Injuries are a common part of everyday life. Whether you hurt your knee playing basketball or have chronic lower-back pain, it’s important to know how to treat the pain. Luckily, you can follow a few simple guidelines to understand when to use heat or ice to reduce your pain, no matter the cause. 

When to use ice 

“Ice is the best remedy for the first 72 hours for any musculoskeletal-related injury,” says Thomas Strawmier, APRN-NP. “Everything from a twisted ankle to a busted knee, if it’s an acute injury, ice is best.”

When using ice, you want to protect your skin so you don’t burn it. “If the skin gets too cold, it can burn,” says Strawmier. “So, I usually tell people to put a barrier between the ice and your skin, like a towel or some kind of cloth. This barrier will permit coldness without direct skin contact.” 

When to use heat 

“Heat is best for chronic or long-term muscle pain or tenderness,” says Strawmier. “For example, if you strained your back while working out or pulled a hamstring running.”

As with ice, you should use a barrier between a heat source and your skin. “Put a cloth between you and the heat source to prevent any burns through direct skin contact,” says Strawmier. Additionally, avoid using a topical rub and a heating pad on the same spot, as this can result in a burn.

The 20/20 Rule

When treating pain, it’s smart to follow the 20/20 rule. Use the ice or heat for no more than 20 minutes, then give yourself a 20 minute rest before applying it again. 

It’s generally safe to use over-the-counter pain medications like acetaminophen or ibuprofen in combination with either heat or ice. “These medications are safe as long as you don’t have any medical restrictions,” says Strawmier. 

Restrictions that could prevent you from using such medications for pain include kidney or liver issues. Additionally, you shouldn’t use these medicines for extended periods, like six to eight weeks. “These medications are safe to use during the first three to four days after an injury, but you shouldn’t use them for chronic medical conditions,” says Strawmier. 

While some people believe you shouldn’t use both ice and heat or only use them in specific instances, using both methods is safe if your injury isn’t worsening. 

“Sometimes, people will use ice and have more discomfort or say it irritates a muscle injury,” says Strawmier. “Still, I generally follow the rule that if it’s feeling better or comforting your pain, then it’s okay to do.”

When you should see a medical provider

One aspect of your injury to look out for is swelling or bruising. “Sometimes you’ll have swelling and bruising immediately after an injury,” says Strawmier. “If this swelling or bruising improves instead of worsens, you generally won’t need to visit a medical provider.”

Still, if you’re using ice or heat as treatment and the swelling or pain isn’t improving, it’s time to see a doctor. “If you’re two days into the injury and it’s not getting better or the color or temperature of the skin changes, those are concerning signs,” says Strawmier.