When To Use Ice or Heat For Pain Relief?

This is very common question that we hear from someone with pain: “I injured my foot, knee, finger, back, blah blah … so should I use ice or heat?”.

Should hot or cold be favoured for torticollis, tendonitis, back pain or muscle pain? What are the most common cases where the use of hot or cold is an important step in healing and managing symptoms?

These are good questions! But it’s not always that obvious. As a general rule, cold is used to reduce pain and control inflammation, while heat promotes healing, reducing muscle tension and stiffness.

Here are some simple guidelines based on the contemporary theories of how and why you should use it.

Two factors usually influence the decision: the time after injury and the reason for use. There are however, few exceptions as well as safety concerns, listed on the bottom.

Time after injury

Acute injuries

Acute injuries are usually treated with ice, or ‘cryotherapy’. This is the first two to three days, up to two weeks depending on the severity. It’s during this phase that inflammation is most severe. Plus, ice seems to be effective for pain in new injuries. Decreasing inflammation and pain should help you move, perhaps allowing you to return to sport faster .

Chronic injuries are usually treated with heat

This happens when the injury is more than a few weeks old. The inflammation should be under control now. Pain is more due to the nervous system, muscle stiffness and lack of mobility. Each of these conditions can be treated with heat, which I have found to be a good choice. During the healing process, cold can be reapplied if inflammatory symptoms and pain worsen.

Confused?

Not sure whether your injury is in the acute or chronic phase? Perhaps it’s one of those pesky ‘repetitive stress injuries’. Try ‘contrasting’, doing 20 minutes of heat, then 20 minutes of ice (or vice versa), then rest 20-60 minutes, and repeat as much as you like.

Reason for use

Ice is usually for ‘flared-up’ injuries

Not just acute (new) injuries either. Sometimes swelling or inflammation can remain for a longer time than usual. Or, you can aggravate an injury that may not be fully healed (it’s not always inflamed). Furthermore, repetitive strain injuries may not have a clear time of onset or mechanism of injury, so knowing what phase of healing you’re in can be confusing. If its an aggravated injury of any sort, it will probably like ice.

Heat is for discomfort

Although that is an ambiguous answer, it pretty much covers it. Of course, discomfort can come from an inflamed (where ice is recommended) injury too, but not always.

Discomfort usually means achy type pain, and that stiff feeling at your joints or muscles. In joints it may feel like tight pressure, in muscles it may feel more like stiffness, as if you needed a massage or stretch, only with more pain. Either way, heat feels great and gives a temporary increase in range of motion, giving you a window of opportunity to get some early mobilization.

Both heat and ice are helpful for pain. In this case it don’t really matter what you use, as long as it feels relieving.

What to use for different type of pain

Torticollis

For neck pain or torticollis, heat is often the most commonly used modality. It can help to alleviate pain and increase mobility by helping to reduce stiffness, spasm and muscle tension. For a wrap, bag, or hot water bottle treatment, apply for 15-20 minutes and repeat as needed.

Some people will find better relief from neck pain with cold application, often when there is swelling or burning. For cold treatment, wrap the cold source in a damp towel and apply for 12-15 minutes. Repeat as needed.

Knee pain

In the case of a knee injury caused by an accident or trauma, if the pain and inflammation are exaggerated or uncomfortable, cold can be used in the first 3 days after the event to help alleviate these symptoms. Wrap the cold source in a damp towel and apply for 12-15 minutes. Repeat every 2-3 hours or as needed.

Once the symptoms are under control, heat can be used to promote healing, reduce muscle tension and stiffness. The heat will also help to reduce the pain created by these symptoms. For a wrap, bag, or hot water bottle treatment, apply for 15-20 minutes and repeat as needed. During the healing process, cold can be applied again if inflammatory symptoms and pain worsen.

For knee pain related to positions or activities, the modality used may depend on the cause of the pain. You can use what feels good and does not aggravate your symptoms.

Tendonitis

Do you have pain and/or swelling in a tendon following an accident or trauma? Or have the symptoms appeared gradually? If your symptoms are exaggerated or limiting, cold can be applied within the first 3 days of the onset of symptoms. Wrap the cold source in a damp towel and apply for 12-15 minutes. Repeat every 2-3 hours or as needed.

Once symptoms are under control, heat can be used to promote metabolism and healing and to reduce muscle tension and stiffness. Heat can also be used to reduce the pain created by these symptoms. For a wrap, bag, or hot water bottle treatment, apply for 15-20 minutes and repeat as needed. During the healing process, if the symptoms worsen, ice can be used again until they diminish.

Muscle contracture or pain

In the case of muscle pain following an accident or trauma, there may be a bruise, strain or tear in the muscle. If the pain and swelling are exaggerated or limiting, cold can be applied within the first 3 days after the event. Wrap the cold source in a damp towel and apply for 12-15 minutes. Repeat every 2-3 hours or as needed.

Once symptoms are under control, heat can be used to promote metabolism and healing, to reduce muscle tension and stiffness. Heat can also be used to reduce the pain created by these symptoms. For a wrap, bag, or hot water bottle treatment, apply for 15-20 minutes and repeat as needed. During the healing process, if the symptoms worsen, ice can be used again until they diminish.

In the case of muscle soreness that occurs as a result of muscular exertion (e.g. gym workouts), the pain often resolves within a few days. However, if the pain, stiffness or soreness is uncomfortable, a heat source can be applied. A hot bath or shower may provide sufficient relief. For a wrap, bag, or hot water bottle treatment, apply for 15 to 20 minutes and repeat as needed.

Sciatica pain

Pain related to the sciatic nerve can be caused by a number of things and can be felt in the buttock and/or leg. In many cases, there may be associated muscle tension. These can be relieved by the application of a heat source. For a wrap, bag, or hot water bottle treatment, apply for 15-20 minutes and repeat as required.

Read also: Best Office Chair for Sciatica

Lower back pain

For back pain, heat is often the most relieving modality. It can help to alleviate pain by helping to reduce stiffness, spasms and muscle tension. For a wrap, bag, or hot water bottle treatment, apply for 20-30 minutes and repeat as needed

Some people will find better relief from lower back pain with the application of cold, often when there is swelling or burning. For cold treatment, wrap the cold source in a damp towel and apply for 12-15 minutes. Repeat as needed.

Read also: Simple Tips To Avoid Back Pain

Exceptions

Almost never heat something that is swollen and hot… ask a professional first, it could be chronic inflammation or an infection. The heat is usually much better for low back and neck pain, even if it’s new pain. If you are still confused, try contrasting ice/heat as described above!

In the end, it probably doesn’t matter what you choose. The science is still unclear (yes, even for something so basic), so other than the warnings below, don’t worry too much. Your best option is whatever you think feels good, relieves your pain, and allows you to move normally.

Contraindications (no, I didn’t mean ‘contradictions‘)

In plain English, these are warnings. Don’t use heat or ice in these cases. If you’re not sure, check with your doctor.

Check for red flags.

Do not use heat:

Decreased sensation
On open wounds
Acute inflammation or hemorrhage
Bleeding disorder
Known malignancy (tumor)
Full body heat (like a tub) when one has conditions affecting core temperature like: Multiple Sclerosis., Adrenal Suppression, Pregnancy, and Lupis.

Do not use ice on

Decreased sensation
Known malignancy (tumor)
Hypertension
Raynaud’s disease
Circulation concerns, such as ischemia, frostbite or arteriosclerosis
Cold allergy (yup)
Rheumatoid arthritis

Look these things up, or preferably, go to a doctor if you are not sure.