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Hot vs. Cold: When to Use Ice or Heat for Pain Relief

Your guide to managing muscle pain at home

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Learn how to manage pain with hot and cold therapy. Discover when to use cryotherapy, ice packs for sciatica or a hot compress for natural pain relief.

About 20 percent of adults cope with regular muscle pain that stems from an injury, medical condition, overuse or even stress. Knowing when to use ice versus heat can help you catch a break the next time your muscles ache.

Orthopedic sports medicine physicians Faisal Al-Alim, MD, and Peter Cognetti, MD, recommend the following tips for managing muscle pain:

Be wise and use ice

Use ice on a new injury within the first 72 hours, especially if you notice any swelling or bruising. 

“Cold therapy is the best way to reduce inflammation,” says Dr. Al-Alim. “For sprains, strains or any bumps or bruises due to a fall or other accident, choose ice or cold therapy to soothe the pain.”

Types of cold therapy

Common muscle pains like lower back strains, arthritis flare-ups, ankle sprains, tendonitis and runner’s knee respond best to cold therapy treatment options including: 

  • Ice pack
  • Ice bath
  • Frozen bag of vegetables
  • Over-the-counter cold therapy machine

Bonus tip: Eat more vegetables like broccoli, spinach or carrots to help reduce inflammation in your body. 

Pain, pain go away

Apply ice for 15 to 20 minutes at a time, up to three times a day with a few hours in between each application. It’s important to always use a barrier such as a paper towel, kitchen towel or other wrap so the ice is not directly against your skin. For safe and effective treatment, use a method of cold therapy that is 50 to 59 degrees Fahrenheit and remember to RICE. 

R: Rest (avoid using the injured area)

I: Ice (use ice therapy for recent injuries, over the last 72 hours)

C: Compression (use compression socks or sleeves to reduce swelling)

E: Elevate (prop up the injured area to help lower inflammation)

Using heat to get relief

If you have a recurring muscle ache or pain, treat it with heat. 

“This type of therapy works well for chronic pain like lower back pain, muscle spasms or muscle tightness,” says Dr. Cognetti. “Heat increases blood flow and allows muscles to relax.”

Bonus tips: To help with flexibility and reduce muscle soreness, try heat therapy to warm up the muscle groups you’re planning to exercise that day. Make sure you also stay hydrated. If you’re dehydrated, you’re more likely to pull a muscle.

Types of heat therapy

For stiff, tight muscles, try one of the following options:

  • Hot pack
  • Microwaveable heating pad
  • Warm compress
  • Hydrotherapy (warm bath or shower)
  • Infrared light
  • Paraffin wax bath

Warm, not hot

Apply a heat pack or microwaveable heating pad for 15 to 20 minutes, every 30 to 40 minutes for pain relief. Make sure the method of heat therapy used does not exceed 113 degrees Fahrenheit. Remember to use a barrier such as a towel or wrap to prevent burns from occurring. 

Bonus tip: Create an at-home first aid kit with reusable ice packs, hot packs and wraps to hold whichever therapy you’re using in place. 

Use ice and heat with caution

Skin sensitivity may occur if ice is left on too long or used without a barrier such as a towel. Avoid using ice for more than 20 minutes. 

If you have an open wound, cut or active skin infection, do not apply ice or heat. Check with your clinician first if you have a heart condition, poor circulation or uncontrolled diabetes with neuropathy before starting regular ice or heat therapy. 

When your muscle condition needs a clinician

Always reach out to your doctor if you have concerns about any injury or muscle pain. Here are some more signs it’s time to schedule an appointment:

  • If your muscle pain or symptoms from an injury continue after 72 hours
  • If you can’t bear weight on the injured area such as your leg or ankle
  • If you experience muscle weakness, tingling or numbness (weak grip, unable to lift arm)
  • If bruising or swelling persists
  • If you have muscle pain with chills and a fever
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