ice vs heat

Grudge Match Revisited - Ice or Heat For Aches & Pains?

It’s been some time since we visited this age-old grudge match so I felt it was time to refresh and re-visit. What is the latest thinking and latest information from the experts on the best thing to use? Is it ice or is it heat?

The first thing I would share with you is the fact that I could not begin to count how many times I’ve been asked the questions over my twenty-plus years in healthcare. “Should I put ice on it when I get home or heat?” says Ice is for injuries and Heat is for muscles, chronic pain, and stress. 

In the words of the world-wide back pain expert, Dr. Stuart McGill, “It depends.”

Ice vs. Heat depends on a few factors:

  • How new or old is the injury or pain? 

  • How severe is the pain?

  • Is there bruising or inflammation?

  • Are there any underlying issues?


How new or how old is the injury or pain?

There is one really simple rule of thumb; if it’s brand new, ice probably makes more sense. If it is more than 3-6 hours old, heat probably makes more sense. Let’s spend a few minutes picking that apart shall we? Ice closes the vasculature. It slows down everything in the area. When vasculature is constricted, it makes sense that inflammation and bruising is lessened. 

On the opposite end of the spectrum, when you heat an area, the vasculature is dilated or expanded. When you expand the vasculature, you will increase the blood flow. Not only that but think about the grade school science experiment where you heat a balloon and it grows and expands. You didn’t put any extra air into the balloon but you excited the molecules. If we excite the area of injury, it isn’t hard to picture an increase in excited tissues which should reasonably lead to more rapid healing. 

If we are thinking purely in these terms, it makes sense that, after initial injury, treating with ice would do nothing significant in benefit and would actually likely slow down the healing process. 

How severe is the pain?

When you put ice on something, it numbs it. In keeping with that thinking, it makes sense that a fresh, very painful injury can be calmed a bit by numbing the area with ice. I remember when I was a kid, I had a tooth go bad on me. Tylenol or ibuprofen did not touch the pain but an ice pack to the jaw got me through the night and day until I could get to the dentist. I would say ice could be used the same way. If pain is really getting your attention, an ice pack can buy you a little time until you can get to the doctor’s office. 

We see athletes using cryotherapy and even cryo chambers after strenuous activities, games, or practices to avoid muscle damage and hopefully decrease the onset of muscle soreness. 

Is there bruising or significant inflammation?

The main purposes of treating something with ice would be to decrease pain, decrease swelling/inflammation, and decrease bruising. For me personally, I am not concerned with bruising unless the bruise in on the face. Otherwise, bruises are badges of courage. Proof of battle! 

Bruising and inflammation commonly occur in the very first stages of a fresh injury. As mentioned before, after the first 3-6 hours or so, it is hard to imagine bruising or inflammation continuing to be a problem. Therefore, heat is probably more effective beyond 3-6 hours after onset of the injury. 

Are there any underlying issues?

For heat, according to, you should not use heat if you have one of the following pre-existing conditions:

  • Diabetes
  • Dermatitis
  • Vascular Diseases
  • Deep vein thrombosis
  • Multiple Sclerosis

You would also avoid heat if you:

  • The skin is hot or red
  • The person has dermatitis or an open-wound.
  • The area is numb and a person cannot feel tissue damage
  • The person is insensitive to heat because of an underlying issue like diabetes

For cold therapy, you should not use if you have a sensory disorder that prevents you from feeling certain sensations. The most common of these being diabetes. You should also avoid icing stiff muscles or joints or if you already have poor circulation. Imagine constricting the vasculature in a patient that already has poor circulation! That would not be a great idea. You also should not use ice just prior to the activity. This makes sense; you would want you muscles and joints to be relatively warmed up before any significant use. 

Medical News Today says that heat should not be used on a new injury, an open wound, or if the person is already overheated and ice should not be used if the person is already cold and applying ice to tense or stiff muscles in the back or neck might actually make it worse. 

At the end of the day, it is important to understand that neither ice nor heat is particularly potent or can be considered strong medicine. We mostly use these two modalities because they are extremely inexpensive, they can be mildly effective when used correctly, they are mostly safe, and they can even have use as a placebo. 

Placebo has a bad rep. If we can use these modalities, even to a mild effect, AND we can get some benefit in the placebo realm, why on Earth would we not leverage it to the advantage of the patient?


Dr. Jeff Williams, DC, FIANM is a Fellowship-trained Neuromusculoskeletal specialist and chiropractor in Amarillo, TX. As an Amarillo chiropractor, Dr. Williams treats chronic pain, disc pain, low back pain, neck pain, whiplash injuries, and more. Dr. Williams is also the host of The Chiropractic Forward Podcast. Through the podcast, Dr. Williams teaches fellow chiropractors and advocates weekly for evidence-based, patient-centered practice through current and relevant research. If you have any questions for Dr. Williams, feel free to email at [email protected]

Learn more about Dr. Williams and his practice at Dr. Williams's full-time Amarillo chiropractic practice is Creek Stone Integrated Care at 3501 SW 45th St., Ste. T, Amarillo, TX 79109 






Jeff S Williams, DC, FIANM, DABFP

Jeff S Williams, DC, FIANM, DABFP


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