Read This Before You Ice (or Heat) Your Muscles
Is one of these at-home temperature therapies better than the other?
“Put an ice pack on it!” If you grew up playing sports (or have kids who play them), this is a familiar refrain, repeated whenever someone gets injured. Sometimes, the quickest way to ease the pain from a sprained ankle or torn muscle is to cover the area with ice. It’s a short-term solution that doesn’t take the place of medical care when you need it—but in a pinch, ice can be a real lifesaver.
Heat therapy can also be a useful tool for soothing pain. People with arthritis often rely on warm baths or compresses to ease morning stiffness and help their joints move freely. But heat isn’t a foolproof treatment, either, and it can be detrimental when used on an acute injury (like a soccer game sprain) or active infection.
So, how do you know when to use ice versus heat? “In general, I recommend ice for acute injuries and heat for more chronic conditions,” says Barbara Bergin, M.D., orthopedic surgeon in private practice at Texas Orthopedics, Sports & Rehabilitation Associates in Austin, TX. They work through different mechanisms: Ice constricts your blood vessels while heat expands them. It really depends on what is causing your pain and what you are hoping to target—pain relief, swelling, or muscle recovery. Let’s dive into the details to sort it out.
Ice, Ice, Baby
During a bad arthritis flare or right after a painful injury, it can feel like your body is on fire. Intuitively, putting ice on the inflamed area just feels good. Here’s why: Ice treatments (a.k.a. cryotherapy) help limit swelling and reduce nerve sensation, immediately lessening your acute experience of pain. “Cold decreases blood flow to the [connective] tissue,” explains Marsha Lawrence, DPT, a physical therapist in Stilwell, KS, and member of the Arthritis Foundation’s Physical Activity Expert Panel. “It decreases the amount of oxygen that gets put into the tissue, and because of this, it slows down the manufacture of inflammatory cells.” Cold also has an anesthetic effect, meaning it changes the sensitivity of pain receptors to make an acute injury hurt less in the moment. This DIY therapy has been used for centuries because of its simplicity—all you need is a few ice cubes or a cold-water source. You can even use a pack of frozen veggies from your freezer.
Ice can also be useful after a procedure such as a steroid epidural, which is used to treat people with severe back pain. “Ice will reduce the inflammation and decrease post-procedural pain and discomfort,” says Puja Shah, M.D., an interventional pain management specialist and anesthesiologist in private practice at DISC Sports & Spine Center in Newport Beach, CA. She typically advises patients to apply ice on and off for about 24 hours after their procedure.
Cold treatment is most effective on joints or muscles that are close to the surface of your skin—say, your foot, ankle, knee, elbow, hand, wrist, elbow, or low back. “These are joints that don’t have a lot of thick tissue covering them,” Lawrence explains. A joint like the hip isn’t going to benefit as much from cold treatment because it’s covered by a lot more tissue. One quick tip to make cold treatment work better: Use a wet cloth or moist ice pack. “If you use a wet cloth against the skin … that temperature change gets transferred a little quicker and more efficiently, and it may even be a little more comfortable,” Lawrence suggests. It also serves as a barrier between the ice and your skin to make the cold feel less intense.
The main thing to be aware of with ice therapy is that it is only advised in the short term—about two to three days after an injury, and only for a few minutes at a time. “An acute trauma—a sprain, a strain, a surgery, a fall—will generally do better with cold applied in the first two to three days,” Lawrence says. Decreasing inflammation is a great way to help you feel better in the moment, but it can slow your body’s natural healing process if used for an extended period (meaning, don’t hop in an ice bath for 20 straight minutes or keep icing an injury on and off for a whole month).
Recent research has explored whether using ice after strenuous exercise might actually be detrimental to overall healing. In a May 2021 study in the Journal of Applied Physiology, researchers found that mice who were treated with ice therapy had trouble repairing damaged muscle fibers after strenuous activity—essentially, using ice after a hard workout might delay recovery. Indeed, Dr. Bergin does not typically advise people to ice sore muscles after a run or weight-lifting session. “I would tend to agree that allowing the natural process of healing to occur is appropriate,” she says. Lawrence notes that using ice during a workout—for instance, a baseball pitcher using cold packs on their arms between innings—might set athletes up for injury because it blocks the body’s ability to “recognize” the limits of the joint.
Icing is a controversial method in sports, but there is a difference between exercise-induced muscle soreness—which your body is naturally equipped to bounce back from—and an injury or post-op swelling. The latter can send your body into major inflammation mode, so if ice helps reduce some of that swelling, experts say it’s OK to use. Still, keep in mind that ice therapy is more about relieving immediate pain than getting rid of the underlying problem. If your pain persists beyond what your doctor tells you to expect (or beyond what feels normal to you), it’s worth getting a second look from your provider.
Turn Up the Heat
There is nothing better than a hot shower before bed, especially for folks with chronic arthritis pain whose joints get exhausted from daily activities. “Warmth opens capillaries and brings circulation to an area,” Dr. Bergin explains. This loosens up your joints and muscles, making it easier to stretch and literally “warm up” your body. Entire exercise regimens are based around this concept—ever tried hot yoga?
Heat therapy comes in two forms: moist heat (like a hot bath or towel) and dry heat (heating pad). Though both can help reduce pain, research has shown that moist heat is better at permeating deep muscle tissue. “Moist heat can be useful to penetrate into tight and sore muscles and help alleviate some of the tension,” Dr. Shah suggests. Feel free to experiment and see which method works best for you. Quick DIY tip: To make a dry heating pad, take a clean sock, fill it with uncooked rice, tie it shut, and put it in the microwave for about one minute. If you prefer moist heat, you can always run a towel under warm water and wrap it around the affected area.
Heat is great for arthritis-related stiffness and other chronic pain conditions, but it is not the best choice for an acute injury or surgery recovery. “If there is a fresh wound, I would advise a patient not to utilize any heat on top of this wound,” Dr. Shah says. “In addition, after a procedure or surgery, there should be no heat applied to the incision or procedural site post-surgery within the acute postoperative period.” In these situations, heat can make the swelling worse. She adds: “If a wound or procedural site ever looks red, angry and is oozing, a patient should immediately call their physician.”
Lawrence cautions that people with rheumatoid arthritis should be careful using heat during a flare because it can sometimes exacerbate inflammation. “It is an inflammatory process, so we don’t want to add heat to that process … or swelling and flexibility to those particular joints,” she explains. Still, some people with RA swear by warm water or a warm towel to help ease their morning stiffness, so it really depends on the situation and context. Talk to your doctor about what’s safest for you.
Hot Versus Cold
Everyone’s body is different, so it may take some trial and error to figure out whether heat or cold therapy provides you with the most relief. “All of us stand to benefit from heat and cold therapy,” Dr. Bergin says. “If aching muscles and joints feel better after applying a little ice or heat, then there is benefit.” As a general rule, remember to use cold for an injury and heat for more chronic pain, and to proceed with caution using these therapies after exercise-induced soreness. Of course, trust your physician if they tell you otherwise because they have the most knowledge of your condition.
It’s also worth noting (yet again) that heat and ice won’t heal underlying medical problems; they’re best used in tandem with medications or other long-term treatment approaches. “A multimodal approach to pain management is always key,” Dr. Shah says, “and therapies such as ice and heat can provide some level of comfort without major side effects.” As always, your doctor is your best resource for helping you craft a well-rounded treatment plan.
Heat Therapy: Arthritis Foundation. (n.d.) “Heat Therapy Helps Relax Stiff Joints.” https://www.arthritis.org/health-wellness/healthy-living/managing-pain/pain-relief-solutions/heat-therapy-helps-relax-stiff-joints
Ice & Delayed Muscle Regeneration: Journal of Applied Physiology. (2021.) “Icing after eccentric contraction-induced muscle damage perturbs the disappearance of necrotic muscle fibers and phenotypic dynamics of macrophages in mice.” https://journals.physiology.org/doi/abs/10.1152/japplphysiol.01069.2020
Moist Vs. Dry Heat: Journal of Clinical Medicine Research. (2013.) “Moist Heat or Dry Heat for Delayed Onset Muscle Soreness.” https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3808259/