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Heat or cold? Here’s how to choose…

Published: 28 Mar 2022

Have you ever been stuck deciding whether to use heat or cold when something is stiff or sore? Keep in mind that it is always worth contacting your healthcare provider for their professional opinion on treatment options for injuries and other medical conditions. 

Most recommendations on the use of heat vs cold are actually based on first-hand experience as there is limited evidence supporting the effectiveness of either (see references below). However, this does not mean that they are not useful to assist in the management of pain and injury.

Examples of cold therapy

• Ice packs
• Ice bath
• Ice massage

Benefits of ice

• Pain relief (numbing effect)
• Decreased blood flow
• Decreased swelling
• Decreased metabolic demand 

This is an image of a hydrocollator and hot packs. The packs are kept in 80 degree water and provide a comforting damp and long lasting heat that is used in clinic.

Examples of heat therapy

• Wheat packs
• Hot water bottle
• Warm bath

Benefits of heat 

• Pain relief
• Increased blood flow
• Increased metabolism
• Increased elasticity of connective tissues

Used at home – and available for purchase in clinic – the Wheat Heat Pack is a convenient at home option. Ensure that the one you purchase is sectioned so that the filling does not shift to one spot.

As a general rule of thumb

• Cold is useful for managing pain and reducing swelling/inflammation in the early stages (first 24-48 hours) of acute soft-tissue injuries such as joint sprains and muscle strains.
• Heat is beneficial for managing pain, promoting blood flow and reducing muscle spasm/stiffness. 

Did you know?

There is moderate evidence supporting the use of heat therapy and exercise in patients with low back pain for reducing pain and improving function in the short-term. 

Precautions/safety – when not to use

• Do not place ice/heat directly onto the skin. Use a thin towel between! Treat using ice/heat for 15-20mins. 
• Check your skin every 5 mins for any redness or blisters when using ice (signs of ice burn).
• Do not use ice if you have: altered sensation, poor circulation, hypersensitivity to cold or open/infected wounds.
• Do not use heat if you have: acute injury, swelling, severe bruising, altered sensation, poor circulation, poor thermoregulation or open/infected wounds.

References:

Gerard A. Malanga, Ning Yan & Jill Stark (2015) Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury, Postgraduate Medicine, 127:1, 57-65, DOI: 10.1080/00325481.2015.992719

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. A Cochrane review of superficial heat or cold for low back pain. Spine (Phila Pa 1976). 2006 Apr 20;31(9):998-1006. doi: 10.1097/01.brs.0000214881.10814.64. PMID: 16641776.