How to choose between ice and heat when dealing with pain

Are you in pain? Are you confused if you should manage your pain with heat or ice? Lets decode this for you and teach you what to use when.

Understanding the role of heat.

Heat or thermo therapy helps boost and increase the local and superficial tissue temperature, which causes dilation of blood vessels (vasodilation). This improves and increases the blood supply locally in the area where heat is applied which causes relaxation of the muscles and other soft tissues around the joints which soothes the nervous system and helps reduce pain and stiffness. Heated water bags, electric heating pads, hot baths, etc are common and some popular age-old techniques that are believed to help manage pain. Heat works great with chronic pain , stiffness and spasms.

Some ways to use heat

Application of heated water bags, moist heat pack, electric heating pads, hot towels, hot baths, hot showers, immersion of a distal body part in a tub/bucket filled with hot water.

Ideal temperature range should be around 40-45 degree Celsius (or as tolerated). Anything higher than that will cause burn risk.


10-15 mins per application – 2-3 times a day or as needed.


Do not apply on a swollen body part, fresh injury or if there is redness and warmth. Remember! You don’t want to heat up an already warmed up tissue. Additionally don’t use heat if you have numbness in the body part and cannot feel temperatures or sensations, if you have open wounds or if you have vascular deficits. Use with caution and frequent visual inspections if you are a diabetic.

Understanding the role of ice

Ice or Cryotherapy is another form of modality used to manage pain. What ice application does is, it initially reduces the blood flow to the injured through constriction of the blood vessels (vasoconstriction). This helps reduce the local pressure on the injured tissues and the surrounding structures as a result of swelling and inflammation that was caused because of a recent injury or inflammation from a chronic condition. You can think about this as cooling down an angry area in the body (viz the injured body part). Cryotherapy is also a numbing agent and acts as a local anesthetic.

Some ways to use ice

Apply gel ice packs or make your own with crushed ice and water sealed in a bag. Gently massage the injured area with an ice cube, immersion of distal body part in a tub/buckets with ice chips and cold water.

Ideal temperature should be around 0-1.7 degree Celsius or as tolerated. Anything lower will put you at a risk for ischemia.


15 mins for 2-3 times a day or as needed


Don’t put ice directly on your skin, wrap it up in a piece of cloth/plastic and apply petroleum jelly on your skin to protect it. Use ice with caution if you are a diabetic, frequent visual inspections are recommended. Avoid using ice if you have vascular insufficiency.

Remember to listen to your body. If you have symptom exacerbation with any of these methods, discontinue use and consult your healthcare provider.

Old injuries , Chronic pain Recent Injuries , Acute pain, Sub-acute Pain or Chronic Pain
Indications Aches , Spasms Inflammation , Swelling
Stiffness Redness , Warmth
Contraindications Numbness, loss of sensations, acute injuries, swelling , redness and warmth in the body part, vascular insufficiencies Numbness, loss of sensations, Reynaud’s phenomenon, skin sensitivity, vascular insufficiencies
Helps with Increasing blood supply, relaxation, reducing stiffness, pain relief, calming, improving mobility Numbing, reducing local inflammation, reducing swelling, pain relief, post exercise soreness, muscle soreness