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Heat or Ice for Pain

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Whether to use heat or ice for pain is not something most people think about until they are in pain. When your back starts to hurt or you sprain your shoulder, though, making the right choice can be the difference between starting to feel better and prolonging the problem. Before we can decide which is best, we need to know what is going on inside an injury.



When a musculoskeletal injury occurs, some type of tissue is torn, and blood runs out into the surrounding area. Similar to when you cut your finger, but inside your muscles or joints. Depending on the type of tissue that is injured, we might call this a strained muscle or a sprained ligament. In any case, you now have the injury surrounded by blood and other body fluids that come out of the injured area. The body also tries to bring extra blood into the injury to help start the healing process. This extra fluid is what we call inflammation. It is the cause of redness and swelling, bruising, warmth and some of the pain.


While this blood is mostly helpful, it can also damage the surrounding healthy tissue as it cleans up the dead cells from the injury. Limiting that extra damage is the first thing we can do to help our bodies get back to normal.

What does heat and ice do for inflammation?
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Heat relaxes body tissues, and allows them to expand. Like a glassblower heating up some glass to form it, applying heat to an injury makes the muscles and ligaments more pliable. Unfortunately, in the early phase of an injury, expanding the tissues allows more blood to flow to the area and more inflammation to form. Heat often feels good, because expanding the surrounding tissues relieves some pressure, but can make the injury more painful once heat is removed, due to the added inflammation.


Applying cold to an injured area does the opposite of heat. It contracts tissues, and slows the blood flow. The slowing of the blood flow limits the amount of inflammation, and squeezes out the extra fluid that has already gathered.

The Verdict: Heat or Ice for pain?

Acute Injury

In the beginning stages of an injury, ice is the consensus best choice. That limits the damage that the spreading inflammation can do, and reduces the swelling that causes pain. Apply a gel pack to the painful spot for 20 minutes every hour. Don’t go longer than that since your body will start to warm the area to prevent frostbite after that time.

Subacute Phase

After the initial injury has calmed down, and you are in the healing phase, it becomes more cloudy as to whether to use heat or ice for pain. In my experience, I have found that staying with ice in this phase leads to faster healing. Imagine the tear in the muscle or ligament is like a tear in a pair of jeans. If you can bring the torn pieces closer to each other, they are easier to sew back together. The body tends to work the same way, if we can reduce the inflammation near an injury with ice, the torn parts of the muscle are in closer approximation, and can heal faster.

So when do you use heat at home?

There are a couple of exceptions to my rules.

  • One, is in contrast therapy. In the healing phase, when the pain has lessened, but you are not back to normal, you can alternate heat and ice, 20 minutes at a time. This gives the best of both worlds. Ice to keep the inflammation low, and heat to encourage blood flow. It is like a pump, the ice pumps the bad stuff out and the heat pumps the good stuff in.
  • Another instance when heat is recommended is arthritis. Arthritic pain flares up in injured joints like your hands or your back. It is usually a joint that has been a problem for many years, and may show signs of wear on x-ray. However, not every pain with arthritis on xray is from arthritis. You may need an experienced practitioner to help you figure out what is causing your pain. Arthritic pain can benefit from moist heat or a paraffin bath.
  • One other time that I recommend heat is during an activity. If you have a big golf tournament coming up that you can’t miss, or you have an injury, and are going to be walking all day, I think the Thermacare patches are a good option. You are going to be moving constantly, which will serve to keep the inflammation down, so the application of heat will not cause more swelling. When you are done with the activity, use ice for 20 minutes to flush the built up inflammation out again.

Let Dr French help you decide


Dr Thomas French is a Chiropractor in Norwalk, CT with years of experience in diagnosing and treating musculoskeletal injuries. He can help you figure out if heat or ice is better for your pain. If you are in the Norwalk area, click below to schedule an appointment. If not, contact us, and we will be happy to help.

Make an appointment with Dr French, Chiropractor in Norwalk, CT