Fire and Ice — Part II

Fire and Ice — Part II

Fire and Ice — Part II


Last month we covered the use of cold in treating joint (ligament) sprains, specifically noting the fallacies of the old – but unfortunately still used – 24-hour rule. Now we’ll turn our attention to treatment of the more common injury to runners – muscle/tendon strains. Again the question always seems to be, Do I use heat or cold?

The answer is a little trickier than with ligament sprains, although the general principle is the same: that is, use cold for acute (inflamed), heat for chronic, conditions. The problem is that while it is relatively easy to determine the phase of ligament sprains by the persistent swelling and warmth in the area, muscle/tendon strains are more subtle in terms of signs and symptoms. Most often there is very little swelling, warmth or discoloration except in the most severe tears of muscle tissue or ruptures of a tendon, and in these cases you should always use ice until you receive medical attention.

The general rule of thumb that I follow in determining the state of injury is to distinguish between pain that is present with activity from pain at rest. In other words, if a muscle or tendon is painful to any degree when the area is not even being used (e.g., a pulled calf hurting while lying down) I consider the injury to still be in the acute stage, regardless of how many days have passed since the trauma, and in this instance I would continue to treat the area with cold. If, however, the muscle hurts only with activity (i.e., running) I would at that point try heat, but would discontinue it if it causes more pain or throbbing afterward.

While heat helps the healing process by increasing circulation to the affected area, its more important function is to improve tissue flexibility which allows you to maintain normal range of motion. Injured tissue (muscle, tendon or ligament) will heal by laying down scar tissue which, if allowed to form in a contracted position, will result in stiffness and pain with movement. Therefore, it is very important to gently stretch the injured area, once the acute stage has passed, to facilitate proper healing, and heat can help you accomplish this more comfortably and efficiently.

One more word about the use of heat — it should be comfortably warm, not hot, and should be applied a maximum of 20 minutes at one time, 3-4 times per day max.

Gabe Yankowitz

Gabe is a long-time runner and physical therapist currently practicing in Manlius. Gabe is a physical therapist in Central New York for the past 35 years, specializing in orthopedic treatment and rehabilitation. His website is

  • Physical therapy degree from Upstate Medical Center (1983)
  • Doctor of Physical Therapy degree from the Massachusetts General Hospital Institute of Health Professions  (2007)
  • Board-Certification as Clinical Specialist in Orthopedic Physical Therapy (2009).