Which to Use For Your Painful Muscles- Ice or Heat?

The short answer to this question is BOTH.

There are specific scenarios in which cold treatment (cryotherapy) is preferred over hot treatments and vice versa. To determine which option is appropriate, it’s important to first understand the physiologic events that lead to muscle pain.

The pain that follows strenuous activity is triggered by the release of inflammation mediators from the damaged muscle. Cytokines, tumor necrosis factor (TNF), Interferon-gamma (INF-g), and prostaglandins are examples of the inflammatory chemicals that circulate around the skeletal muscles, lowering the pH in the environment. This change in the environment activates the pain-receptors (proprioceptors), which are found near the muscle’s blood vessels, thus causing the sensation of pain. Ibuprofen blocks the production of prostaglandin, so, this is the reason it is recommended to treat inflammatory conditions.

Keeping in mind how muscle pain occurs, it becomes clear why cold treatment would be recommended immediately following an injury. The cold constricts blood vessels that carry the inflammation chemicals to their pain receptors. By limiting the blood flow to the muscle, inflammation is less, which means less pain. Cold temperature also numbs the injured area and can prevent bruising, which is blood that has leaked from tiny broken blood vessels (capillaries) near the skin’s surface.

Cold treatment is a safe, non-medicinal way to treat minor, localized pain, and decrease inflammation and swelling after an acute injury, and works best if applied immediately after the injury and up to 48 hours following.

If the injury is sub-acute (>48 hours old) or chronic (>6 weeks), then heat is the better option for pain control. Heat dilates blood vessels, allowing more blood flow to the area. This increased circulation to the area improves the body’s ability to clear the inflammation mediators away from the area, improving pain. Heat can also improve muscle tightness, stiffness, and spasms that cause pain. Because heat increases circulation to the area, it shouldn’t be used to treat a new injury otherwise there will be more swelling, more pain, and delayed healing.

Would alternating cold and hot compresses be beneficial in relaxing muscles?

Alternating hot and cold treatment is called contrasting therapy. This technique stimulates the muscle and can improve blood flow and relieve tightness. Pain that is related to injuries that are older than 48 hours or during the recovery phase of healing should benefit from alternating hot and cold compresses

What is the best way to apply hot and cold compresses?

There are several ways to apply cold treatment to an injured area- ice directly onto the skin, ice packs, and topical cold sprays. Each method has its’ benefits.

Applying raw ice directly onto the injured area is very effective. Keep the ice moving to avoid a cold burn. The temperature of the area treated with raw ice therapy is often more effective than ice packs because as the ice melts, the cold water spreads into the wrinkles of the skin, conducting heat away. Try freezing water into small Styrofoam cups. When ice therapy is needed, tear away a portion of the Styrofoam, and apply!

Topical cold sprays are a convenient way to apply cold therapy to an injury. These sprays contain refrigerant which evaporates from the skin almost immediately after spraying. Trained personnel should be the only ones applying this, as there is a risk for cold burn if incorrectly sprayed. Athletes are often treated at the side-line with a quick spray over the injured area to decrease the potential for inflammation and pain later.

Ice packs can provide prolonged and deeper tissue cooling effects, unlike raw ice or cold sprays. If a deep cooling effect is desired, don’t place the cold pack directly onto the skin. Cover the skin with a towel, then cover the pack to contain the cold. The cold pack may be left in place until numb, then removed. Using an ice pack provides much deeper cooling effects and is best for muscle injury.

ice pack

When applying cold therapy, remember these rules: Start cold therapy as soon as possible after an injury, or in the 48 hours following the injury, for best effects. Keep ice moving if applying onto bare skin. Cover the skin if using an ice pack. Apply the cold treatment only until the area is numb. Re-apply the cold treatment when the pain returns. Continue treatment cycles until symptoms improve.

Heat therapy can be used for non-inflamed, non-acute body pain. As with cold therapy, there are several ways to apply heat to an injury.

Microwaveable hot pack

Gel hot packs are convenient and can be activated when needed, but the temperature doesn’t get very hot and doesn’t last long. For its’ convenience though, gel hot packs are still a good option. As with gel ice packs, do not place directly onto the skin and cover with a towel to contain the heat more effectively.

Other methods in applying heat therapy are hot water immersion, electrical heating pad, or heated body wraps. The heat will penetrate the tissue deeper, however, these methods are not as convenient.

There is no standard temperature or duration for heat therapy- most literature will advise a level of heat that is “tolerable”, and applying heat therapy until there is a relief. The main precaution is related to prolonged use of heat and the risk of burning. (Don’t fall asleep on a heating pad!)

How long should hot or cold compresses be applied?

There are no evidence-based guidelines for the duration of hot or cold therapy for muscle pain. A rule of thumb is to use ice therapy until the injured area is numb, then stop. Use heat therapy until pain, tightness, or stiffness improve, then stop.

Always seek medical attention if pain worsens or if the pain doesn’t improve to any degree when using hot or cold therapy. Remember that cryotherapy and heat therapy is meant to treat minor injuries and provide mild symptom improvement only. Severe injuries should be evaluated by the appropriate caregiver.


Is it advised to use a cold compress to reduce a fever?

A cold compress may be used to reduce a fever temporarily in both children and adults but shouldn’t be used for infants or babies.

A fever is confirmed by measuring body temperature > 38*C using a thermometer. Aside from fever-reducing medications such as acetaminophen and ibuprofen, cold compress treatment may be added to help reduce the temperature temporarily.

Use a towel soaked in an ice bath, ring out excess water then dab onto the skin. Dry the skin immediately with a separate towel. Don’t immerse the ill individual into an ice bath because the extreme cold temperature will cause shivering and elevate the body temperature even further.

Always seek medical attention for persistent fever!

What is best for back pain, a cold compress or hot compress?

Back pain is most commonly due to muscle spasms, tightness, and stiffness, therefore, heat therapy is typically recommended. Even if the back pain is acute, using ice therapy on the low back may increase the pain worse. Cold triggers increased muscle tightness while heat can help tense muscles relax.

Neither heat or ice has been proven very effective in relieving back pain, so the bottom line is whichever method improves the symptom, go ahead and do it!

Remember that if the pain is severe or associated with other symptoms such as numbness or weakness in the legs, a sudden difficulty with bladder control, or other neurologic symptoms, seek immediate medical attention.


Are there any adverse effects of cold or hot treatment?

Prolonged exposure of bare skin to extreme temperatures can be dangerous and can lead to tissue damage, so use caution, especially if there is a decreased sensation in the area being treated. (examples include diabetic neuropathy, Reynaud’s phenomenon, and topical muscle rubs).

Using either hot or cold treatments on areas that appear infected (painful, red, hot swollen, oozing skin) should be avoided. 

Finally, hot and cold therapy is reserved for minor pain or injury, not major trauma, abraded or open skin areas, or if symptoms are severe or prolonged. Seek medical attention for the serious or concerning pain reasons.

I was asked by eMediHealth, an online resource for health information, to provide my ‘expert opinion’ on these questions regarding heat or ice for muscle pain. This article was featured on November 12, 2019 on their website under the title, Hot vs. Cold Therapy For Minor Muscle Pain? An MD explains.

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Christine Nedeau

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