Living With Chronic Pain

Hot Or Cold Therapy?

Looking for a natural way to get your joints moving in the morning? Close the medicine cabinet and try an age-old remedy that has stood the test of time: heat and ice.

The only question? Which works best and when?

What ice and heat do for our bodies 

When you warm up a sore joint or tired muscle, the blood vessels get bigger. This allows more blood, oxygen, and nutrients to be delivered to the injured tissues. Better circulation means more relaxation for those stiff, aching muscles and joints.

An acute injury (one that has occurred within the last 48 hours) or flare is best treated with ice, at least for the first 48 hours. If you have a sudden onset of swelling and redness from overdoing it yesterday, cold treatments are the better option for a few days. It is usually the result of sudden trauma, such as a fall or collision. Signs and symptoms of an acute injury may include pain, tenderness, redness, warm skin and swelling.

Chronic injuries differ from acute injuries. They usually develop slowly because a body part is being overused or because an acute injury has healed improperly. Pain from a chronic injury may not be constantly bothersome, but it can come and go in the form of soreness or dull pain.

Sometimes both treatments are helpful- applying heat before exercise to increase flexibility and to stimulate blood flow to the area. That’s why I take a bath before I start exercising. After exercise, ice is the best choice for a chronic injury because it discourages the onset of swelling and pain. That’s why I lie in an ice pack every night after a long days activity before sleep.

How heat therapy works 

There are two different types of heat therapy: dry heat and moist heat. Both types of heat therapy should aim for “warm” as the ideal temperature instead of “hot.”

  • Dry heat (or “conducted heat therapy”) includes sources like heating pads, dry heating packs, and even saunas. This heat is easy to apply. 
  • Moist heat (or “convection heat”) includes sources like steamed towels, moist hot packs, or hot baths. Moist heat may be slightly more effective as well as require less application time to feel results.

Professional heat therapy treatments can also be applied. Heat from an ultrasound during physical therapy for example, can be used to help pain from tendonitis. 

Small heated gel packs or a hot water bottle work great for one stiff muscle. For more widespread pain or stiffness in a larger region treatment with a steamed towel, large heating pad or heat wraps are best. Full body treatments include options like saunas or a hot bath. 

When not to use heat therapy 

Heat therapy is not recommended if the area in question is either bruised or swollen (or both)- cold therapy may be a better option. And never apply to an open wound. 

People with certain pre-existing conditions where circulation or feelings of sensation may be reduced should not use heat therapy due to higher risk of burns or complications due to the heat application. These include:

  • diabetes
  • dermatitis
  • vascular diseases
  • deep vein thrombosis 
  • multiple sclerosis (MS)

If you have heart disease, hypertension or are pregnant, ask your provider before using heat therapy, saunas or hot tubs.

How to apply heat therapy 

Heat therapy is often most beneficial when used for a good amount of time, unlike cold therapy, which needs to be limited. 

Minor stiffness or tension can often be relieved with only 15 to 20 minutes of heat therapy. Moderate to severe pain can benefit from longer sessions of heat therapy like a warm bath, lasting between 30 minutes and two hours. 

Risks of heat therapy

Heat therapy should utilize “warm” temperatures. If you use heat that’s too hot, you can burn the skin. If you have an infection and use heat therapy, there’s a risk it can spread. Any direct application to a local area, like with heating packs, should not be for more than 20 minutes at a time. 

If you experience increased swelling, stop the treatment immediately. 

If heat therapy hasn’t helped lessen any pain or discomfort after a week, or the pain increases within a few days seek medical attention.

How cold therapy works

Cold therapy is also known as cryotherapy. It works by reducing blood flow to a particular area, which then significantly reduces inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain. 

There are a number of different ways to apply cold therapy to an affected area. Treatment options include:

  • ice packs or frozen gel packs 
  • Coolant sprays
  • ice massage
  • ice baths

When not to use cold therapy 

People with sensory disorders that prevent them from feeling certain sensations should not use cold therapy at home because they may not be able to feel if damage is being done. This includes diabetes, which can result in nerve damage and lessened sensitivity. 

You should not use cold therapy on stiff muscles or joints. This usually responds better to heat therapy. 

Cold therapy should not be used if you have poor circulation.

How to apply cold therapy 

For home treatment, apply an ice pack wrapped in a towel or ice bath to the affected area. You should never apply a frozen item directly to the skin, as it can damage the skin and surrounding tissues.

Use cold therapy for short periods of time, 10 – 15 minutes, several times a day but not more than 20 minutes at one time to prevent nerve, tissue, and skin damage. After an acute injury, reducing blood flow is the goal to decrease swelling and inflammation so the sooner ice is applied the better. Elevating the affected area helps as well.

Risks of cold therapy

If you’re not careful, cold therapy applied for too long or too directly can result in skin, tissue, or nerve damage. If you have cardiovascular or heart disease, consult your provider before using cold therapy. If cold therapy hasn’t helped an injury or swelling within 48 hours, call your provider.

Alternating hot and cold therapy 

When cold is applied to the body, the blood vessels contract and vasoconstriction occurs. This means that circulation is reduced, and pain decreases. Removing the cold causes vasodilation, as the veins expand to overcompensate. As the blood vessels expand, circulation improves, and the incoming flow of blood brings nutrients to help the injured tissues heal.

Alternating heat and cold can be useful for:

  • osteoarthritis
  • exercise-induced muscle damage (EIMD) that can lead to delayed onset muscle soreness (DOMS). DOMS commonly emerges 24 to 48 hours after exercise.

Contrast water therapy (CWT) uses both heat and cold to treat pain. Studies show that it is more effective at reducing EIMD and preventing DOMS than doing nothing. A review of studies has suggested that, for elite athletes, CWT is better at reducing muscle pain after exercise compared with doing nothing or resting.

In real life this means getting into a hot shower or tub and soaking the effected areas while gently moving it in all ranges of motion to increase mobility, then applying ice for a few minutes, then repeating the cycle. Any worsening of the pain, stop and seek professional advice.

Knowing when to use cold therapy and when to use heat therapy will significantly increase the effectiveness of either treatment. Some situations may benefit from both. Arthritic patients, for example, may want heat when joints are aches and stiff and cold when they are acutely swollen and painful. Either can be incredibly effective in dealing with pain. I know I couldn’t live without them. So much so that my life revolves around my bath and cold pack times. They are the only way I survive.

If either treatment makes the pain or discomfort worse, stop immediately. If the treatment hasn’t helped much with regular use in a few days, seek medical care to discuss other treatment options. 



-ncbi.nlm.nih.gov/pmc/articles/PMC3808259/

-ncbi.nlm.nih.gov/pmc/articles/PMC3633882/

-medicalnewstoday.com/articles/29108#alternating_cold_and_heat

-health.clevelandclinic.org/should-you-use-ice-or-heat-for-pain-infographic/

-arthritis.org/health-wellness/healthy-living/managing-pain/pain-relief-solutions/heat-therapy-helps-relax-stiff-joints

-healthline.com/health/chronic-pain/treating-pain-with-heat-and-cold#takeaway

-cochranelibrary.com/cdsr/doi/10.1002/14651858.CD008262.pub2/abstract

-pubmed.ncbi.nlm.nih.gov/17023239/

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