphasized that neither would cure an injury. “It’s not going to fix anything, it’s not going to impede your progress if you choose one over the other,” she said. “They’re essentially techniques that could be helpful in alleviating symptoms.”

Generally, Dr. Han recommends icing during the first one or two weeks following an injury to reduce pain caused by acute injuries, while the injury is swollen or bruised. She suggests switching to heat therapy afterward to relax and warm up the muscle if it is stiff. She notes, however, that there is no hard-and-fast rule.

“Choose what feels better for you,” Dr. Han said. The most effective treatments are nonsteroidal anti-inflammatory medications, like ibuprofen, and physical therapy, she added.

Corey Kunzer, a supervisor of physical therapists at the Mayo Clinic in Rochester, Minn., said he typically recommends ice at the initial onset of an injury to help with the pain, and that both ice and heat can be helpful. He tends to recommend heat in the morning, when muscles may be stiffer, and ice in the evening.

Ice is the “safest pain medicine available today,” Dr. Mirkin said. But it also reduces inflammation, which is needed for healing, he added.

Mr. Kunzer said, “You want some of that swelling and inflammation because that is what some of the healing process happens with,” he said. “At the same time, you don’t want too much because it can be painful.”

Why Movement Is Better Than Rest

Over the last 20 years of his work in physical therapy, Kunzer has seen recommendations shift away from immobilization and toward more early movement. “You want to walk that tightrope, that fine line between getting that motion, but also still protecting it,” he said of the injured muscle.

Moving too quickly after an injury can prolong the pain, while too much rest can result in stiffening and further loss of strength. Kunzer tells patients that exercise is the best medicine and uses the phrase “motion is lotion” to encourage them to keep moving, especially when they have conditions like osteoarthritis.

The Best Approach Depends on the Injury

The best method of recovery depends on the type of injury, its severity, and its location. While many strains heal on their own within a few weeks, more serious ones may require surgery or immobilization in a cast. If an injury is serious, seek recommendations from a doctor as soon as possible for advice on treatment. Understanding the cause of your pain through a professional diagnosis can help you determine whether it is safe to keep moving or whether rest is necessary for healing.

Injuries often occur when people add too much to their exercise regimen too quickly, so it’s essential to increase intensity, frequency, and duration gradually. As you age, warming up and cooling down become even more crucial. Eating a balanced diet and getting enough sleep are good ways to stay healthy and prevent future injuries.