Hot vs. cold - the do's and don'ts

Hot vs. Cold: The Do’s and Don’ts

Cryotherapy (ice) and thermotherapy (heat) are some of the most frequently used forms of non-invasive at-home therapy treatments, but also some of the most misused. Their popularity is understandable: they are both inexpensive, reasonably effective and simple to use. But their accessibility and seeming simplicity also contributes to their misuse. Although heating or icing certain injuries incorrectly doesn’t usually have long-term, harmful effects, the misuse of these therapy methods can cause disruptions in the healing process and sometimes exacerbate pain.

To avoid any potential issues with recovery, we at The Physio Clinic @ West Durham have outlined some of the do’s and don’ts for heat and ice therapy. It is important to note that these therapy options are not foolproof nor are they universally effective; furthermore, neither of these therapies necessarily promote healing, but are rather analgesics that contribute to pain management. Also worth noting is these treatment options are best used in conjunction with oral or topical analgesics (more about this below) and when your injury has been clearly identified by a certified healthcare practitioner, such as a member of The Physio Clinic @ West Durham team!

How They Work

Theoretically, ice therapy is used whenever there is inflammation, such as at the site of a fresh injury where the superficial tissues are red, hot or swollen. This inflammatory reaction is completely natural – and necessary – but the amount of pain associated with this process is not required, which is why applying ice to the injury immediately helps to reduce both the inflammation and the amount of pain.

It essentially works as an analgesic that helps to numb the nerve endings that are releasing pain signals to the brain, while the cooling sensation can help reduce the irritation caused by the heat and swelling at the injury site.

Heat therapy, on the other hand, is generally recommended for stiff and sore muscles, or chronic issues, like tendonitis and stress pain. Naturally, you wouldn’t want to apply heat to a fresh injury where the site is already hot and inflamed. There are two main types of heat therapy: dry and moist. Dry heat includes sources like saunas and heating pads while moist heat includes hot baths and moist heating packs. For more specific and local injuries (like a sore neck), heating pads or packs are the best options, while hot baths can be great for generalized muscle stiffness.

These heat therapy options all work in a similar way: they each improve circulation and blood flow, while soothing certain trigger points within the joint or tissue that are causing pain.

The generally-accepted rule of thumb has been that ice therapy should be used on fresh injuries (i.e. a sprained ankle) while heat therapy should be used for stiff, aching muscles and joints. But, as with most rules, there are exceptions! Here are some do’s and don’ts to help you determine which therapy option is best for pain:


1.) Do use ice therapy for fresh injuries or traumas to the muscle (if it is definitely a muscle injury) for the first few days after the injury occurs. You’ll know if it is a true muscle injury or tear if there is a sudden, severe pain after a period of straining. Even in the event of a tear, the ice will help to reduce inflammation.
2.) Do use heat therapy for older muscle injuries or chronic pain and muscle stiffness, especially those associated with the neck and back.
3.) Do use warm rather than hot temperatures when applying heat therapy to aching and stiff muscles.
4.) Do use ice therapy for chronic injuries like plantar fasciitis, shin splints, iliotibial band (IT band) syndrome, patellofemoral pain syndrome (PFPS), and tennis elbow.
5.) Do speak to your physician or consult us at The Physio Clinic @ West Durham if you’re injury is not improving after a few days, or if you are unclear about what kind of injury you have sustained.
6.) Do stop icing your injury as soon as the area feels numb. Icing beyond this point can cause damage to the skin.
7.) Do Ice deeper, thicker injuries for longer periods of time (15-20 minute intervals) but do not apply ice directly to the skin surface. Use a thin cloth or towel as a buffer.
8.) Do use topical NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) like Voltaren® Gel, Fisciocrem SOLUGEL or arnica-based ointments.


1.) Don’t use ice on neck and back pain unless the pain is definitively from a fresh muscle injury (i.e. where redness and inflammation are identifiable). Since most back and neck injuries aren’t due to fresh trauma to a particular muscle, heat therapy is the safer way to go as the pain is most likely due to muscle stiffness. Applying heat to these irritated trigger points causing the aches will soothe them and reduce pain, while applying ice will actually aggravate these trigger points and further stiffen the muscles due to reduced blood flow.
2.) Don’t apply ice or ice packs directly to fresh injuries where the skin is broken as this can lead to infection and irritate the wound. Avoid direct contact with the wound and try to ice around the abrasion.
3.) Don’t use heat therapy to any injuries that are bruised or swollen as this will increase the existing swelling tremendously and further bruise the superficial layers of the affected area.
4.) Don’t use unregulated heat or ice therapy if you have a pre-existing condition that affects your sensory abilities, such as diabetes, dermatitis, vascular disease, deep vein thrombosis or multiple sclerosis. Contact your general practitioner or consult us at The Physio Clinic @ West Durham for appropriate treatment options.
5.) Don’t overuse over-the-counter oral NSAIDs (Nonsteroidal Anti-Inflammatory Drugs) such as Aspirin or Advil for pain management.

Contact us today to schedule an appointment with one of our trusted clinicians if you are having issues treating a persisting injury!