When "Just Ice It" Might Not Be the Best Advice: Smart Cooling Strategies for Sprains and Swelling

We have a lot of athletes keeping themselves cool from the inside, out, but sometimes you need a little extra cool when you have just suffered an injury. If you have ever rolled an ankle during a tournament, you have probably been told to ice it immediately to keep swelling down. But here is the truth, it really depends. And if you plan to keep playing, icing right away may be the worst advice someone could give.

Icing is most effective after you have decided you will not be using that ankle again for the rest of the day. The goal is not just pain relief, it is the way cold affects blood flow, inflammation, and the healing response. Here is what you need to know.

Why Immediate or Continuous Ice Is Not Always Ideal

Ice causes vasoconstriction, which means the blood vessels narrow. This temporarily reduces swelling, pain, and inflammation. However, too much icing, or icing before you intend to keep playing, can reduce circulation to the point that it slows the early healing response. The Cleveland Clinic notes that icing is best for managing swelling, but not necessarily for speeding up tissue repair¹.

The classic RICE method (Rest, Ice, Compression, Elevation) has been widely recommended, but modern sports medicine has shifted toward a more balanced approach. The University of Michigan Health system notes that ice is helpful early on, but healing ultimately depends on restoring healthy circulation, not suppressing it completely².

This is where contrast therapy comes in.

Why Contrast Therapy Works Better Than Ice Alone

Contrast therapy alternates cold with heat. Cold constricts blood vessels, then heat dilates them. This creates a flushing effect that may help remove inflammatory byproducts while bringing oxygenated, nutrient rich blood back into the area.

Sports medicine clinicians often use contrast therapy because it supports circulation while still controlling swelling. A clinical review published in the Journal of Athletic Training found that contrast therapy can increase blood flow more effectively than heat or cold alone³.

A simple and effective protocol:

1. Ice for 10 minutes

2. Heat for 10 minutes

3. Repeat for 2 to 3 cycles, ending with ice if swelling is still present

4. Use a towel or cloth between skin and any pack to avoid skin irritation⁴

Cold should feel uncomfortable but tolerable, and heat should feel warm but never hot enough to burn.

When to Use Ice, Heat, or Contrast

Use Ice When:

• The injury is new (within 24 to 48 hours)

• There is visible swelling

• You are done playing for the day

• You want pain relief

Mayo Clinic recommends applying ice for 15 to 20 minutes per session and allowing skin to rewarm between sessions⁴.

Use Heat When:

• Swelling has decreased

• The area feels stiff, tight, or sore

• You want to encourage blood flow

Heat alone should not be used when there is active swelling.

Use Contrast Therapy When:

• Swelling has stabilized

• You want to promote circulation

• You are entering the early healing phase (typically after 24 to 48 hours)

Contrast therapy gives you the best of both worlds, supporting healing rather than just numbing pain.

A Word of Caution

• Ice may mask pain, but it does not stabilize a sprained ligament. Returning to play too soon can worsen the injury.

• If swelling or pain lasts more than a few days, seek medical evaluation.

• Severe swelling, inability to bear weight, or numbness requires professional care.

• This guidance applies to mild to moderate sprains and soft tissue injuries.

Bottom Line

When it comes to injuries, smart cooling matters just as much as smart hydration. Ice is helpful, but not always the whole solution. If you are done for the day, use ice to control early swelling. Once the initial inflammation settles, contrast therapy can help revive circulation, flush out waste products, and support real healing.

Recover well, stay hydrated, and listen to your body. That is the fastest way back to playing at your best.

Sources

1. Cleveland Clinic. (2021). Heat vs. Ice: Which Should You Use for Your Pain? https://health.clevelandclinic.org/heat-vs-ice

2. University of Michigan Health. (2022). Heat or Ice: Which Is Best for Your Injury? https://www.uofmhealth.org/health-library/aa90920

3. Higgins, T., & Kaminski, T. (1998). Contrast therapy does not cause fluctuations in human gastrocnemius intramuscular temperature. Journal of Athletic Training, 33(3), 336–340. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320360/

4. Mayo Clinic Staff. (2023). First Aid for Sprains. Mayo Clinic. https://www.mayoclinic.org/first-aid/first-aid-sprains/basics/art-20056622