A recent analysis of treatment methods for new injuries suggest that many physicians (both chiropractic and medical) as well as most patients, are confused as to whether heat or ice should be used after an injury.  The general advice is that applying ice for the first 24 to 48 hours followed by heat is based on the often inaccurate assumption that the patient has progressed beyond the acute inflammatory phase to the repair phase of healing according to a “normal” time scale. As a clinician since 1996, having attended over 20,000 treatment visits, I have seen that many, many patients show signs of acute inflammation for as long as a week or more after the original injury. Therefore, overuse or premature application of heat can prolong the normally short-lived inflammatory response.

My guidelines are as follows:
~ Within the first 48 hours of an injury, ICE ONLY;
~ For the next 72 hours (within the first 5 days after the injury), Heat and Ice can be alternated, always ending with Ice (this includes after “hot tubs”!), then,
~ After 6 days, PERHAPS Heat-only can be applied, or Heat/Ice/Heat ending with Heat.

Two more “guidelines” (to be applied only after the 48 / 72 / 6-day rule!):   If no body position is pain-free – use Ice; If there are pain-free positions, but there is pain with muscle contraction – MAYBE use Heat.  Remember, “stiffness” in the morning with some mild pain might seem like a time for Heat. However, at the end of the day, the activities of your day may have triggered a recurrence of an inflammatory response, hence a return of constant pain in the evening – and thus heat is not best. For muscle fatigue spasm only (no injury) use heat. When in doubt – remember you can ASK!