When to use ice or heat for a pulled muscle
- Maryke Louw
- 1 day ago
- 4 min read
"Is ice or heat better for a pulled muscle?" This must be one of the most common questions that I’ve been asked in my years of practising as a physiotherapist. Whether you use ice or heat will depend on what phase of healing your injured muscle is in.
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In this article:
I explain this in detail in this video:
Immediately after pulling your muscle
Phase of healing: Inflammatory phase
What to use: Ice
Why ice rather than heat?
Your main aim immediately after injuring your muscle is to stop internal bleeding and prevent excessive swelling.
Excessive bleeding and swelling inside the muscle causes an increase in pressure, which can cut the blood circulation off to the adjacent, uninjured cells. Without an adequate blood and oxygen supply these cells may also be damaged, causing your injury to be worse than what it should be.
Heat might increase the bleeding and swelling, as well as inflammation in your newly pulled muscle. Inflammation is a part of the natural healing process, but excessive inflammation can cause trouble. The same goes for the next stage, when inflammation still plays a role (see below).
🚨 Important
Do not apply the ice for more than 10 minutes at a time.
I explain this in detail in the video, but in short: If you apply it for more than 10 minutes the blood vessels may open up because the brain thinks that you are at risk of getting frost bite. This can then actually cause more bleeding.
👉 Check out this Ice User Manual for exact instruction on how to safely apply ice to an injury.
Here's a selection of ice packs on Amazon. All of them are reusable and can be used for icing and heat (read on to see when using heat is appropriate).
First 3 to 5 days after injury
Phase of healing: Inflammatory phase
What to use: Ice – but only if needed
Why ice rather than heat?
Some muscle strains can continue to ooze inside, and we still don’t want the blood vessels to expand like they would if you were to apply heat on the injured muscle.
Also, muscles use an inflammatory response during this period to help them heal and heat can cause inflammation to increase – excessive inflammation is also not good for healing.
Ice can be useful to use if your strained muscle is very painful, swollen, or is showing signs of excessive inflammation.
🚨Important
Inflammation is an extremely important part of the healing process as it is needed to absorb the debris from the injury site. Excessive inflammation can cause trouble, but suppressing it too dramatically is also not great.
👉 Ice can calm down the inflammatory process and prevent excessive inflammation. However, if you use ice too frequently or for very long periods, then it might interfere with your healing – it won't stop you from healing but it might just take a bit longer to build strength. Using it for the short periods suggested in our Ice User Manual has not been shown to have any negative impact on healing.
After Day 5
Phase of healing: Regeneration and remodelling phases
What to use: Ice or heat or contrast therapy
Why doesn't it matter?
For most injuries, the blood vessels in your muscle will be fully repaired after Day 5 (of course this may vary depending on your injury, so check with your doctor or physio), so you no longer have to worry about internal bleeding. The inflammation has usually also done its job and no longer a factor to consider.
The main reason for using ice and/or heat during this period are:
Pain relief: Both ice or heat can work well for this. I usually let the patient decide what works best.
Reducing swelling: Ice and/or contrast therapy (where you alternate hot and cold) can be used for this.
Improving circulation: Contrast therapy or heat may be best for this. The idea is that the increase in circulation helps to deliver more nutrients and oxygen to your injured tissue, helping it to heal more quickly. I’m not aware of any research to support or contradict this, but some of my patients swear by it.
🚨Important:
You can injure yourself by applying heat or ice for too long.
Never apply it to areas where your sensation is dull or numb.
Using ice shortly before doing exercise can also predispose you to injuries, because it numbs your nerve endings – check out the Ice User Manual for more detail on this.
Never apply heat or contrast therapy over an area with signs of inflammation (red, hot, swollen) as it can make the inflammation worse.
How we can help
Need more help with your injury? You’re welcome to consult one of the team at SIP online via video call for an assessment of your injury and a tailored treatment plan.
We're all UK Chartered Physiotherapists with Master’s Degrees related to Sports & Exercise Medicine. But at Sports Injury Physio we don't just value qualifications; all of us also have a wealth of experience working with athletes across a broad variety of sports, ranging from recreationally active people to professional athletes. You can meet the team here.
About the Author
Maryke Louw is a chartered physiotherapist with more than 20 years' experience and a Masters Degree in Sports Injury Management. Follow her on LinkedIn, ResearchGate.
