Woman relaxing with a heated neck and shoulder wrap

Heat or Ice for Pain? A Simple Guide to Choosing the Right One

Short answer: use ice for a new injury, swelling or a flare-up that feels hot, mainly in the first 48 hours. Use heat for stiffness, tight muscles and aches that have been around for a while. Ice calms things down by narrowing blood vessels and numbing the area. Heat loosens things up by increasing blood flow and relaxing muscle. If you remember only one rule: swollen and recent means cold, stiff and ongoing means warm.

When should I use ice?

Cold is for acute problems. Johns Hopkins Medicine and Harvard Health both recommend cold for recent injuries because it reduces blood flow to the area, which limits swelling and dulls pain signals.

  • A sprained ankle, a twisted knee or a pulled muscle in the first one to two days.
  • A joint that is visibly swollen or feels warm after activity.
  • Tendon pain that has just flared up, such as tennis elbow after a weekend of yard work.
  • Sore spots after a hard workout.

How to do it: wrap a gel pack or ice in a thin cloth and apply it for 10 to 20 minutes at a time, with at least an hour between sessions. Never put ice directly on bare skin.

When should I use heat?

Heat is for chronic, stiff and tight problems. Warmth widens blood vessels, brings more blood to the tissue and makes muscles and connective tissue more flexible.

  • A stiff lower back or neck, especially first thing in the morning.
  • Osteoarthritis stiffness in the knees, hips or hands.
  • Muscle knots and tension in the shoulders.
  • Menstrual cramps.
  • Warming up a stiff joint before gentle exercise or stretching.

How to do it: apply a heating pad, microwavable wrap or warm towel for 15 to 20 minutes. It should feel comfortably warm, not hot. Moist heat, such as a warm damp towel or a warm shower, tends to penetrate better than dry heat. Do not fall asleep on a heating pad unless it has an automatic shut-off.

Our heating products include wraps shaped for the neck, shoulders, back and knees. For cold therapy, see our cooling products.

Should I use heat or ice for lower back pain?

For a back that suddenly "went" while lifting, start with ice for the first day or two, then switch to heat once the sharp, inflamed feeling settles. For the far more common ongoing, achy, stiff lower back, heat usually feels better and helps you move, and moving is what helps a back recover. If sitting is what sets your back off, read our guide to lower back pain from sitting.

Should I use heat or ice for arthritis?

Both have a place. Mayo Clinic's advice for arthritis is to use heat, such as a warm bath or heating pad, to ease stiff joints, and cold to calm a joint that is swollen or painful after activity. Many people with arthritis use heat in the morning to get moving and cold in the evening if a joint has puffed up.

Can I alternate heat and ice?

Yes. Alternating is safe for most people and some find it works better than either alone, for example for a sore knee after a long walk or for stubborn muscle tightness. A simple routine is 15 minutes of cold, a break of an hour or two, then 15 minutes of heat. Leave the area to return to normal temperature between applications.

When should I not use heat or ice?

  • Do not use heat on a fresh injury, on an area that is already swollen, red or hot, on open wounds, or over skin with reduced sensation.
  • Do not use ice on stiff muscles right before activity, on areas with poor circulation, or if you have a condition such as Raynaud's that makes you sensitive to cold.
  • Take extra care if you have diabetes, neuropathy or any condition that reduces feeling in your skin. You may not notice a burn or frostbite developing. Ask your doctor what is safe for you.

When should I see a doctor instead?

See a doctor if pain follows a significant fall or accident, if a joint looks deformed or cannot take weight, if swelling keeps increasing after 48 hours, if you have numbness or weakness, or if pain has not improved after a week or two of home care.

Key takeaways

  • New, swollen or hot: use cold, 10 to 20 minutes, cloth between ice and skin.
  • Old, stiff or tight: use heat, 15 to 20 minutes, warm not hot.
  • For a sudden back strain, ice first, then heat after a day or two.
  • For arthritis, heat for stiffness and cold for swelling.
  • Be careful with both if you have reduced skin sensation or circulation problems.

Sources

This article is general wellness information and is not medical advice. It does not replace an examination by a qualified healthcare professional. If your pain is severe, sudden or getting worse, please see a doctor.

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