Pain Relief: When To Use Heat Vs Ice To Treat Injuries

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It should go without saying that no one likes to be in pain. We will do whatever we can to facilitate pain relief, particularly if the pain-relieving modalities are non-pharmacological. 

Narcotic pain medication, as well as anti-inflammatories like Advil (ibuprofen) and Aleve (naproxen sodium), and Tylenol (acetaminophen), are all associated with negative health effects, side effects, and in some cases, addiction, so natural pain relief techniques are almost always preferable.

Ice and heat are two of the most common natural pain-relieving modalities, but knowing when to use heat vs ice for pain is confusing to many people. 

Does heat help inflammation? Does ice help pain? Is it better to use heat or ice for pain?

In this article, we will discuss using heat and ice for pain and swelling, when to use heat vs ice for pain, and when to use ice vs heat for pain and inflammation.

We will cover: 

  • Does Heat Help Inflammation and Pain?
  • How to Use Ice and Heat for Pain
  • When to Use Ice vs Heat for Pain
  • When to Use Heat vs Ice for Pain
  • When Not to Use Heat for Pain or Injuries

Let’s jump in!

A person holding an ice pack on their knee.

Does Heat Help Inflammation and Pain?

So, does heat help swelling?

Knowing which types of situations call for heat vs ice for treatment can help you best manage your pain and inflammation. 

In general, ice is best for acute injuries, particularly when you have swelling, while heat is best when you have chronic injuries or tight muscles, though there’s certainly some overlap and a few exceptions.

Many times, a combination treatment alternating heat and ice can be most effective, at least during certain stages of the healing process.

However, there are also certain times when using ice vs heat is ideal and others where heat vs ice is better for the particular issue you have.

A person putting a heating pad on their neck.

How to Use Ice and Heat for Pain

In terms of practically applying heat and ice, there are a few OTC or home treatment options for each.

Ice, also called cryotherapy, typically involves using gel ice packs, crushed ice in a bag, frozen peas or other vegetables, or submerging a body part in an ice bath or ice bucket.

To protect the body against frostbite, ice should only be applied for 10-15 at one time, depending on the format and temperature of the cooling material.

Ice should not be applied directly to the skin, and if you start to experience numbness or yellowing of the skin, you should remove the ice immediately and start rewarming the skin.

Heat treatments at home usually involve using a heating pad, hot water bottle, or warm wet towels. These forms of heat therapy, which are also called thermotherapy, are good for treating localized areas of pain or injuries.

Sitting in a hot tub or sauna can also be an effective way to apply heat therapy to a larger area of the body.

The application of heat treatments can last anywhere from 15-30 minutes or more, depending on the intensity of heat and the form of the heating mechanism.

For example, you might use a hot pack on your neck for 15 minutes, while you might use a heating pad on your back on medium-low heat for 30 minutes as you lie on the couch.

So, do you use ice or heat for swelling and pain? Let’s get into detail about when to use heat vs ice in different situations:

A person putting a heat pad on their foot.

When to Use Ice vs Heat for Pain

Here are some guidelines for when to use ice vs heat for pain:

Use Ice for Acute Injuries

Icing is particularly important in the acute phase after a muscle strain. As soon as the injury is sustained, getting ice on and initiating a consistent icing protocol during the first 24 to 48 hours can help manage the early recovery and potentially quell significant swelling and other sequelae.

Cold therapy works by reducing blood flow to the treated area. In doing so, icing can decrease inflammation and swelling that otherwise causes pain, stiffness, and limited mobility. 

Another way that ice can temporarily alleviate pain is by reducing nerve activity; certain nerve fibers can transmit pain signals to the brain via nociceptors (pain receptors), so dampening the nerve activity can attenuate these pain impulses.

Essentially, by reducing swelling and temporarily decreasing nerve activity, applying ice can reduce the pain associated with an injury such as a pulled muscle, sprain, strain, or fracture. In this way, ice can act as a temporary local anesthetic.

A person putting an ice pack on their ankle.

Use Ice for Swollen Joints or Tendonitis

Icing is particularly helpful around a joint or a tendon. Swelling in these areas is particularly prone to cause mobility impairments and stiffness because there is less “space” available to accommodate extra fluid volume without compromising the range of motion. 

Tendonitis is an inflammation or irritation of a tendon, which is the connective tissue that attaches muscle to bone. It commonly occurs due to repetitive overuse from activities such as running, tennis, cycling, etc. 

The pain and inflammation associated with tendonitis can limit mobility, but icing may help reduce swelling and temporarily decrease pain.

Use Ice Right After a Workout

Using ice immediately after a workout is recommended to help reduce post-workout muscle soreness (DOMS).

A person putting a heat pack on their knee.

When to Use Heat vs Ice for Pain

Most people have anecdotally noted the benefits of heat for relieving pain. 

However, the benefits of heat and swelling are not as well understood. Does heat help swelling?

Heat therapy is thought to work by increasing circulation to the heated area. 

Because blood carries oxygen and nutrients to tissues and helps circulate away waste products such as metabolic byproducts and cellular debris from damaged cells, heat therapy can aid recovery while also easing muscle tension, increasing muscle flexibility, and reducing the intensity of pain.

Use Heat to Ease Tight or Stiff Muscles or Menstrual Cramps

Typically, although ice is recommended for acute injuries and to reduce swelling, heat can be helpful for easing chronic pain and reducing stiffness.

For example, if you have pulled a muscle in your low back or you have menstrual cramps, a heating pack applied to the area can help provide relaxing warmth that soothes and eases your pain and discomfort.

A person putting a heat pack on his neck.

Use Heat After Acute Swelling Has Subsided

In most cases, a combination of heat and ice—alternating between the two—is recommended for most musculoskeletal injuries such as sprains, strains, and pulled muscles. However, you should wait to start applying heat to the injury until after the initial swelling has subsided (generally 24-72 hours after the injury).

Similarly, a combination treatment involving alternating between heat and ice can be most effective for reducing the muscle soreness associated with working out—delayed onset muscle soreness (DOMS).

For example, studies show that contrast water baths are effective at minimizing exercise-induced muscle damage, which is the root cause of DOMS.

Use Heat On Tendinosis

Although tendonitis and tendinosis both involve pain and inflammation of the tendons, tendinosis is a chronic condition due to the degeneration of a tendon.

The Cleveland Clinic recommends using heat instead of ice for tendinosis to help relieve associated stiffness in the joints.

A person holding their calf muscle.

When Not to Use Heat for Pain or Injuries

There are certain instances wherein using heat can be counterproductive if not even contraindicated.

According to the Cleveland Clinic, you should never use heat on acute injuries, as warming the tissues can further increase inflammation. 

For this reason, you should also not use heat on areas that are acutely swollen or bruised unless specifically recommended by your doctor or physical therapist.

Most importantly, heat shouldn’t be used over an open wound, and caution should be taken when using heat if you have fragile skin, are prone to burns, or have difficulty with sensation in your tissues.

Examples of conditions that warrant extra caution include diabetes, multiple sclerosis, dermatitis, cellulitis, deep vein thrombosis, and vascular disease. 

A person with an ice pack on their knee.

If you have hypotension or are pregnant, you should also use caution when doing whole-body thermotherapies, such as sitting in a hot tub or sauna.

Overall, the exact treatment protocol with when to use heat vs ice typically depends on the severity of your injury and the level of disability or dysfunction it is causing you.

Additionally, the amount of activity you will be able to do, as well as the specific types of exercise or activities that will be workable, will depend on the severity and cause of your pain (muscle strain, fracture, general muscle soreness, tendonitis, etc.) as well as the location.

Speaking with your doctor or physical therapist is the best way to ensure that you are using heat and ice in the correct ways to promote healing. 

Additional treatment modalities to ice or heat for swelling and injuries, such as anti-inflammatories or pain-relieving medications, may be necessary, as well as rest, bracing, or activity modification depending on the nature of your pain.

If you are instructed to perform icing on your injury, check out our article on ice baths and their benefits: 6 Ice Bath Benefits, What Is The Optimal Time To Stay In?

There are also alternative treatments that may work for you:

Red Light Therapy For Muscle Recovery

Acupuncture For Athletes

A person getting acupuncture on their back.
Photo of author
Amber Sayer is a Fitness, Nutrition, and Wellness Writer and Editor, as well as a NASM-Certified Nutrition Coach and UESCA-certified running, endurance nutrition, and triathlon coach. She holds two Masters Degrees—one in Exercise Science and one in Prosthetics and Orthotics. As a Certified Personal Trainer and running coach for 12 years, Amber enjoys staying active and helping others do so as well. In her free time, she likes running, cycling, cooking, and tackling any type of puzzle.

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