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Sprains and strains? Ice or heat?

making an ice pack

March 13, 2013

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This is a monthly column by Dr. Zahra Bardai in which she guides our path to well-being.

Our bodies were designed for movement. That’s why we have a sophisticated system of bones, muscles, tendons and ligaments that work together to enable us to flex, contract, rotate and move. Strains occur when muscles and the tendons that hold muscles get injured. Ligaments hold joints and bones together and when injured result in sprains. The usual signs of sprains and strains are pain, swelling and sometimes heat, redness and weakness. Wherever in the body they occur, sprains and strains usually cause some sort of short-lived decline in the function of the muscle or joint affected. If you suspect a sprain or strain injury, see your health care practitioner for diagnosis and recommendations regarding resting, compression, bracing, elevation, medication and rehabilitation with services such as physiotherapy.

In this article, I’d like to address one of the most common questions asked about an acute sprain or strain injury: Should I ice it or should I put heat on it?

Conventional medical practice has been to ice during the first couple of days of the injury and then heat after that. Icing techniques vary, but to get maximum benefit, I recommend protecting the skin with some sort of light covering and placing an ice pack on the area in question, then leave the ice pack on, knowing that initially it will feel cold, then uncomfortable and finally numb. Remove the ice pack when this numbness sensation is felt; this usually means about 20 to 30 minutes of ice pack application, repeated every few hours in the first couple of days after injury.

When the initial injury period is over (usually about two days) heat can be added. Heat compresses should be comfortably warm, not scalding. Once again, protect the skin, apply the heat pack and leave on for about 20 to 30 minutes, repeating a few times in the day. After the first couple of days, whether you use ice or heat is really a matter of what makes you feel comfortable.

Another technique to aid in the healing of a sprain or strain is to use ice/heat alternation. This treatment should be initiated a couple of days after the acute injury. It uses the sequential application of ice then heat: apply ice for a minute, followed by heat for a minute, then ice again for a minute and then heat for a minute and so on for about 15 minutes, remembering to start and end with ice. Joints that are amenable to immersion, such as an ankle or hand, should be placed into ice water or comfortably hot water for maximum benefit. If this is not possible, ice and hot compresses can be used. By using a contrast of cold and warmth, inflammatory debris created during a sprain or strain is removed by the blood using a mechanism known as the flush response.

Sprains and strains are common sports-related injuries. They are generally benign and self-limiting conditions that usually heal within a few weeks. Unfortunately, they can cause a lot of pain and really put a crimp in your game. While active rehabilitation is a key ingredient in returning to play, remember to respect your body’s edge and it’ll continue to move you.

About the Author(s)

Zahra Bardai

Zahra Bardai is a family physician. If you have any questions about her topic please e-mail her at

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