Q. How do I know if I should put heat or ice on an injury?

A. Author and educator Art Riggs says it’s difficult to establish a fail-safe rule for when to apply ice or heat.

“The general rule is to apply ice for the first forty-eight to seventy-two hours after an acute injury and then to switch to heat.
“It is important to have a thin covering of cloth or paper towel between the ice and your skin. Be careful of falling asleep while lying on a heating pad; I’ve seen some serious burns. Usually, ten to fifteen minutes should be the maximum amount of time for application. For ice, frequent applications are helpful. If alternating ice and heat—the heat will increase circulation and soften tissue, while the ice will flush out the blood and curtail inflammation. So, it’s best to end with the ice.

“The reality is that many conditions are not necessarily the result of a specific injury. I call these conditions ‘recurrent acute’ and find them by far the most common: sciatica that occurs when you drive a car; backs that flare up every time you garden; or tennis elbow from intense computer work. In these cases, consistent and frequent applications of ice may prove very helpful over long periods of time, particularly immediately after the event that causes problems.

“On the other side, back or other muscle spasms that are caused by overexertion rather than injury, may benefit greatly from heat immediately upon the onset of symptoms or immediately after exercise in order to relax the muscles and increase circulation. Generally, muscle belly pain not resulting from acute and serious trauma responds well to heat, which can break the spasms and release the strain. Nerve and tendon pain, regardless of the duration of symptoms, even for months, benefit from ice.

“Finally, different individuals will constitutionally vary greatly in their reactions. Some people are more prone to the types of inflammation exacerbated by heat, while others find their bodies contracting and tightening at just the mention of ice. Try each and see what works best for you.”