Should I use heat or ice?

I sat down to write a nice simple article titled ‘should I use heat or ice‘ on your aches and pains and I’ve ended up down a rabbit hole of myths, legends, half truths, sceptical science and very few reliable facts. The following is my interpretation of what I’ve found.

Read right through to the end for my recommendations! 

Should I use ice or heat?

Should I use heat or ice on an injury?  This is something I hear on a weekly occasion and also something that doesn’t have a perfectly clear answer. The answer can vary from one to the other, to none and to it depends. 

When should you (if at all) use heat or ice? Is ice for injuries and heat for soreness as commonly suggested? Let’s find out!


Cryotherapy (cold)

I’m sure you’ve all heard of the R.I.C.E. (Rest, Ice, Compression & Elevation) principal in some variation. It might have been drilled into you since high school, at first aid courses and by every man and his dog who’s ever injured something. It was also taught to me at uni as part of my Bachelor of Health Science (Clinical Myotherapy). Although it’s served you well up till now, it’s due for an update….

For you at home, icing is best used as an analgesic, to help relieve pain, and not to actually treat an injury. That is, it doesn’t “fix” anything. Use it like you use Panadol or Nurofen. It’s mostly intended to simply numb painfully inflamed or other hurting tissues. Although inflammation is a natural biological process that we don’t want to interfere with too much, sometimes it can get out of hand or can become unnecessarily painful. Ice can help with the painful symptoms of inflammation without disturbing the whole inflammatory process.

In theory, cold slows down metabolic activity and numbs nerve endings. It will limit and control inflammation (to a certain extent) and it WILL make it hurt less. It helps you get through the day. And that’s an especially good thing!

In the clinic, a more up to date acronym is P.O.L.I.C.E. (Protection, Optimal Loading, Ice, Compression & Elevation). In the first couple of days after an injury ie: an ankle sprain, this would be my recommendation and how I would approach your rehab within the clinic.

The addition of Protection might seem like an obvious addition but you’d be surprised. Protection and rest after injury are important to unload and/or prevent joint movement for various periods. Essentially its protection from further damage.

The challenge is to find the balance between loading and unloading as your healing progresses. If tissues are loaded too aggressively after injury, there is the potential for further damage. But, too much rest may be harmful and inhibits your longterm recovery. The secret is to find the ‘optimal loading’.

Optimal Loading is replacing rest with a rehab program that exposes the injured area to gradually increasing loads with the aim of encouraging and stimulating recovery. Injuries and the people they happen to can vary greatly, you require a rehab program that is suited to you and your needs. An optimal loading rehab program finds the right balance of strengthening the injured area preparing you for the rigours of your daily life without fear of aggravation or further damage.

Next time you experience an acute injury don’t reach for the RICE, call the POLICE. (I really need to work on my jokes)

(except if you hurt your lower back – read on for why)

Thermal Therapy (heat) 

By far the most common home remedy I recommend other than to get you moving, is using heat and it turns out there are some beneficial therapeutic properties in it for you.

You should understand heating the same way you know to put a bandaid on a small cut: it is a cheap, drugless way of taking the edge off an array of common painful problems, especially neck and back pain (most of what I see), and maybe more.

Heat is generally best applied in the following situations:

  • Soreness from overuse – think the pain you get after going for your first run in a long time or the dreaded D.O.M.S after a heavy session in the gym.
  • Stiffness and pain related to osteoarthritis, muscle spasms or from sitting in one position for too long.
  • Pain and sensitivity related to fibromyalgia, rheumatic conditions, drug side-effects and even sleep deprivation.

Heat works partly by being reassuring, and reassurance is analgesic (pain relieving). Heat can penetrate a few centimetres into tissue, and cells and biochemistry speed up when the tissue temperature rises, which probably has a beneficial effect too.

This sums it up best – “So a nice controlled source of warmth is probably just about the most basic reassuring thing there is. And that’s always good for pain. You might mistake this for a psychological effect, and it is in a sense, but it’s more useful to look at it as “applied neurology”: leveraging what we know about how pain neurology works. It’s more akin to triggering a reflex than a mind game. Reference.

Recommendations – 

Both cryotherapy and thermal therapy can be used for temporary relief of symptoms, and they should be! Symptom relief is an important part of the treatment process too. It allows other processes to take place ie: optimal loading as discussed above.

Ice is probably fine to use all the time, at least in the first 48hrs after injury – but it’s not recommended to ice your lower back as there is some evidence (albeit a little old now) that ice will irritate or aggravate muscular pain.

  • Gel ice packs
  • Ice cups
  • Ice in a bag
  • Frozen peas
  • Raw ice (be careful not to burn yourself)

Heat is also fine most of the time – but not on acute inflammation and don’t burn yourself!

  • Gel heat packs
  • Microwaveable ‘wheat/rice’ bags
  • Chemical heat packs
  • Hot water bottles
  • Towels soaked in hot water
  • Hot baths and saunas

In Summary – 

Clear as mud I reckon 😉

Studies have shown both heat and cold can result in mild yet similar improvement in pain severity. Yet there are clear situations where one is preferred over the other.

The recommendation is that the “choice of heat or cold therapy should be based on patient and practitioner preferences and availability.”

It’s winter, I’m cold, grab me a hot water bottle 🙂

P.S. – Tiger Balm and similar products are “spicy” not warm, but they might tinker usefully with sensation: a neurological distraction, which in turn may offer some symptom relief.

Got any comments or questions? CONTACT US!

Used heat and/or ice and still in pain, consider booking an appointment.