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Hot or Cold: Which treatment best for exercise injuries?

Linda Melone, CSCS, is an NSCA Certified Strength and Conditioning Specialist and certified personal trainer based in Orange County, CA. Visit her website at www.LindaMelone.com.

Treating injuries with ice and heat

It's bad enough you tripped in front of that hot guy in aerobics class, but now you have a sore knee to show for it. What do you do? If you're lucky, Mr. Aerobic Guy is a paramedic who'll come to your rescue. But in reality, you'll likely have to choose between ice or heat. Which works best so you can save face--and feel better?

Woman with ice packCold case:

When to ice exercise injuries

In short, ice is best for the initial stage of an injury. (Note: Only mild cases should be self-treated; see a doctor if you experience swelling or pain that seems out of the ordinary.) While a hot shower or bath may sound soothing and wonderful, in the end it can cause further problems. Heat causes increased blood flow and produces an inflammatory response that may increase the healing time of the injury -- not fun nor soothing.

Cold, on the other hand, acts as a counter-irritant. Cold compresses such as ice packs or gel packs help decrease blood flow to the area, reducing inflammation. Cold also helps decrease the likelihood of developing an unsightly hematoma (a bruise-like appearance) following an acute injury. Ice packs and frozen gel-packs are all helpful, although in the initial stages, compression along with elevation and cold is best to reduce swelling. Ice the injury for no more than 20 minutes at a time but avoid direct contact with the ice, or you risk freezer burn. Wrap the ice pack in a towel or cloth.

Bi-Polar:

Alternating heat and ice for exercise injuries

After a week, start alternating with heat and ice, unless the area still seems inflamed, in which case you want to stick with ice for a bit longer. (At this point you may want to see a doctor if it's not any better.) Apply a hot compress for three minutes followed by a cold compress for one minute; repeat three times. Repeat two to three times a day.

Overall, both hot and cold treatments have their place during the recovery of an injury. In general, cold is more appropriate immediately after an injury occurs to reduce pain and inflammation. Use heat after the initial inflammation stage is over, at least seven to 14 days after the initial injury. When in doubt, make an appointment with your doctor.

ACSM Recommendations:

RICES for exercise injuries

In addition, the American College of Sports Medicine (ACSM) stands by RICES as the best way to handle injuries. RICES stands for:

  • Rest: Prevents further injury and ensures initiation of the healing process
  • Ice: Reduces swelling, bleeding, inflammation and pain
  • Compression: Reduces swelling and bleeding
  • Elevation: Decreases blood flow and controls edema
  • Stabilization: Reduces muscle spasm in the injured area by assisting in the relaxation of associated muscles

More on exercise injuries

How to avoid dance-related injuries
Yoga injuries on the rise in women
Women at risk for weight-lifting injuries

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