Hot vs Cold. Heat vs Ice

I often get asked what is best heat or ice for an injury, it simple comes down to preference and what the symptoms are. I have tried to outline the pros and cons of both heat and ice below, the choice is up to you.

Use of Cryotherapy During Soft Tissue Repair

Cryotherapy is defined as the therapeutic application of any substance to the body that removes heat from the body, resulting in decreased tissue temperature.

Ice for injuries is to calm down damaged superficial tissues that are inflamed, red, hot and/or swollen. The inflammatory process is a healthy, normal, natural process that also happens to be incredibly painful and more biologically stubborn than it needs to be. Icing is mostly just a mild, drugless way of dulling the pain of inflammation and taking swelling down a bit. An example of this is a freshly pulled muscle or a new case of IT band syndrome (which is more likely to respond than the other kind of runner’s knee, patellofemoral pain, because ITBS is superficial and PFPS is often a problem with deeper tissues).

Physiological and neurological effects of using ice during soft tissue repair can decrease local metabolism, reduced oxygen requirements, vasoconstriction, hyperaemia, decreased haemorrhage, reduced muscle efficiency, analgesia, relaxation of muscle spasm, reduction in nerve conduction velocity, stiffening effect on connective tissue.

Methods of applying cryotherapy for soft tissue repair can include Ice, cryocuff, cooling creams and gels, silica gel packs, ice pack, ice cups, cold compress, ice massage, wet towel/sponge and immersion. Contra-indications to cryotherapy for soft tissue repair include Vasospasm i.e. Raynaud’s disease, acute febrile illness, cold urticaria, some autoimmune diseases e.g. rheumatoid arthritis or lupus. When applying cyotheraphy treatment precautions will need to be accounted for as it can cause decreased sensitivity and/or hypersensitivity to the cold tempreture, circulatory or sensory impairment, hypertension, uncovered open wounds, cardiac disease, adverse psychological factors. Adverse reactions to cryotherapy may be Ice burns or frostbite, increased pain, neurological effects, hyperaemia, allergic reaction, chemical burns. Actions to take in event of adverse reactions: Remove source of cold, gradually allow to come back to normal temperature, seek medical care if necessary. Everyone will react differtently so care and caution is advised when applying cryotherapy.

Be especially wary of icing muscle pain. You may think your back is injured, for instance, but it may “just” be muscle pain. Trigger points (painfully sensitive spots) can be surprisingly intense and easily mistaken for “iceable” injury and inflammation. But if you ice trigger points, they may burn and ache even more acutely. This mistake is made particularly often with low back pain and neck pain — the very conditions people often try to treat with ice.

Although cold and hot treatment modalities both de- crease pain and muscle spasm, they have opposite effects on tissue metabolism, blood flow, inflammation, edema, and connective tissue extensibility. Cryotherapy decreases these effects while thermotherapy increases them. In response to tissue injury, specialized nerve endings called nociceptors are activated. Nociceptors transmit nerve signals that travel through the spinal cord to the brain, where the sensation of pain is recognized. At the same time, neurotransmitters initiate a spinal re- flex that increases muscle motor activity and tonicity at the site of injury, leading to a reflexive muscle contraction. If persistent, the increase in muscle tone can cause painful muscle spasms, which can lead to further tissue damage due to de- creased blood flow and oxygen (hypoxia) to the surrounding tissues. Pain in turn increases. This injury process is called the pain-spasm-pain cycle. This cycle must be interrupted to prevent further tissue injury and to reduce the sensation of pain.

Icing may be used along with compression, elevation, bracing, and/or support when treating acute injuries. Nonsteroidal anti-inflammatory drugs (NSAIDs) can produce a similar effect to icing. However, they may delay healing with acute injuries (like sprains, strains, and fractures). If your doctor recommends medicine, make sure you are aware of the right dosage and when to take it, and if there are any side effects.

The use of ice and heat is just one part of a treatment program. Even if symptoms are relieved, there is usually a need for exercises to restore flexibility and joint motion, strength, general fitness, and sport-specific skills.

Use of Heat Treatments During Soft Tissue Repair

Heat can be used for muscles, chronic pain, and stress, heat can take the edge off symptoms like muscle aching and stiffness, which have many unclear causes, but trigger points are probably one of the usual suspects. Chronic pain, especially back pain, often involves lots of tension, anxiety, hypervigilance, and sensitization, and comfortable heat can soothe a jangled mind and nervous system. Stress and fear are major factors in many painful problems, of course.

Physiological and neurological effects of using heat can be increased local metabolism, increased blood flow, vasodilation, erythema, increased oedema, increased haemorrhaging, analgesia, reduced muscle spasm, increased soft tissue extensibility, reduction in muscle spasm, decrease in muscle ability to contract, increase in nutrient delivery to damaged tissue.

Methods of applying heat can be Infrared lamp, wax bath, hot compress, hot packs, heat pads, silica gel packs, hot water bottle, immersion, hydrotherapy. Contra-indications to heat treatments can be decreased sensitivity to heat, recent haemorrhage in the treatment area, skin carcinoma, acute dermatitis. Precautions to heat therapy could be Impaired local circulation, damaged or infected tissue. When using heat as a form a therapy for recovery always apply with caution as the adverse effects can be worse than the intial injury. Adverse reactions to heat treatments can be Burns, scalds, chemical burn, increased blood pressure, decreased blood pressure, muscle metabolic fatigue, optical damage, dizziness, headaches, increased oedema, heat stroke. Actions to take in event of adverse reactions to heat therapy, remove from heat source, cool skin rapidly under running water, first aid if required, seek medical attention if necessary. Heat and inflammation are the other particularly bad combination. If you add heat to a fresh injury, it’s going to get worse.


Ideal uses of ice and heat are roughly equal in potency, which can be argued not very potent, neither is strong medicine. Some experiments have shown that both have only mild benefits, and those benefits are roughly equal in treating back pain. The reason to use them is not that they are highly effective treatments but because they are so cheap, easy, and mostly safe, especially compared to many other popular treatments.

Ice can aggravate muscle pain, which is routinely mistaken for an “iceable” injury, especially in the low back. Back pain is rarely caused by an injury — that is, the pain is rarely caused by inflammation which might be helped by ice. Even in cases where inflammation is present, it is mostly going to be deep in the back under a thick layer of insulating muscle where ice cannot “reach” it.

Meanwhile, back pain almost always does involve muscle pain in the form of muscular trigger points (muscle knots) a small patch of acutely sensitive soft tissue, a poorly understood little patch of sensory misery — which are more likely to be aggravated by ice and helped by heat. And so most people with back pain seem to prefer heat, and some have negative reactions to ice. (The situation is similar for neck pain.) 

Although experiments have shown that both ice and heat are modestly and equally helpful for low back and neck pain, that evidence isn’t exactly bulletproof, and here are some good reasons to err on the side of heat in any case. But the main reason is that ice is more likely to aggravate the trigger points that are so common in neck and back pain. I recommend that ice should only be used in back and neck pain cases where … you clearly prefer it (for whatever reason) and there is definitely a fresh injury (a clear mechanism of injury, and obvious inflammation: heat, swelling, redness).

Those cases are surprisingly rare, because the back is much tougher and immune to injury than people think, and also much more prone to painful trigger point activity than most people realize. Indeed, many garden variety aches and pains, especially in younger people, are probably caused not by arthritis and injury as people tend to assume, but by ordinary muscle pain — which tends to be irritated by ice and soothed by heat.

Your own preference is the most important consideration. 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, Icing is primarily an analgesic — a pain-reliever — and not an actual treatment. That is, it doesn’t “fix” anything. Use it like you use ibuprofen. It may help to resolve chronic problems, but it’s mostly intended to simply numb painfully inflamed or other hurting tissues. it is useful mainly where tissue are damaged and/or “inflamed.”

The most commonly iced acute injuries are fresh injuries, for example ligament sprains, muscle strains, and severe bruises. A fresh injury is when the tissue has recently been physically damaged, it will be inflamed for a few days, give or take, depending on the seriousness of the injury. If superficial tissue is sensitive to touch, if the skin is hot and red, if there is swelling, these are all signs that your injury is still fresh, and should definitely not be heated. Heat will increase the circulation and significantly facilitate the immune system activity.

Ice is also often helpful with chronic overuse or tissue fatigue injuries like carpal tunnel syndrome, tennis elbow, supraspinatus tendinitis, iliotibial band syndrome, patellofemoral pain syndrome, shin splints, and plantar fasciitis just to mention a few. Ice may also be useful for garden-variety “wear and tear” arthritis, and sometimes the nasty inflammatory arthritides (rheumatoid, ankylosing spondylitis).

Both ice and heat have the potential to do some minor, temporary harm when used poorly. Heat can make inflammation significantly worse. Ice can aggravate symptoms of tightness and stiffness; it can also just make any pain worse when it’s unwanted. Both ice and heat are pointless or worse when unwanted: icing when you’re already shivering, or heating when you’re already sweating. The brain may interpret an excess of either one as a threat, but icing is more threatening — and when brains think there’s a threat, they may also amp up the pain. Ice seems to be more threatening to most people.

If you’re supposed to ice injuries, but not muscle pain, then what do you with injured muscles (a muscle tear or muscle strain)? That can be a tough call, but ice usually wins — 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.

The use of ice and heat is just one part of a treatment program. Even if symptoms are relieved, there is usually a need for exercises to restore flexibility and joint motion, strength, general fitness, and sport-specific skills.

A sports massage is a great way to help relive any pain and help restore the tissue back to normality, along with other treatments and exercises it can be a permanent change and not a quick fix.

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