A for Athlete

Ice or Heat?[]

by Dr. Mel C Siff

The use of ice treatment may not be universally superior to the use of heat in enhancing recovery or rehabilitation.


The use of localised or more extensive ice or cold treatment has been well authenticated over the years and there is little doubt that, in many cases, it is a highly effective and cheap method of restoration and rehabilitation.

However, any literature searches for definitive studies that compare the effectiveness of ice cold versus very hot treatment of the same sort of injury are not as common as one would believe.

It seems as if we have all accepted that heat is contraindicated largely on the basis of theoretical considerations or extrapolations form cases where bleeding is apparent. We know that heat causes blood vessels dilatation, temporary increase in inflammation and the decrease in blood viscosity, but does this necessarily imply that it will be detrimental to the course of restoration or rehabilitation of all sore, bruised and fatigued soft tissues?

Why I am saying this is because I have been experimenting, much against my education and scientific traditions, with the use of very hot water as a restorative means with myself and several other athletes, some of whom are top pro footballers and basketballers.

Surprisingly, this seems to diminish muscle soreness and speeded up recovery in many cases, especially if we use alternate hot and cold bathing. I have an 8 ft deep jacuzzi and long lap swimming pool and have my athletes alternate between hot and cold immersion. Interestingly, I have found that the water has to be almost unbearably hot (about 108 deg F or 41C) to be optimally effective. Movement under these conditions also seems to be valuable ('cryokinetics' for ice old immersion and 'thermodynamics' for hot immersion).

Certainly my comments on this controversial topic merely constitute anecdotal evidence at this stage, but I am curious to hear if anyone else has had similar experiences or come across scientific research which legitimately shows that dedicated ice treatment is significantly better than very hot treatment or ice-heat contrast methods. Failing that, is there any evidence that the use of heat is a general contraindication for musculoskeletal recovery and rehabilitation, other than cases where there is obvious bleeding or serious pathology?

Are we promoting ice therapy far too liberally to the exclusion of heat therapy, when the latter may well also play a very helpful role in musculoskeletal rehabilitation? Are we unfairly proclaiming that heat is potentially harmful for treating any soft tissue repair? Does this attitude go against our recent attestations to the value of 'holistic' treatment?

There have been a huge number of studies on the effect of stretching, jogging, supplements, heat, cold, drugs, you name it .... and virtually nothing has yet been found that appears to make some significant and consistent difference to the dissipation of DOMS. Do a Medline search and you will see what I mean. Many higher level weightlifters and ppwerlifters rarely if ever suffer from DOMS even after very heavy workouts, which afflicts mainly newcomers to a given exercise or routine - or certain more susceptible individuals. For general recovery, I have found it difficult to beat sensible program (or periodisation) design and hot-cold contrast bathing, as I have written in previous letters. Your recommendation to do some mild post-exercise activity probably is a sound idea for general relaxation and recovery, but it has not been shown to have any real effect on DOMS.