When Do I Use Heat or Cold Therapy for Better Pain Relief?

As a physiotherapist, this may be the most commonly asked question I have received in my career. If you have suffered an acute injury or are dealing with a nagging pain, you may not know whether heat or cold is better for you. The answer to that question depends on the timeline of your injury and your medical history. In this article, I will help guide you on which modality is best for you. It is important to know that consulting with a local physiotherapist is advisable, as they will be able to get a full scope of your injury. This will allow them to provide with an extensive and effective program to help you with your pain.

Cold therapy can be used to reduce swelling and pain at the start of the healing process. When you suffer a sprain or strain, your body will create an inflammatory response at the level of the injured tissue. This inflammatory response will start the recovery of the injured muscle, tendon or ligament. With inflammation, acute pain and swelling are often by-products of this process, so cold therapy can work to reduce these as the body begins to heal itself.

When applied to the affected area, heat can increase blood flow and nutrient delivery to the injured tissue. Heat therapy can be helpful after the inflammatory process finishes (usually 2-5 days after injury). The heat will work to bring oxygen and other healing factors to the tissue to allow for enhanced recovery. Heat therapy can also:

– Help with alleviating joint and muscle stiffness
– Aid in warm-up before activity
– Help with increasing muscle flexibility

When not to use heat

There are times when you should not use heat therapy.

As mentioned above you should not use heat for very acute injuries, particularly when there is swelling or bruising. You also should not apply heat to an open wound.

If you have any of these conditions below you should not use heat because of a higher risk of burns or other complications:

Dermatitis
Vascular disease
Deep vein thrombosis
Sensation issues
Local malignancy

Here’s how you should apply heat therapy:

Use heat for around 15-20 minutes for minor stiffness and tension
More moderate to severe pain benefits from longer heat sessions (20-30 minutes)
Make sure to place a towel on your skin when applying heat to avoid skin irritation or burns!

Heat Therapy courtesy of Active Recovery Physiotherapy & Hand Clinic (Read the caption)

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Types of cold therapy

There are different ways you can apply cold therapy, such as:

Pain relieving cold gels
Ice Packs
Ice baths
Ice massage.
Cold therapy chambers

How to apply cold therapy

If you’re at home you can wrap a towel around an ice pack and place over the injured area. Additionally you could complete an ice bath for injuries in the extremities.

It’s best to apply ice within the first 48 hours after acute injuries or if you still have swelling or sharp pain 3-5 days after the initial injury.

Unlike heat therapy you should not use it for more than 20 minutes at a time. You can apply it several times a day.

Additional tips:

Never apply ice directly to your skin because it can damage your skin, tissues, and nerves. Instead wrap it with a towel.
Never use ice before an activity because your muscles need to be warm not cold. This may negatively impact your performance!

How to use cold and heat therapy together for the best results

To summarize, within the first 48 hours of injury use ice therapy while the inflammation comes down. Once the swelling and acute pain is down then you can start applying heat therapy.

If your pain doesn’t improve in 48 hours or you are uncertain about the best way to treat your symptoms then schedule an appointment on this page with a physiotherapist near you to learn the best way to treat your injury.

Book Your BACK NECK SHOULDER KNEE ELBOW HIP WRIST FOOT Pain Consult

This appointment is your opportunity to tell us what hurts and discover whether physiotherapy or chiropractic care is a good fit for you! During this session, you will talk with a physiotherapist or chiropractor on a phone call (or online) and create the right care plan specifically for your pain. There is no obligation on this session is to find out whether physiotherapy or chiropractic care can help you getting back to doing the things you love in life.

Frequently Asked Questions

Is sleeping with a heating pad bad for you?

Yes because it can result in minor burns or skin irritation.

Which is better: ice or heat for inflammation?

Ice is the most effective way to reduce inflammation and initial pain.

What is better for back pain, heat or ice?

This depends on the stage of your recovery. If acute, use cold. If it is a long-standing injury then heat may be more appropriate for you.

About Taylor Sipos

Taylor is a physiotherapist at The Orthopaedic Therapy Clinic located in Toronto, Ontario. He treats patients with various musculoskeletal conditions using patient education, exercise therapy, manual therapy and acupuncture. His treatment philosophy involves giving his patient’s the means to self-manage their injuries. He does this through reassurance, education and health promotion. Taylor uses the same principles as a patient educator at Pain Hero. He aims to provide you with high-quality, easy to understand information to teach you about your condition and how to improve it.

Medical Disclaimer:

The information presented in this blog post is for educational purposes and should not be interpreted as medical advice. If you are seeking medical advice, treatment or a diagnosis, consult with a medical professional such as one suggested on this website. The Clinic Accelerator Inc. and the author of this page are not liable for the associated risks of using or acting upon the information contained in this article.

When Do I Use Heat or Cold Therapy for Better Pain Relief?