Ice or Heat – Is Cold or Heat Therapy Better for Running Injuries?
By Rick Morris
What’s the first thing you reach for when you suffer from most common running injuries? You always head for the ice. It’s become an accepted practice to use ice or cold therapy to treat nearly every type of running injury from sprains and strains to tendonitis and plantar fasciitis. Do you need ice or heat for running injuries? Is ice really the best way to treat running injuries of minor to moderate severity?
Generally speaking, ice is the best choice for both immediate or acute treatment and long term or chronic treatment. The reason ice or cold therapy works so well is because of the anti-inflammatory properties of cold temperatures. In addition to reducing swelling around your injury, ice will also help reduce muscle spasm.
There is very little debate concerning the effectiveness of ice immediately following and for the first few days after an injury occurs. How about longer term treatment? Heat has commonly been used for longer term treatment as a way to increase blood circulation to the injured area and speed up the healing process. Current medical recommendations now say that heat may not be a good choice even after the initial acute injury stage. It seems that continued ice therapy is best because as the cold creeps deeper into your tissues your body figures out that it needs to send warming blood to the area. Your deeper blood vessels dilate which increases the healing deep circulation to your injured area. The deep cold response is similar to what happens when you are out in the cold. After about 15 minutes you cheeks will become flushed. That is caused by the circulation increasing to your very cold face. Heat, on the other hand, tends to increase fluid accumulation and swelling to the area rather than decrease it.
Does this mean you should never use heat to help treat or rehabilitate a running injury? I don’t think so. There are still time when heat is the way to go. Here are my recommendations for treating with ice or heat.
| Situation | Cold Therapy | Heat Therapy |
|---|---|---|
| First response to injury | Recommended - Cold will decrease swelling, decrease muscle spasm, lessen pain, reduce local bleeding. Don't use ice in an area of previous frostbite injury. | Not Recommended - Heat will increase swelling. |
| Sub Acute Stage - two days to 2 weeks following injury - during periods of inactivity. | Recommended - Continued cold therapy will increase healing deep circulation. | Not Recommended - Heat will increase swelling. |
| Sub Acute Stage - two days to 2 weeks following injury - just before a workout. | Not Recommended - Cold therapy can cause muscle tightness. | Recommended - heat will increase circulation to the injured area, help raise your muscle temperature and help loosen tight muscles. |
| Sub Acute Stage - two days to 2 weeks following injury - just after a workout. | Recommended - cold will decrease swelling and inflammation caused not only by your injury but also by your workout. | Not Recommended - heat can increase both swelling and inflammation. |
| Chronic Stage - 2 weeks or more following injury - during periods of inactivity. | Recommended - Cold will decrease swelling and inflammation caused not only by your injury but also by your workout. | Recommended - Heat and cold can both be used during the chronic stage. I believe that the addition of heat may accelerate healing when used in conjunction with cold therapy. |
| Chronic Stage - 2 weeks of more following injury - just before a workout. | Not Recommended - cold therapy can cause muscle tightness. | Recommended - heat will increase circulation to the injured area, help raise your muscle temperature and help loosen tight muscles. |
| Chronic Stage - two week or more following injury - just after a workout. | Recommended - Cold therapy will decrease swelling and inflammation caused not only by your injury but also by your workout. | Not Recommended - Heat can increase both swelling and inflammation. |
