The Great Heat versus Ice Debate

by Karen McDonald, PT, MDT

Heat and ice are used frequently to relieve pain for a variety of musculoskeletal conditions. Heat produces many desirable benefits including an increase in local blood flow, an analgesic effect on pain nerve endings, and a relaxation of muscles around a given joint. Heating pads, hot showers, and warm tubs/whirlpools (98 to 102 degrees) are good sources of heat. Most heat applications are used for 15-20 minutes.

Cold applications can also be effective
against pain. Cold can help control swelling and inflammation, have an analgesic effect on nerve endings, and relieve muscle spasm. A reusable gel ice pack, crushed ice in a Ziploc bag, or a package of frozen peas or corn wrapped in a thin towel can be used.

When to Use Cold:

  • In the first 72 hours of an acute injury where inflammation is present (as noted by heat, redness and/or swelling)
  • For relief of pain and muscle spasm
  • After an exercise session
  • If the use of heat to a joint or muscle increases pain or swelling





When to use Heat:

  • For joints or muscles that are stiff
  • For relief of joint pain or muscle spasm
  • Prior to an exercise session


Whether you use heat or cold, take care to protect your skin. For example, place adequate toweling between your skin and a heating pad/ice pack. Never fall asleep while lying on a heating pad or ice pack as tissue damage in the form of burns or frostbite could occur.