Marie Curie knew: Precision matters. In research, it saves time; in medicine, it saves tissues — and in everyday life, it enhances performance. When someone twists an ankle after a sprint or strains a muscle during weight training, they face a seemingly simple choice: heat or cold? The answer is more nuanced than the myth suggests — and it determines how quickly you return to training and life with full energy.

Acute injuries primarily affect muscles, tendons, and ligaments. Typical injuries include ankle sprains, strains, or contusions. The crucial phase is the early one: In the first 48 hours, the inflammatory response dominates — a necessary repair response characterized by pain, redness, and swelling. Cold, or Cryotherapytherapeutic cooling of tissue, slows down the local metabolism and can thus reduce swelling and pain. Heat, or Thermotherapytherapeutic warming of tissue, increases blood flow and is more suitable for tense muscles or the later rehabilitation phase, not for fresh trauma. Compressionpressure applied through an elastic bandage to limit swelling stabilizes and limits fluid leakage, but it is not a substitute for a cast. Important: Cold is a tool, not a contest — too much can damage tissues.

Targeted cooling in the first 48 hours can subjectively relieve pain and limit swelling, which brings mobility and everyday function back more quickly ^[1]. Compression is traditionally recommended to promote stability and minimize edema; however, current evidence shows neither clear benefit nor harm compared to no compression in the early phase, at least for acute ankle injuries ^[2]. Excessive or incorrectly applied cold — such as ice directly on the skin for extended periods — can cause iatrogenic frostbite and endanger the healing tissue ^[3]. For high performers, this means: quick, smart intervention accelerates the return to performance, but dosage and technique are critical.

A systematic review of RICE components in acute ankle sprains found eleven studies after a strict selection process and came to a sober conclusion: there is a lack of high-quality evidence that clearly demonstrates the superiority of RICE or individual subcomponents. Nonetheless, early, moderate application of cold within 48 to 72 hours is pragmatically recommended, as it can reduce pain and swelling, while decisions should be made individually based on risk-benefit assessment and guidelines ^[1]. A second systematic review on compression in the pre-hospital setting examined eight studies on ankle injuries and showed no significant difference in pain, swelling, function, mobility, or recovery time between elastic bandages and no compression or non-compressive alternatives; the quality of evidence was low to very low ^[2]. Furthermore, dermatological literature on cryotherapy urges caution: case reports indicate that improper or prolonged application of cold can cause frostbite — a rare but avoidable injury that demands clear application limits ^[3]. The overall picture: Cold yes — dosed and protected. Compression — optional, not proven harmful, but also not clearly superior. Heat — later, not in the acute phase.

- In the first 48 hours after an acute sprain or contusion, start cooling: 10–15 minutes of ice pack with fabric protection, then at least 1–2 hours of rest; 3–5 times a day. Goal: reduce swelling and pain without endangering the skin ^{[1] [3]}.
- Never place ice directly on the skin and avoid prolonged applications: Avoid applications longer than 20 minutes at a time to prevent frostbite ^[3].
- Compression as a pragmatic option: An elastic bandage can provide subjective stability. Since the documented additional benefit is uncertain, choose moderate pressure, check blood circulation (finger-to-toe perfusion), and loosen the bandage if you feel tingling or coldness ^[2].
- Elevate and rest during the first 24–48 hours: Keeping the leg above heart level reduces venous congestion; combine this with short, pain-free movements in the pain-free range to maintain joint mechanics ^[1].
- Apply heat only after the acute phase: From day 3–5, when swelling and resting pain diminish, well-dosed heat or active warming can promote tissue elasticity — not during the fresh inflammatory phase.
- Decision check before training: Persistent severe swelling, instability, or activity-dependent resting pain? Pause training and seek medical evaluation. The goal is a quick, safe return to full performance.

The smartest acute strategy is sober: early, cool, dosed — and with healthy respect for limits. This way, you shorten the path back to performance without risking the healing tissue. Precision beats reflexes: Less is often more in the first 48 hours.