Dr. Mel Siff PhD
Dr. Mel Siff was an exercise scientist and biomechanist best known for integrating Soviet and Western research into practical strength and conditioning methods, especially through his co-authored textbook Supertraining. His expertise spanned biomechanics, applied physiology, and advanced strength training concepts such as explosive strength, power, plyometrics, and periodization, which he applied in both academic research and coaching Olympic-level weightlifting and other sports.
The following is an editorial on the topic of Ice or Heat. It is provided complements of Dr. Mel C Siff and is reproduced with his permission.
About This Article
The following article was written by Dr. Mel Siff, PhD — one of the most influential exercise scientists of the 20th century. Dr. Siff (1945–2003) was a South African biomechanist best known for co-authoring Supertraining with Yuri Verkhoshansky, widely regarded as one of the most comprehensive texts on strength and conditioning ever written. He also authored Facts and Fallacies of Fitness and spent much of his career challenging assumptions in rehabilitation, sport science, and physical training.
This piece is presented as originally written. At the time, the conventional wisdom in rehabilitation was unambiguous: ice was good, heat was risky. Dr. Siff wasn’t convinced. His questioning of ice therapy’s dominance — and his interest in contrast bathing as an alternative — predated by more than a decade the clinical and scientific shifts that eventually produced POLICE (2012) and PEACE & LOVE (2019), both of which moved significantly away from the traditional RICE model. His article has aged better than most assumed it would.
The use of ice treatment may not be universally superior to the use of heat in enhancing recovery or rehabilitation.
THE PROBLEM
The use of localised or more extensive ice or cold treatment has been well authenticated over the years and there is little doubt that, in many cases, it is a highly effective and cheap method of restoration and rehabilitation.
However, any literature searches for definitive studies that compare the effectiveness of ice cold versus very hot treatment of the same sort of injury are not as common as one would believe.
It seems as if we have all accepted that heat is contraindicated largely on the basis of theoretical considerations or extrapolations form cases where bleeding is apparent. We know that heat causes blood vessels dilatation, temporary increase in inflammation and the decrease in blood viscosity, but does this necessarily imply that it will be detrimental to the course of restoration or rehabilitation of all sore, bruised and fatigued soft tissues?
Why I am saying this is because I have been experimenting, much against my education and scientific traditions, with the use of very hot water as a restorative means with myself and several other athletes, some of whom are top pro footballers and basketballers.
Surprisingly, this seems to diminish muscle soreness and speeded up recovery in many cases, especially if we use alternate hot and cold bathing. I have an 8 ft deep jacuzzi and long lap swimming pool and have my athletes alternate between hot and cold immersion. Interestingly, I have found that the water has to be almost unbearably hot (about 108 deg F or 41C) to be optimally effective. Movement under these conditions also seems to be valuable (‘cryokinetics’ for ice old immersion and ‘thermodynamics’ for hot immersion).
Certainly my comments on this controversial topic merely constitute anecdotal evidence at this stage, but I am curious to hear if anyone else has had similar experiences or come across scientific research which legitimately shows that dedicated ice treatment is significantly better than very hot treatment or ice-heat contrast methods. Failing that, is there any evidence that the use of heat is a general contraindication for musculoskeletal recovery and rehabilitation, other than cases where there is obvious bleeding or serious pathology?
Are we promoting ice therapy far too liberally to the exclusion of heat therapy, when the latter may well also play a very helpful role in musculoskeletal rehabilitation? Are we unfairly proclaiming that heat is potentially harmful for treating any soft tissue repair? Does this attitude go against our recent attestations to the value of ‘holistic’ treatment?
Editor’s Note: Where the Research Stands Today
When Dr. Siff wrote this piece, RICE — Rest, Ice, Compression, Elevation — was the unchallenged standard for acute soft tissue injury management. It had been popularized by Dr. Gabe Mirkin in his 1978 Sportsmedicine Book. Mirkin himself later recanted the ice recommendation, writing in 2015 that icing an injury may delay healing by suppressing the inflammatory response the body needs to begin tissue repair.
The clinical guidelines have since moved in the direction Siff was pointing:
| Protocol | Year | Key Change |
|---|---|---|
| RICE | 1978 | Rest + Ice as standard acute care |
| POLICE | 2012 | Replaced Rest with Optimal Loading; ice retained but questioned |
| PEACE & LOVE | 2019 | Explicitly recommends avoiding ice and anti-inflammatory modalities in the acute phase |
The PEACE & LOVE framework — published in the British Journal of Sports Medicine — argues that inflammation is not the enemy. It is the first phase of a necessary healing cascade. Suppressing it with ice or NSAIDs may reduce short-term pain but at the cost of slowing the tissue remodeling process.
That said, the debate is not fully settled. Ice remains widely used in clinical practice for pain management in the acute phase, and some clinicians argue that short-duration icing for analgesia — without the goal of reducing inflammation — is still reasonable. The evidence on contrast therapy (alternating hot and cold immersion, as Siff discussed) remains mixed; it is still used in sport and performance contexts, particularly for recovery between competitions, though robust clinical trials are limited.
What’s clear is that the reflexive “always ice an acute injury” recommendation Dr. Siff questioned is no longer supported by current evidence or clinical guidelines. His instinct to look more carefully at heat — and at movement during immersion — was ahead of where the field eventually landed.
Ice vs. Heat: A Quick Clinical Reference
| Ice (Cryotherapy) | Heat (Thermotherapy) | |
|---|---|---|
| Primary effect | Vasoconstriction, pain reduction, reduced nerve conduction velocity | Vasodilation, increased circulation, muscle relaxation |
| Best used for | Short-term pain management post-injury; reducing perceived swelling | Subacute and chronic conditions; muscle tension; joint stiffness |
| Duration | 10–20 minutes; never directly on skin | 15–20 minutes; monitor skin carefully |
| Avoid when | Raynaud’s syndrome, cold hypersensitivity, impaired circulation, reduced sensation | Acute inflammation, open wounds, impaired circulation, reduced sensation |
| Current guideline status | Questioned in acute phase by PEACE & LOVE (2019) | Not specifically endorsed in acute phase; appropriate for subacute/chronic |
Frequently Asked Questions
Has the recommendation on ice for acute injuries changed?
Yes, significantly. The PEACE & LOVE framework (2019) explicitly recommends avoiding ice and anti-inflammatory modalities in the acute phase of soft tissue injury, arguing that inflammation is necessary for healing. This represents a major departure from RICE, which had been the standard since 1978. Even Dr. Gabe Mirkin, who coined RICE, has since walked back the ice recommendation. Many clinicians still use ice for short-term pain relief, but the goal of “reducing inflammation with ice” is no longer supported by current evidence.
When is heat more appropriate than ice?
Heat is generally more appropriate for subacute and chronic conditions — muscle tension, joint stiffness, chronic low back pain, and tight soft tissue before exercise or manual therapy. It increases local circulation and tissue extensibility, which can improve range of motion and reduce pain in non-acute presentations. Heat is typically not recommended in the first 24–72 hours of an acute injury, though Dr. Siff’s article challenges even that convention.
What is contrast therapy and does it work?
Contrast therapy involves alternating between cold and warm immersion — typically hot bath followed by cold, repeated in cycles. It is commonly used in sport and athletic recovery contexts. The proposed mechanism is a “pumping” effect on circulation driven by alternating vasoconstriction and vasodilation. The evidence is mixed — some studies show benefits for perceived recovery and delayed onset muscle soreness (DOMS); others show no significant advantage over passive rest. It remains popular among athletes and coaches despite the limited high-quality trial evidence.
Who was Dr. Mel Siff?
Dr. Mel Siff (1945–2003) was a South African exercise scientist and biomechanist who spent his career questioning assumptions in fitness and rehabilitation. He is best known for Supertraining, co-authored with Soviet sport scientist Yuri Verkhoshansky — a foundational text in strength and conditioning that remains influential today. He also wrote Facts and Fallacies of Fitness, a systematic examination of myths in exercise science. His work emphasized critical thinking over convention, which is evident in his approach to the ice vs. heat debate in this article.
Should I use ice or heat on a sprained ankle?
Traditionally, ice has been recommended for acute sprains. Current guidelines (PEACE & LOVE) suggest prioritizing protection, elevation, compression, and early controlled loading over icing. If ice is used, it should be for short-term pain management rather than inflammation reduction, applied for no more than 20 minutes and not directly on the skin. Heat is not typically applied in the acute phase of a sprain. Your physiotherapist or physical therapist can give guidance specific to your injury.