If you twist a joint, pull a muscle or over-exert yourself, you're going to be faced with a decision. Which is better for the injury, a cold pack or heating pad? Before you guess, first look at what happens with those types of injuries. Damaged tissue reacts by releasing chemicals that increase inflammation and swelling.

Inflammation is caused by your body sending plasma proteins and phagocytes (white blood cells that fight infection) to the injured area to ingest and neutralize foreign material. That works well if the tissue is torn. However, if it's a pulled muscle, strain or sprain, there is no foreign material to deal with. The inflammation actually damages tissue.

Swelling after an injury is largely due to the leakage of blood from ruptured capillaries. In pre-historic times that was good because swelling worked to immobilize the injured body part and prevent further damage. In modern times we know to protect the injured area and the swelling simply causes more pain.

So which is best? NEITHER. If heat is applied, it increases tissue destruction and prolongs the healing process. Ice doesn't decrease the pain and it restricts healing blood flow. The steps previously were summed up in a word, PRICE.

Protect yourself from further injury.
Rest the muscle and minimize movement of the injured body part.
Ice the injured area with a cold pack. (Don't do this step anymore unless a doctor or medical professional tells you to!)
Compress the affected body part with a light pressure wrap to minimize blood loss and swelling.
Elevate the injured body part so that fluids drain from that area by gravity, reducing pressure from the blood and swelling.

UPDATE: All the steps of P.R.I.C.E. may not be as effective as once believed. Click here for the full story.

If you're instructed to use ice, here's what you need to consider.

Ice is typically applied one of two ways. Either as a bunch of ice cubes in a plastic bag or as a gel pack. Ice cubes in a bag is the cheapest way to go, but if you don't have any ice a bag of frozen peas is a good substitute.

Gel packs have two major differences from ice. The first is a benefit; they're convenient. If you're dealing with a chronic injury that requires frequent attention, gel packs can save you time overfilling bags with ice.

The second difference can pose a problem. Because water freezes at 32 degrees Fahrenheit, when you make an ice pack it's always about 32 degrees. But the freezing temperature of gel packs is much lower, so they drop to the actual temperature of your freezer. That's typically zero degrees Fahrenheit. If you use a gel pack, because it starts out colder, it's easier to give yourself frostbite if not used properly.

When you apply ice, there are four distinct stages or levels of feeling you'll experience. When the pack is first put on, it's going to be cold. That's quickly followed by a burning ache. Gradually the ache is replaced with pain and eventually the area becomes numb. The entire process takes 10-15 minutes to complete.

The correct way to use ice therapy is to avoid putting it directly against the skin. Keep a layer of cloth, such as a towel or pillowcase between your skin and the bag. Leave the cold on your injury for 10 to 15 minutes, and then remove. Let the injured area warm back up to normal body temperature, at least 1 hour, before applying the ice pack again. A typical cycle is to re-apply the ice pack every other waking hour.

There are times when ice should NOT be used. If you are a diabetic or over the age of 65, ice shouldn't be used in areas of decreased circulation. People who suffer from Raynauds disease should never use ice therapy without direction from a doctor. You should also avoid cold packs if you've had frostbite in the injured area, suffer from gout or other rheumatoid conditions.

PLEASE REMEMBER: The information on this site is intended for general reference purposes only and is not intended to address specific medical conditions. This information is not a substitute for professional medical advice or a medical exam. No health information on this site should be used to diagnose, treat, cure or prevent any medical condition.

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2/15/2009
Updated 4/19/2014
Updated 12/18/2015
Updated 12/25/2020