Have you ever finished a hard run or race and thought to yourself, “I’m going to be sore tomorrow.” Or, perhaps you twisted your ankle on a trail run or felt a niggle in your IT band at mile 12 of what was supposed to be a 16-mile long run.
In any of these cases and a plethora of other situations, you might find yourself wondering whether you should use heat or ice therapy for sore muscles.
Both ice and heat are used by runners to aid recovery from a workout, reduce normal delayed onset muscle soreness (DOMS) or the pain from an acute or chronic injury, and promote tissue healing from an injury.
However, when is it best to use ice for muscle recovery? Should you use heat or ice for sore muscles? What about pain relief?

Using Hot and Cold Therapy for Workout Recovery and Pain
While many exercise recovery and injury treatment modalities have only emerged in the past several years or so, cold and heat have been used for thousands of years for these purposes.
The application of hot or cold therapy to muscles and tissues can alter blood flow, which in turn affects how the tissues feel and their metabolic activity.
Although both can provide pain relief and can affect healing, in general, ice is best for acute injuries and swelling, and heat can be helpful for easing chronic pain and reducing stiffness.
Benefits of Ice or Cold Therapy
Cold therapy, also called cryotherapy, is the application of cold to tissues after exercise or to alleviate pain. Cold therapy can take the form of ice packs or cold packs applied to the painful or injured area, cold water hydrotherapy (ice baths), and ice massage.

Ice or cold therapy is usually used to reduce inflammation, edema, and pain.
By reducing swelling and temporarily decreasing nerve activity, cold treatment can reduce the pain associated with an injury such as a pulled muscle, muscle sprain, muscle strain, tendonitis, or fracture. In this way, ice can act as a temporary local anesthetic.
Ice or cold therapy is usually applied for 10-15 minutes. Ice should not be applied directly to the skin.
Drawbacks of Cold Therapy
There are several risks associated with ice baths, using ice packs, or applying other forms of cold therapy on sore muscles.
For example, cold therapy can cause localized frostbite on the tissue in contact with the ice pack or cold water. Hypothermia is also a concern, particularly with total-body immersion in an ice bath or cryotherapy tank.
For these reasons, runners with circulation disorders and sensory disorders that limit blood flow and skin sensitivity, as well as those with diabetes and peripheral neuropathy should not use cold therapy without consulting their healthcare provider.
Cold therapy can also cause tissue contraction due to blood flow constriction and a decrease in tissue temperature. As such, cold therapy can be counterproductive for stiff muscles and joints.

Benefits of Heat Therapy
Hot therapy, or the application of heat, is called thermotherapy. Heat therapy can be applied to muscles in tissues in a variety of ways, including moist, hot towels, dry heating pads, heat wraps or heat packs, infrared saunas, hot baths, hot tub immersion, and ultrasound.
Dry heat therapy modalities use conduction whereas moist heat therapy transfers heat to the tissue via convection. While the effects of dry heat last longer, according to research, the effects of moist heat therapy set in more rapidly and may be up to 25% more effective.1Petrofsky. (2013). Moist Heat or Dry Heat for Delayed Onset Muscle Soreness. Journal of Clinical Medicine Research, 5(6). https://doi.org/10.4021/jocmr1521w
Heat increases blood flow to tissues, which is thought to expedite healing by transporting more oxygen and nutrients to injured tissues and removing more waste products. It can reduce stiffness and increase the range of motion by warming up muscles and connective tissues.
Heat therapy is often said to be soothing and can also reduce muscle pain.
Heat therapy is usually applied for 15-30 minutes, depending on the method of application, the temperature (for example, warm bath vs. hot spa), and the goal of the treatment.

Drawbacks of Heat Therapy
Heat therapy increases blood flow, so it can increase swelling. As such, heat therapy is often contraindicated in the acute phases of an injury when there is swelling.
Heat therapy can also be potentially harmful to runners with certain medical conditions, such as diabetes, deep vein thrombosis, multiple sclerosis, dermatitis or an open wound, and vascular disease.
Runners who are pregnant, have heart disease, or have hypertension should also heed caution before using full-body heat therapy like a sauna or hot tub. Consult your physician if you have a medical condition before using these types of hot therapy.
Other drawbacks of heat therapy include the risk of burns, and the potential of heat to increase swelling.

Hot vs Cold Therapy: Is Heat Or Ice Better For Sore Muscles and Recovery After Running?
Do hot and cold therapy actually work? Should you use heat or ice for sore muscles after a workout?
There’s evidence to suggest that both ice and heat can potentially reduce the muscle aches associated with delayed-onset muscle soreness (DOMS).
One review found that both ice and heat therapy were effective at reducing the severity of muscle soreness and aching following exercise, so long as the cold therapy or heat therapy was applied within one hour after finishing the workout. There was no significant difference between the results for either heat or ice.2Wang, Y., Li, S., Zhang, Y., Chen, Y., Yan, F., Han, L., & Ma, Y. (2021). Heat and cold therapy reduce pain in patients with delayed onset muscle soreness: A systematic review and meta-analysis of 32 randomized controlled trials. Physical Therapy in Sport, 48(1), 177–187. https://doi.org/10.1016/j.ptsp.2021.01.004
Ice baths have been shown to reduce the severity of DOMS.3Bleakley, C., McDonough, S., Gardner, E., Baxter, G. D., Hopkins, J. T., & Davison, G. W. (2012). Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database of Systematic Reviews, 2. https://doi.org/10.1002/14651858.cd008262.pub2 Moist and dry heat therapy can also reduce the severity of DOMS to varying degrees.4Petrofsky. (2013). Moist Heat or Dry Heat for Delayed Onset Muscle Soreness. Journal of Clinical Medicine Research, 5(6). https://doi.org/10.4021/jocmr1521w

Another study found that the application of a heat wrap to the lower back reduced pain intensity by 47%, disability by 52%, and deficits by 45% 24 hours after a workout relative to the control group.5Mayer, J. M., Mooney, V., Matheson, L. N., Erasala, G. N., Verna, J. L., Udermann, B. E., & Leggett, S. (2006). Continuous Low-Level Heat Wrap Therapy for the Prevention and Early Phase Treatment of Delayed-Onset Muscle Soreness of the Low Back: A Randomized Controlled Trial. Archives of Physical Medicine and Rehabilitation, 87(10), 1310–1317. https://doi.org/10.1016/j.apmr.2006.07.259
Moreover, back pain relief in the affected area with the heat wrap was 138% greater than with the cold pack, which is suggestive of the fact that heat therapy may be more effective at reducing muscle soreness after a run.
Another study confirmed these results, noting that heat improved recovery whereas ice actually delayed or compromised healing and recovery due to the fact that ice limits healthy inflammation and reduces metabolic activity of the tissue.6Cheng, A. J., Willis, S. J., Zinner, C., Chaillou, T., Ivarsson, N., Ørtenblad, N., Lanner, J. T., Holmberg, H.-C., & Westerblad, H. (2017). Post-exercise recovery of contractile function and endurance in humans and mice is accelerated by heating and slowed by cooling skeletal muscle. The Journal of Physiology, 595(24), 7413–7426. https://doi.org/10.1113/JP274870
On the other hand, when it comes to the actual pain associated with muscle damage after a workout, there is also some evidence to suggest that ice can be a more potent analgesic relative to heat. It seems like a close race between the two.7Petrofsky, J. S., Khowailed, I. A., Lee, H., Berk, L., Bains, G. S., Akerkar, S., Shah, J., Al-Dabbak, F., & Laymon, M. S. (2015). Cold Vs. Heat After Exercise—Is There a Clear Winner for Muscle Soreness. Journal of Strength and Conditioning Research, 29(11), 3245–3252. https://doi.org/10.1519/jsc.0000000000001127

So, Should You Use Heat Or Ice For Sore Muscles and Recovery?
Since there are benefits of both heat and cold therapy for recovery and muscle soreness after exercise, alternating between the two modalities can also be helpful.
Studies show that contrast water baths are effective at minimizing exercise-induced muscle damage, which is the root cause of DOMS.8Bieuzen, F., Bleakley, C. M., & Costello, J. T. (2013). Contrast Water Therapy and Exercise Induced Muscle Damage: A Systematic Review and Meta-Analysis. PLoS ONE, 8(4), e62356. https://doi.org/10.1371/journal.pone.0062356
The other guiding principle is to use ice or cold therapy with acute injuries and when inflammation is present and to use heat therapy to increase circulation and reduce stiffness.
After reading about all of these case studies, you should have a better idea of whether to use heat or ice for sore muscles the next time you have a case of the DOMS, or any other injury for that matter.
To help prevent injuries from occurring in the first place, or help treat them to the best of your ability, check out our running injuries resources. Here you will find information from shin splints to runner’s knee, to low pack and shoulder pain.
