Ice or Heat: Which One Should You Use for Pain Relief?

Melanie Wintle
Mar 23
4 min read

One of the most common questions I get as a chiropractor is: Should I use ice or heat for my pain?

Whether it’s a stiff back, a sore knee, or a sudden injury, people are often unsure which one will help the most. The truth is, both ice and heat can provide relief, but choosing the right one depends on what’s causing your discomfort.

Let’s break down when to use ice, when to use heat, and when a combination of both might be the best approach.

How Ice and Heat Work

Ice and heat work in opposite ways, which is why choosing the right one matters.

Ice reduces blood flow by constricting blood vessels, which helps limit swelling and numb the area. It acts as a natural painkiller, temporarily dulling nerve activity. While some swelling is necessary for healing, bringing nutrients to repair tissue or fight infection, too much can increase pain and stiffness. Ice helps balance this by controlling excessive inflammation.

Heat increases blood flow by dilating blood vessels, which helps relax muscles, improve flexibility, and deliver oxygen and nutrients to tissues. This makes it great for easing stiffness and chronic aches. It also promotes healing by improving circulation and helping flush out waste products.

So, when should you use which?

When to Use Ice

Ice is best for new injuries and inflammation. If you rolled your ankle, tweaked your knee, or strained a muscle, ice can help control swelling and prevent further tissue damage.

Ice is Best For:

✔ Acute injuries – Sprains, strains, or bruises that are swollen and red.

✔ Tendinitis – Overuse injuries where tendons become inflamed, like tennis elbow or Achilles tendinitis.

✔ Gout flare-ups – Ice can ease inflammation and reduce sharp joint pain.

✔ Headaches & migraines – A cold pack on your temples or neck can reduce blood flow and numb pain.

How to Apply Ice:

Use an ice pack, frozen vegetables, or a gel pack wrapped in a thin towel to protect your skin.
Apply for 10–15 minutes at a time, then take a break.
Avoid using ice for more than 20 minutes per session, as prolonged exposure can cause frostbite or nerve damage.
Repeat every couple of hours as needed, especially in the first 24–48 hours after an injury.

When to Use Heat

Heat is best for chronic pain and muscle tension. If you wake up with a stiff back or feel tight from stress, heat can help loosen things up.

Heat is Best For:

✔ Muscle stiffness & knots – Heat increases circulation, helping tight muscles relax.

✔ Arthritis – Warmth can reduce joint stiffness, especially in the morning.

✔ Tension headaches – Applying heat to your neck and shoulders can ease muscle tightness that contributes to headaches.

✔ Menstrual cramps – A heating pad on the lower back or abdomen can relax cramping muscles.

How to Apply Heat:

Use a heating pad, warm towel, or soak in a warm bath.
Limit sessions to 15–20 minutes to avoid burns or overheating.
Be cautious with heating pads—falling asleep with one can increase the risk of burns.
Moist heat (like a hot shower or warm compress) penetrates deeper than dry heat and may be more effective for muscle tightness.

When to Use Both (Contrast Therapy)

Sometimes, alternating ice and heat, a method called contrast therapy, can be helpful.

How Contrast Therapy Works

Contrast therapy involves switching between cold and heat, triggering a pumping effect in your blood vessels. Cold causes vasoconstriction (narrowing of blood vessels), reducing inflammation and numbing pain, while heat causes vasodilation (widening of blood vessels), increasing blood flow and delivering oxygen and nutrients to tissues.

This alternating effect enhances circulation, flushes out waste products, and stimulates the lymphatic system, which plays a role in reducing swelling and promoting recovery. Studies suggest that contrast therapy may improve oxygen supply in muscles, helping reduce pain and speed up healing (source).

How to Try Contrast Therapy:

Apply 10 minutes of ice, followed by 10 minutes of heat.
Repeat a couple of times, always ending with ice if inflammation is still present.
Some people find contrast therapy useful for chronic pain or muscle soreness.

Personal Preference Matters

While there’s science behind when to use ice or heat, personal preference plays a role, too. Some people hate the cold, while others find heat unbearable. If one method isn’t helping, try the other, the goal is to feel better, and both modalities have research backing their effectiveness.

When to Seek Professional Help

If your pain isn’t improving with ice or heat, or keeps coming back, it may be a sign of an underlying issue that needs attention. Persistent joint pain, muscle stiffness, or recurring injuries can often be managed with targeted exercise rehab and movement strategies.

As a chiropractor and exercise rehab specialist, I help people over 45 stay active, manage pain, and recover from injuries with personalized movement and rehab programs. If you’re unsure what’s causing your pain or need a recovery plan that fits your lifestyle, I can help.

My EASE program focuses on practical, sustainable exercise and positive lifestyle habits that fit into real life so you can build strength, overcome injury, and stay active in a way that works for you.

Ready to take control of your health and start living a more active life. Contact me today to learn more! Get started today

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References:

Cleveland Clinic. (n.d.). Should you use ice or heat for pain? Cleveland Clinic. https://health.clevelandclinic.org/should-you-use-ice-or-heat-for-pain-infographic

Hopkins Medicine. (n.d.). Ice packs vs. warm compresses for pain. Johns Hopkins Medicine. https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/ice-packs-vs-warm-compresses-for-pain

Malanga, G. A., Yan, N., & Stark, J. (2022). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury and pain management: A review. Pain Medicine, 23(2), 212–225. https://doi.org/10.1093/pm/pnab289

WebMD. (n.d.). When to use heat or ice for pain. WebMD. https://www.webmd.com/pain-management/when-use-heat-ice

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