If you’re a runner following conventional wisdom on how to treat an injury, you’d likely go with the RICE — rest, ice, compression, elevation—guidelines. But research also suggests icing injuries can actually delay their healing. In that case, you may be more inclined to use heat to treat your aches. And yet, there’s another method that you might also turn to in an effort to help heal injuries: PEACE & LOVE, which certainly sounds nice.

In short, there’s a lot of confusion when it comes to how best to deal with a running injury.

Let’s explore why there’s so much conflicting information about ice versus heat (and beyond) for treating injuries — and get to the bottom of when you should use ice, when to use heat, and when there’s a better solution altogether.

The Pros and Cons of Using Ice for Injuries
“More research has come out showing that ice delays the tissue healing response and should no longer be used with acute injuries (such as within the first 48 hours of suffering a sprained ankle or strained lower back),” says physiotherapist Kristi Barker. However, she still does recommend it for pain relief (after the acute phase) because ice has a numbing effect.

Other experts note that ice could be useful in the immediate aftermath of an injury by taming the body’s natural inflammatory response. “Mild inflammation is okay (and can be protective and allow cells to get to the site and repair the injury), but we don’t want the inflammation to become chronic as it can increase pain and limit [the] ability to recover,” says physical therapist Allison Gibbons.

Gibbons says muscle strains (think: quad or hamstring) are prime examples of injuries that could benefit from icing. She adds that with something like an ACL tear, ice could also help mitigate pain.

To avoid over-icing and taming inflammation too much, ice two to three times for 10 minutes within 12 hours of getting injured, Gibbons suggests. Make sure to put a towel between your skin and the ice to avoid ice burns.

Experts seem to agree that there’s one instance where ice unequivocally gets the greenlight: If you’re not injured, and you think it feels good. “Ice itself is analgesic so it can be helpful from a pain-relief perspective,” because it numbs the area, says physical therapist Michelle Cilenti. “I have runners or patients who ice every time they run and they have no particular reason [other than] it just feels good, and that’s fine,” she says.

In addition to icing specific sore spots, this is where cold plunging/ice baths could come into play. “Deliberate cold exposure can have plenty of physiological effects [for non-injured runners] from improving core body circulation to improving metabolism, reducing stress, and increasing energy,” says Gibbons, who adds that it’s best to avoid cold plunging within the first four hours after a workout to avoid interfering with the natural post-workout response that leads to strength adaptations. As with many things in fitness, however, more research is needed to definitively support these recommendations.

Also, those with conditions like hypertension, heart disease, or poor circulation should avoid ice baths as it increases heart rate and blood pressure, and causes constriction of blood vessels.

The Pros and Cons of Using Heat to Treat Injuries
Experts agree that heating pads can also feel good to people for pretty much any non-acute injury, like low back pain, a muscle strain (after that initial 48-hour window), or tendonitis and probably won’t harm you as long as you’re using them correctly. However, there may be better ways to heal injuries as heating pads can only penetrate so deep into the tissue.

Physical therapist Dylan Mutchler, says that soft tissue (e.g. sprains, tendonitis) or musculoskeletal-related injuries (e.g. fractures), tend to fare well with heat because it increases blood flow to the affected area.

Barker adds that heating pads can be helpful for both pain relief (for those with non-acute injuries) and reducing joint stiffness (which means creating more space to promote movement/mobility at the joints) and suggests using them for 10 minutes at a time.

The one instance you should definitely avoid heat is in an acute situation — as in, you just twisted your ankle on a trail run. Mutchler reiterates that injuries result in inflammation. Again, while some inflammation can be a good thing, Mutchler explains that heat can exacerbate the inflammatory response by causing blood vessels to send more stimulants to the area, increasing inflammation and delaying the healing process.

And if you’re looking to manage “regular” soreness and aid recovery, a sauna or hot tub, which Barker recommends to runners, could be useful. “They are great for pain management, they improve circulation and sleep quality, and reduce overall stress,” says Barker.

Mutchler adds that sauna bathing has been shown to reduce muscle soreness and help runners acclimate to heat, which can enhance endurance during activities (read: running) in hot environments. “Just be sure to drink enough fluids to decrease risk of dehydration,” he says.

Also, if you’ve had any recent cardiac conditions or symptoms, like chest pain, recent heart attack, or uncontrolled high blood pressure, it’s best to avoid a sauna.

How to Treat Your Injuries With Peace & Love
According to Barker, the new acronym for treating injuries is PEACE & LOVE which stands for protect, elevate, avoid anti-inflammatories and ice, compression, education, load, optimism, vascularisation, and exercise. PEACE is for immediate care (those acute injuries) and LOVE is for the management of injuries thereafter.

Cilenti agrees these guidelines are stronger than RICE, but notes that for some of the recommendations (like load), it’s important to work with an expert like a physiotherapist who can make appropriate personalised recommendations.

Protect: This one is pretty straightforward — you’ll want to avoid doing anything that could exacerbate your pain.

Elevate: If you want to try elevation, which could help get fluids moving around, Cilenti underscores the importance of getting the injured body part above the level of your heart.

Avoid anti-inflammatories and ice: This one goes back to the idea discussed above that some inflammation can be beneficial to the healing process and both anti-inflammatory medications and ice can disrupt that process.

Compression: Cilenti says there are a few options for compression, including socks, leggings, or boots like those from NormaTec. The guidelines note compression may help reducing swelling after something like an ankle sprain.

Educate: With injuries like shin splints, for example, it’s likely your form or overtraining that’s to blame — and a good Biokineticist or coach can help you better program your mileage, take a look at your form, and make footwear recommendations, for example.

Load: When it comes to the more chronic injuries like tendinopathy, load (e.g. resistance training), exercise (anything that gets the joints moving including walking), and vascularisation (see below) are probably going to be your BFFs. “The main treatment for those [chronic injuries] is just going to be getting stronger through whatever tissue that’s sustained injury,” Cilenti says. “Athletes tend to get better faster by just being active [and] getting stronger.”

Optimism: This one can go a long way. After all, the mind-body connection is everything.

Vascularisation: The guidelines recommend pain-free aerobic activities to increase blood flow to repairing tissues. To circle back to those heating pads, Cilenti explains that cardio activities (think: hopping on a bike for 20 minutes or swimming a few laps) are a way to “warm up” the body in a deeper way. Of course, you’ll want to find a way to move that doesn’t aggravate your injury.

Exercise: The guidelines note that “exercises help to restore mobility, strength and proprioception early after injury,” whether you’re dealing with an ankle sprain or soft tissue injury. Anything including a brisk walk and/or mobility drills can count here.

The Debate on Ice vs Heat
There could be a few reasons that there’s so much confusion on whether you should use cold or heat therapy for injuries. First, Mutchler says there’s a lack of quality studies on these topics. “When really examined, many of the research studies have poor designs in place or are not conclusive with the results they find, creating a difficult time for the medical field to have a solid foundation on what advice to give on heat [and/or] ice,” he says.

“That’s the hard thing with research in the medical field,” says Cilenti. “You could run a study and say the patient got better because they iced, and then you could look at it and say, well, these patients weren’t controlled or these patients also received this [other] treatment, [so] how do you know it was the ice? It could have been the 10 jumping jacks.” And when you add in the fact that some of these studies are funded by companies selling related products, things get even more complex.

Another possible explanation is that people get stuck in their ways — both doctors and patients. If your doctor has always recommended ice to patients in certain scenarios and they’ve gotten better (likely not related to the ice), they’re probably inclined to keep recommending it.

You could also be (part of) the problem: “I think athletes expect to receive ice for certain [injuries] and [don’t] realise that things have changed,” says Cilenti. That could lead to providers giving them what they want, i.e. laying on a table with ice on their injury. “We’ve realised that patients are doing a lot better that way,” she says. “Things are shifting, which is a good thing, but also could be confusing for patients and athletes.”

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