Is it Hot or Is it Cold??

by | 21 Jun 2017

There’s a lot of opinion out there over when, or if, you should use heat/ice on an injury.

As a general rule of thumb, use ice on acute or new injuries, and heat on stiff & aching muscles. Ice is rarely used for back pain, though if it feels right to you, trust your instincts.

There are benefits to using both heat and ice. Both are cheap, effective, easy, drug-free, provide minor pain control, and are safe when used correctly.

How do you know which one to choose?

Cryotherapy (Icing)

  • Icing should be used when tissue is damaged and inflamed – on acute or new injuries that are red, hot, and swollen. It can be a highly effective pain reliever.
  • Safe application of ice to injuries can dull pain and relieve symptoms.
  • Icing slows metabolic activity and numbs nerve endings, causing pain to lessen.
  • It reduces tissue temperature, which decreases cell metabolism around the injured area. This, in turn, decreases tissue damage.
  • There is conflicting evidence to show icing reduces swelling
  • There are many methods of icing such as gel packs (with or without a towel wrap to reduce intensity), raw ice, or a good old bag of peas
  • The most effective icing technique is crushed ice in a bag applied directly to the injury site. This can be uncomfortable when applied however has shown the most effect in reducing tissue temperature to its desired degree.
  • Most recommendations are to ice the injury for 20 minutes on, 20 minutes off, or ‘when you’re numb, you’re done.’
  • Depending on the injury site research has shown that using crushed ice can achieve the desired result in up to 5 mins. Longer time may be required for deeper structures such as hamstring/buttock muscles.
  • Cold masks can be used over eyes and temples to minimise pain caused by headaches and migraines.
  • It is not generally recommended for back pain relief, which usually is more trigger point muscle pain (i.e. ‘knots’). Ice treatment for back pain may cause more acute pain at trigger points.
  • It can, however, be helpful with chronic overuse or tissue fatigue ailments such as plantar fasciitis, shin splints or carpal tunnel syndrome.
ice therapy

Thermotherapy (Therapeutic Heating)

  • Heat therapy is best suited to muscle pain caused by cramps, spasms, over-exertion, chronic pain, stress and stiffness.
  • As with ice, it provides symptom relief but is not going to treat the underlying issue. It is soothing and offers relaxation and comfort, however it can worsen inflammation.
  • Heat should not be applied to new injuries for at least 48-72 hours.
  • If there is tissue damage, swelling, or skin is red and sensitive to touch, DO NOT USE HEAT.
  • Heat therapy brings more blood to the applied area, relaxing the muscles and thereby reducing tightness.
  • Applied neurology tells us that heat is reassuring and provides a feeling of inner warmth and safety; such reassurance is analgesic.
  • Similarly, ointments such as Deep Heat and Tiger Balm provide neurological distraction due to their warming sensations, though they are not actually ‘hot’, rather they are ‘spicy’.
  • Natural anti-inflammatory gels and creams, such as Fisiocrem can also be used in conjunction with heat therapy to reduce muscle aches and pains.
  • Heat therapy methods include gel packs, hot water bottles, bean bags, a hot bath, or a sauna.
  • Moist heat can also be effective in helping to loosen injured muscles before commencing stretching and activity.
heat therapy

Therapeutic Contrasting (Alternating Hot and Cold)

  • Alternating therapies is often used by athletes recovering from repetitive strain injuries. It is not good for new injuries.
  • Contrasting forces muscles to adapt to sudden changes. Icing shocks the muscles to attention; heat loosens and relaxes them. These changes stimulate a gentle tissue workout without the stress, which is helpful to promote rest while still healing.
  • Immersion is the most effective method of therapeutic contrasting, since large areas (calves, forearms etc.) are often being treated.


Whatever method you decide to use, remember that heat and cold therapies are not always the only answer.


  • Stick to the general guidelines
  • Trust your instincts, and
  • If in doubt, consult your local Physiotherapist for more information.

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