Shedding Some Light on the Icy Hot Debate

By Lakeview Physio
Gayle Hulme
BScPT, Acupuncture, Certified Gunn IMS, Pelvic Health Physiotherapist
Joint Pain
January 17, 2018

Like any good debate, there are pros and cons; the good and the bad. The current debate on whether ice should be used to treat injuries is no exception.

Like any good debate, there are pros and cons; the good and the bad. The current debate on whether ice should be used to treat injuries is no exception.

There is a new wave of research that has proposed that using ice could be potentially harmful to the healing process of injured soft tissue and interfere with the body’s natural response to inflammation. But some clinicians are skeptical about tossing out such a useful pain-relieving tool.

In this article, we hope to shed some light on this Icy Hot Debate.

Dr. Gabe Mirkin, sports medicine doctor, was the first to coin the term RICE back in 1978. Following publication of research suggesting the use of ice is possibly harmful to the body’s natural inflammation response, he has since made an amendment to his commentary.

Hmm….did you read the end of his article? I’ll wait right here while you go back. You see it? Dr. Mirkin still promotes the use of ice for acute injuries! “You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10 minute application once or twice.”

If you are saying “I am so confused right now – what should I do?” Well, we have some advice for you.

The Good and The Bad

Let’s not toss out all the GOOD that ice has to offer in light of a few speculations about if or how it works.  


  • Ice is an excellent pain reliever. Reducing pain helps us move better and sooner.
  • Ice has very few side effects (as compared to medications) – yes it can burn your skin so you have to be careful about how long and how often you apply it to an area.
  • Ice is inexpensive and easy to obtain – especially here in Alberta’s climate!

Does Ice Really Impair the Body’s “Natural” Response to Healing?

This study investigated the use of ice on Delayed Onset Muscle Soreness (DOMS). They found that cold packs significantly elevated circulating creatine kinase-MB isoform (CK-MB) and myoglobin levels.

Unexpectedly, greater elevations in circulating CK-MB and myoglobin above the control level were noted in the cooling trial during 48-72 hours of the post-exercise recovery period. Subjective fatigue feeling was greater at 72 hours after topical cooling compared with controls.

Removal of the cold pack also led to a protracted rebound in muscle hemoglobin concentration compared with controls.

Bottom line from this research: don’t use ice after a workout or for DOMS!

So…I Need to Decide When Ice is a Good Thing?

Science writer and a former Registered Massage Therapist, Paul Ingraham, has laid out some great ground rules for the use of ice and heat:

When to use ice:

  • For pain control after an acute (just happened) injury such as bruises, ligament or muscle tear, or lacerations (as long as there is no risk of infection)
  • For more chronic repetitive injuries that just won’t seem to go away
  • Joint pain and swelling associated with arthritis such as osteoarthritis and rheumatoid arthritis (see our blog on joint pain )
  • If you prefer ice over heat!

When to use heat:

  • For muscle pains such as trigger points
  • Usually for neck and back pain
  • Persistent pain and stress
  • If you prefer heat over ice!

Is It Really That Simple?

Yes and no. We need to remember that ice and heat should help us feel temporarily better by taking the pain down a notch or two. But, when ice or heat makes the pain worse, there is no sense in continuing!

However, we also need to echo the ice nay-sayer’s beliefs about using physical movement as a treatment method – because we also believe in getting the body to move! The goal of physiotherapy after an injury is comfortable, protected movement as early as possible. And if using ice or heat assists in regaining movement, then our clinical judgement is to use that wonderful pain-reliever.

We want the body to do its part in healing (so long as it’s helpful healing – not all body reactions to injury are useful), and we want to get people back “in the game” or back to work, or whatever it is that makes you happy.

So, let’s all give each other a handshake or a high-five and decide that there can be some middle ground on this Icy Hot Debate. In most cases, ice will not be harmful – so you just need to test it out to see if it’s right for you to help your recovery and activity goals.


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