Ask a PT: should I ice or heat?

This week’s question came from a patient who had a lateral ankle sprain (the most common form of ankle sprain) one week ago, who has been told conflicting things from different health care providers.Should I ice or heat?”

This is actually a common question, and is not uniformly agreed upon by all health care providers when to heat and when to ice. The idea behind icing is to reduce pain and swelling by inhibiting blood flow and the inflammatory process and thus the painful chemicals that go along with that.  The inflammatory process is necessary to a point for tissue healing, but can be very painful.  The idea with heat is to increase blood flow and tissue extensibility, and can help ease tight or sore muscles.

Immediately following a sprained ankle (within the first 48 hours), resting, icing, elevating, and compressing (RICE) can help reduce the pain involved with the inflammatory process that occurs after an injury.  There is some evidence to suggest that icing within the first 48 hours of an ankle sprain results in a faster return to painfree prior level of activity.1 However, once the swelling has subsided, there is really no longer a need for ice.  If the sprain is mild (grade I), the swelling has often completed subsibed at 1 week. At this point, if there is residual pain and stiffness, heat may be beneficial for you to loosen up tissue that had tightened up after the initial healing process. This may not work for everyone, and evidence is inconclusive as to whether or not you should ice, heat, or do neither at this point.

So to summarize the answer to the question, if you still have some residual swelling and pain along with it at one week following an ankle sprain, you may want to continue your RICE regimen. But if there is no swelling and just some stiffness, in order to get back to activity as normal, you can try heat prior to activity. With ice, you apply for 20 minutes, and with heat 5-10 minutes should be sufficient.

1. Thompson C, St. Anna L. Heat or ice for acute ankle sprain? The Journal of Family Practice. 52(8);2013.

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