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Ice or Heat after injury?




Ouch!  This young lady has a Grade 2 hamstring strain.  Luckily, she has done herself a favour and followed the RICE regime.  Believe it or not, her bruising and pain would be significantly worse if she hadn’t iced her injury regularly in the first 72 hours.

Have you ever sustained an injury and not been sure whether to apply ICE or HEAT?


The general principle is to follow the RICE regime in the first 48 to 72 hours after sustaining an injury, such as the hamstring muscle strain sustained by our unlucky patient in the attached picture. RICE refers to Rest, Ice, Compress and Elevate the injured area, the aim of which is to minimize the inflammatory response and therefore reduce swelling, bruising and pain from the injury.  Applying ice results in vasoconstriction, meaning less blood flow through the area, therefore reducing bleeding/bruising.  Applying heat in the first 72 hours potentially makes this inflammation and bruising worse, as it dilates the blood vessels which results in more blood flow to the injured area.  Alcohol can have the same effect, so is also best avoided in the first 72 hours.

So, ICE for the first 72 hours.

The general recommendation is that after the initial inflammatory phase (first 72 hours) has passed, heat can then be applied.  The reasoning here is that the worst of the inflammation should have passed, and so ice will not be as effective anymore.  Heat stimulates more blood flow to the injured area, resulting in more “healing cells” such as fibroblasts in the area which help to repair injured soft tissue.

So, HEAT after the first 72 hours.

Unfortunately, there are always exceptions to this rule.  In some cases, applying ice beyond the initial 72 hour stage can still be beneficial.  It is best to seek professional guidance from your physiotherapist, who can assess and diagnose your injury, and advise you specifically on what approach of applying ice or heat will help you achieve the quickest recovery alongside other treatment techniques such as compression and soft tissue massage.