Ice or Heat:  What do I do?

A common question patients ask Shoulder and Sports Medicine Surgeon Dr. Rocco Bassora, and a topic that has recently become more controversial is whether to apply ice or heat to their aches and pains.  As people become more and more active, irrespective of age, the rate of injuries tends to increase. 

Before we delve into what the best solution is for injuries and pain, it may be a bit helpful to go over some basic tissue physiology and what happens during an injury. 

What Happens to the Body During an Injury?

Tissue, whether its muscle, ligaments or tendons, all require oxygen and nutrients.  Oxygen and nutrients are transported to various tissues via blood vessels.  Blood vessels have the ability to either dilate, or widen, in order to increase blood flow, or constrict and tighten up, ultimately diminishing flow to a particular tissue.

When an injury occurs, various chemicals are produced to help increase blood flow to the injured tissues (muscles, ligaments, tendons) by causing blood vessels to widen; unfortunately, they also cause them to become more porous and leakier, causing fluid to extravasate into surrounding healthy tissue leading to increased swelling and pain.  It is not the body’s intention to cause these unwanted side effects, but it is part of the process while attempting to heal the injured tissue.  

How Does Ice and Heat Help an Injury?

Ice causes blood vessels to constrict, essentially shunting blood away from injured tissue. On the flip side, heat causes them to widen, increasing blood flow to affected tissue. So, this raises the question—why would we want to decrease flow to injured tissue if it is in need of chemicals and cells to begin the healing process? This is where the recent controversy kicks in. There are some scholars who are proponents of ice and argue that leakier blood vessels cause fluid and chemicals to spill over into healthy tissue, potentially causing damage to an unaffected area.  Yet there are others who have recently moved away from this train of thought, stating that ice decreases your ability to heal.  

What Does Dr. Bassora Think?

The truth, in my mind, lies somewhere in the middle.  

In my practice, I recommend ice for acute injuries (sprains/strains or joint injuries less than 48 hours old) to help decrease swelling and pain.  A bag of iced vegetables works because it conforms nicely to the site of injury, and should only be applied for 15 minutes at a time to prevent skin burn.  Heat, on the other hand can have deleterious effects on acute injuries, adding fuel to the fire by increasing swelling and pain, and should be avoided. 

On the other hand, chronic muscular pain or arthritic joints can benefit from heat. Heat should be used for long standing muscular pain, such as neck pain or low back pain, in order to help relax and loosen up muscles, and can also be used to improve range of motion in arthritic joints.  A warm moist towel, or a heating pad can be used to achieve this, and it is important to never use excessive heat for a prolonged period of time to avoid burns.  

Keep this quick guide in mind when dealing with icing or heating an injury:


  • Shoulder, elbow or knee sprains
  • Swelling
  • After acute injuries
  • Apply for no more than 15 min to prevent burns


  • Muscular pain or soreness
  • Arthritic joints
  • Chronic pain
  • Warm, moist heat is best

Dr. Bassora is a Shoulder and Sports Medicine surgeon who specializes in shoulder reconstruction and sports related injuries of the shoulder, elbow and knee. He sees patients in Montvale, Paramus and Rutherford. For more information or to make an appointment, click here.

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