It was the ancient Romans who initially found and named the 5 cardinal signs of inflammation. These are:

  • calor (heat)
  • rubor (redness)
  • tumor (swelling)
  • dolor (pain)
  • and functio laesa (loss of function)

We all have experienced these five or maybe one or two at a time. Our bodies do their best to make repairs as fast as possible. 

In response to an acute injury (0-4 days after) the body is in an acute inflammatory cascade that attempts to stabilize the injury. After the initial injury, subacute healing (5-14 days after) comes in to clean up what the acute phase left. Chronic healing (14+ days after) goes in to eventually help to fully heal the tissue. Unfortunately, this isn’t always the case as we humans are prone to reaggravating the injury. So what helps to speed up this process? Is it ice or is it heat?


Let’s start with ice. Ice does many great things to help inflammation. First, ice helps to slow nerve flow down. This helps to slow the many different signals that flood our brain and the affected area during a painful spell. Second, ice helps to slow blood flow in an area. Vasoconstriction is important to slow the swelling of an area. This can slow the blood flow that likes to bring irritants along with the nutrients it provides. Plus if you can get an area cold (decreasing the skin temperature 3-4 degrees Fahrenheit very quickly) cold shock proteins are produced which significantly speed soft tissue healing.


Now on to heat. Heat is a very popular remedy. Heat increases the size of the blood vessels so more blood flows to the area. The more blood you have the more oxygen and nutrients come into the area giving it the nutrition it needs. Heat also improves function to an area by loosening tightened muscles and invigorating tendons and ligaments. Heat shock proteins (released at 105-107 degrees Fahrenheit) have recently been shown to “chaperone DNA repair” by allowing cells to adapt to stress and slowing cellular breakdown.

To me, if I wanted to slow some inflammation and pain between acute and subacute healing phases, ice would be the best option. Between subacute and chronic inflammation, heat can be used exclusively if there is no pain but alternating ice and heat is also an option. In my experience, it’s very safe to alternate ice and heat if you don’t know what to do. 

So it’s easy to see how there is a lot to factor in when it comes to these two. Let’s go through a couple of scenarios to better grasp these ideas.

Example Scenarios

As an example, I just rolled my ankle today and I want to help with the swelling and pain. What would you do? In my opinion, ice would be the best option for the first 0-72 hours after an injury like this. Afterward, I would then start to alternate ice and heat. For the next 2 weeks, this ice and heat alternation should be done ideally 3 times per day. 

Another example would be someone with chronic lower back pain. In my experience, most of these folks live on heat! They find it relieving to their tight muscles and general soreness. 

As a general rule, we at Sandstone recommend using 15 minutes of ice and immediately after 15 minutes of heat. Rest is taken for 30 minutes then the process can be repeated. It works well for decreasing inflammation and pain then increasing blood flow thus getting the best of both worlds.

If you’re to the point where you think you need to call in a professional, or if the pain just isn’t going away, give us a call or schedule a consultation online.