Heat or ice: which should you use for muscle pain?

Heat pack or ice pack sits in the top five questions we are asked, and the internet is full of contradictory answers. The practical rule we give clients is simple: ice for the first two days of a new injury if it helps the pain, heat for tight, stiff and aching muscles after that. Here is the reasoning and the exceptions.

Ice: fresh injuries and hot, swollen spots

In the first 48 hours after a strain, sprain or knock, the tissue is inflamed and swelling is still building. Ice numbs the area and reduces pain, and brief periods can limit excess swelling. Use a wrapped ice pack or frozen peas for 10 to 15 minutes, with a cloth between the ice and your skin, and let the area return to normal temperature between applications.

Current sports medicine guidance has moved away from icing everything for days on end, because some inflammation is part of healing. Use ice for comfort in the acute period rather than as a cure, and combine it with gentle movement and compression. We cover the early days of a strain in the first 48 hours after a muscle strain.

Heat: stiffness, tension and old aches

For a stiff neck in the morning, a tight lower back after a long drive, or muscles that are sore from training or sitting, heat is the better choice. It increases blood flow, relaxes muscle tone and makes stretching and movement easier. A wheat bag, heat pack or warm shower for 15 to 20 minutes before exercises or before bed works well. Heat is also what we suggest for the day-after soreness from dry needling or deep tissue work.

The exceptions

• Numbness or reduced sensation in the area: avoid both until you have been assessed, because you may not feel a burn or frostbite.
• Poor circulation, diabetes or skin conditions: check with your doctor about heat and ice use.
• A hot, red, swollen joint with fever: see a doctor rather than treating it at home.
• Night-time back pain that does not change with position: see a doctor; this is not a heat-or-ice question.

What usually works better than either

Heat and ice are comfort measures. The things that change a muscular problem are movement, the right exercises and, when tension is deep or long-standing, hands-on treatment to release it. If you find yourself reaching for the heat pack every evening for the same spot, that is a sign to book an assessment and fix the cause.