A question that comes up just about every time someone is having pain is whether they should use heat vs ice. The traditional line of thinking is that you use ice if the injury is recent (meaning within 7-10 days) or if there is swelling, and you use heat for general soreness or chronic pains. There is research to support some of these ideas, but the newest evidence shows a slightly different story, especially when it comes to overuse injuries.

With regards to ice, there’s not much strong evidence to suggest that it’s as useful as we thought. Ice is typically used in any instance where swelling already exists or when swelling is likely to happen. As an extreme example, the vast majority of people have swelling after surgery, and icing is commonly prescribed to reduce swelling. With knee replacements (a very common and standardized procedure), icing can reduce swelling when combined with compression(1) (such as an ice wrap or a vasopneumatic device). This information could be applied to other severe injuries, like an ankle sprain with significant swelling, but that doesn’t necessarily mean this works for something like a sore muscle or joint from a heavy workout or a day in the garden(2).

Heat (in this case referring to a hot pack, often referred to as moist heat) has been shown to have similarly mixed results. Heat does have uses for arthritic pain(3), or more acute injuries for the low back or neck, such as a strain(4). In terms of being helpful for overdoing an activity though, heat has little benefit(2). Most individuals will find that heat at a comfortable temperature at the very least is calming, which has some value in pain reduction.

So if you are dealing with soreness after a lot of exercise or activity, what should you do? Oddly enough, activity itself can be used to help recover from activity. This is referred to as active recovery, meaning that you are doing some version of light activity to work the areas that are sore. Some examples could be walking, gentle stretching, or just doing a significantly easier version of the same activity you did to make you sore in the first place. Massage has been shown to be highly helpful as well, and may be one of the best things you could do(5).

If you are a person who is insistent on using heat and/or cold, however, you can try a contrast bath. This involves submerging the sore area into a bath of cold water for 1-2 minutes, and then quickly moving to a warm (not hot) bath of warm water for 2-5 minutes, and repeating the process for a total of 15-20 minutes. This does take some time, and it’s pretty difficult to do for certain areas like the back, hips/thighs, or shoulders. Submersion in water (regardless of temperature) has also been shown to be helpful(5). If you want some specifics on contrast baths, the Ohio State University has a protocol (linked here) that has specific temperatures and time frames.

If all of this sounds like there’s conflicting information, that’s because there is! Heat vs ice both have a fairly large body of evidence, and a lot of it is mixed. What you’ll find as you sort through the information is that the “best” choice is largely based on the individual’s preference. If you’re trying to recover from an intense day of activity or exercise though, there is a lot of evidence that points to massage and active recovery as the best options, but if you want to dip into a hot tub or bath of ice water, those certainly aren’t going to hurt.

Got questions? Feel limited in what you’re able to do?  The staff at Limitless Physical Therapy in Eugene, OR can show you how to discover your future without limits.

***The above information, including text, images, and all other materials, is provided for educational purposes only, and not as a replacement or supplement to professional medical advice.  Please contact a certified physical therapist, your primary physician, or a certified healthcare professional for any personal concerns.

1. Markert SE. The use of cryotherapy after a total knee replacement: a literature review. Orthop Nurs. 2011 Jan-Feb;30(1):29-36. doi: 10.1097/NOR.0b013e318205749a. Review. PubMed PMID: 21278552.

2. Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015 Jan;127(1):57-65. Epub 2014 Dec 15.  Review. PubMed PMID: 25526231.

3. Denegar CR, Dougherty DR, Friedman JE, Schimizzi ME, Clark JE, Comstock BA, Kraemer WJ. Preferences for heat, cold, or contrast in patients with knee osteoarthritis affect treatment response. Clin Interv Aging. 2010 Aug 9;5:199-206. PubMed PMID: 20711439; PubMed Central PMCID: PMC2920200.

4. Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. J Clin Diagn Res. 2014 Sep;8(9):LC01-4. doi: 10.7860/JCDR/2014/7404.4818. Epub 2014 Sep 20. PubMed PMID: 25386469; PubMed Central PMCID: PMC4225921.

5.  Dupuy O, Douzi W, Theurot D, Bosquet L, Dugué B. An Evidence-Based Approach for Choosing Post-exercise Recovery Techniques to Reduce Markers of Muscle Damage, Soreness, Fatigue, and Inflammation: A Systematic Review With Meta-Analysis. Front Physiol. 2018 Apr 26;9:403. doi: 10.3389/fphys.2018.00403. eCollection 2018. PubMed PMID: 29755363; PubMed Central PMCID: PMC5932411.