Should you use Ice or Heat for Pain? When should you use what?

Generally if you have just injured yourself, ice is best, and if you have a longer lasting injury heat is best – particularly for stiff, aching muscles.


Ice helps to reduce the pain of an acute (just happened) injury.

When you injure tissues what happens is that those tissues – whether they are tendon, ligament, muscle, disc, skin – whatever – they are all body tissues – become inflamed. Inflammation is a normal reaction to injury but it can be incredibly painful. Why is this?

At a cellular level injury causes the walls of cells to release a substance called prostaglandin, which bathes the cells but causes pain and also makes the small blood vessels around the injury swell. This makes the injured area stiffen. When you can’t use the area as freely as usual, you allow the cells to rest and recover. However, this HURTS and although a small amount of inflammation is helpful to healing, you don’t want it to get out of control.


If inflammation gets worse and worse, it can get in the way of the normal healing process as flow of nutrients to the area will be reduced and then the speed of healing will be reduced. It can also lead to more scar tissue developing, which will get in the way of normal movement later.

The theory about putting ice over an area that is inflamed is that it reduces blood flow to the area, and it is this that reduces the inflammation and hence reduces pain and it also acts to reduce nerve activity so you can’t feel the pain as much.

The less inflammation, the less pain you will feel so restricting the amount of inflammation is a good idea. That is why you see footballers and sportsmen and women sitting at the side with ice packs over an area if they injure themselves and can’t continue to play. They have a relatively minor injury and they are trying to restrict the development of inflammation so they recover quicker.

You can also use alternating heat and ice which is called contrasting therapy, which stimulates tissue recovery.

Some claim that compression plus ice is most useful as it prevents excessive swelling. Sometimes this can be enhanced by using pneumatic compression that increases and decreases the pressure in cycles and this mimics the natural pumping action of the body, removing any excess fluid and encouraging blood flow to the area, which in turn brings more nutrients to promote healing. It is possible to use a compression band with circulating water which acts to circulate cold water through an ice reservoir through a wrap that you put around the affected area. The temperature remains the same while the water circulates and the compression means that the cold can penetrate all the affected tissues from every angle.


When you have stiffness or tightness in a joint or muscle.


Ice packs made from gel are the most efficient way of cooling an area as they mould to the shape of your body. Never use ice or an ice pack directly on the skin as it will burn the skin and cause discolouration. You want to cool the area not give yourself frostbite! You should aim for 10 minutes on and five minutes off and keep doing this for a few rotations.


Heat is good for helping with the pain of muscle overuse, chronic (long lasting) pain, pain of arthritis and stress and muscle tension.


Muscle pain caused by over exertion or spasms can be relieved by heat as it speeds up blood circulation. Heat is also reassuring and reassurance is in itself a painkiller, which is why you feel better when you have been to see one of the chiropractors – they help you to understand your problem and you stop worrying about it and that helps to reduce the pain sensations. The brain interprets ‘warmth and safety’ as sensations that enable you to relax your body – which is ‘applied neurology’ – your brain sends signals to your body that it is not in danger and it can relax.

Delayed onset muscle soreness is particularly responsive to heat and research in 2006 showed that using a ‘heat wrap’ for chronic low back pain was very beneficial. Heat also distracts you from your pain – it is another sensation going into the brain and that can take away from the pain sensation itself.

Twenty minutes on and twenty minutes off is advisable for heat therapy.

Don’t add heat to a new injury – it will make it worse! Don’t use heat after you have seen the chiropractor unless advised otherwise. Chiropractic treatment can cause a local inflammatory response, which can be sore and will certainly be eased by an ice pack.

Heat and inflammation are a bad combination. If you add heat to a new injury, it will feel worse as you will encourage more blood flow and that will create more inflammation and pain.

If you are unsure what to do because you have injured a joint and the muscles surrounding the joint, you are probably better to use ice but only for the first few days at most, and only if it really is a true muscle injury. A true muscle injury usually involves obvious trauma during intense effort, causing severe pain suddenly. If the muscle is truly torn, then use ice to take the edge off the inflammation at first. Once the worst is over, switch to heat.


Our ice packs can also be used to heat an area – just immerse in hot water as per the instructions.


The bottom line is that you should use whatever feels best to you!  For instance, heat cannot help if you already feel unpleasantly flushed and don’t want to be heated. And ice is unlikely to be effective if you have a chill and hate the idea of being iced!

If you start to use one and you don’t like the feel of it … just switch to the other or call the clinic and ask your practitioner for more advice – we are always here to help you! Listen to your body; don’t use ice directly on your skin; don’t ice for more than 15 minutes at one time and listen to your chiropractor’s advice!