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Outdoor ice bath

Athlete’s Tip — Alternate Heat and Ice For Speedier Recovery

A simple trick we like to incorporate with our marathon runners in training, as well as our elite athletes, is to introduce the use of alternating ice and heat on the lower extremities following a long run, rigorous workout or even an acute soft tissue injury.  This modality  has been popular for years in treating acute injuries, in particular those of the lower extremity.  The theory behind alternating ice and heat, or contrast baths, is to create a “pumping” mechanism of opening up the vasculature (vasodilation) with heat and closing the vasculature (vasoconstriction) with the application of ice.  The protocol can be introduced by alternately submerging the extremity in hot and cold baths, or by simply applying alternating hot and cold packs.  I find both methods sufficiently effective. A standard protocol follows below ( but a modified version with fewer cycles is acceptable as long as we always start with, and end with ice):

-10 min ice followed 10 min heat

-8 min ice then 8 min heat

-6 min ice then 6 min heat

-4 min ice then 4 min heat

-2 min ice then 2 min heat

-End with 1-2 min of ice.

Although the research on this subject is limited and frankly, not very supportive of the efficacy of  alternating ice and heat, I remain a hugh fan of this approach! If heat brings healthy blood into an area, and ice helps to flush out lactic acid and other inflammatory agents, then incorporating both heat and ice will provide both therapeutic benefits.

Traditionally, this approach was thought to be most effective in the sub-acute phase of healing after the inflammation has mostly subsided, but I find the approach more beneficial than ice alone, especially in the acute or early phase of injury.  My only disclaimer is that you may experience some additional soreness initially, but the benefits will quickly follow.

If you are training for a sport, in particular an endurance sport OR have recently suffered a soft tissue injury, try incorporating the use of alternating heat and ice to flush out lactic acid, speed up recovery and reduced post workout soreness.

Read How to Take Ice Baths.

Read How to Use Cross Friction Ice Massage for Chest Pain.

10 thoughts on “Athlete’s Tip — Alternate Heat and Ice For Speedier Recovery”

    1. Dr. Bill Booker

      Hi, Bob,

      Thanks for your question. If time isn’t an issue, each session should go like this: 10 minutes ice followed by 10 minutes heat, then 8 minutes ice, 8 minutes heat, then 6/6, 4/4, 2/2, and end with ice for 2-5 minutes.

      In the very acute phase (for instance, 24-48 hours after a sprained ankle), do that 2-3 times per day. After that 1-2 times a day is sufficient until the swelling has resolved and function is normalized.

      – Dr. Bill Booker

  1. Abraham Shajrah


    After you ice, do you immediately do heat. Or is there a few minutes rest in between heat and cold.


  2. Hi I have a 6 month old spraind wrist.
    X ray and MRI showed everything fine except joint effursion.
    I have had 8 physiotherapies recently and keep applying ice but my injury has not healed yet.
    Should alternate heat and ice help my condition.
    Though I have tried it and felt little uneasy.

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