Does icing or heating help with pain and inflammation?

Ice vs. Heat for Pain and Inflammation

For acute injuries with inflammation, use ice for the first 48-72 hours; for chronic or persistent pain without acute inflammation, use heat therapy. 1

Acute Pain and Inflammation (First 48-72 Hours)

Ice is the treatment of choice for acute injuries because it reduces tissue metabolism, blunts the inflammatory response, and decreases swelling by slowing the release of blood and proteins from surrounding vasculature. 1

Proper Ice Application Technique

• Apply ice wrapped in a damp cloth (melting iced water is most effective) for 10-20 minutes at a time, several times daily during the first 48-72 hours after injury 1, 2
• Use intermittent applications of 10 minutes rather than continuous 20-30 minute sessions—this approach maintains reduced muscle temperature more effectively while allowing superficial skin temperature to normalize between applications 2, 3
• Repeat applications 3-4 times daily for optimal therapeutic effect 1
• Never place ice directly on skin—always use a barrier like a damp towel to prevent cold injury 4, 1
• Target temperature reduction of 10-15°C in the affected tissue 2

Important Caveats for Ice Therapy

• Reflex activity and motor function are impaired for up to 30 minutes following ice treatment, making patients more susceptible to re-injury during this period 2
• Limit each application to 20-30 minutes maximum to avoid tissue damage from prolonged cold exposure 4, 1
• Avoid ice on large burn areas as even brief exposure can cause further local tissue injury and hypothermia 4

Chronic or Persistent Pain (After 48-72 Hours)

Heat therapy is more effective than ice for chronic muscle pain, with moderate-quality evidence showing that heat wraps moderately improve pain relief and reduce disability compared to placebo. 4, 1

When Heat is Superior to Ice

• Heat provides more effective pain relief than acetaminophen or ibuprofen after 1-2 days for chronic conditions 4, 1
• For chronic low back pain specifically, moderate-quality evidence demonstrates that heat wraps moderately improve both pain and disability 4, 1
• Heat works by increasing blood flow to deliver nutrients and remove waste products from the affected area 1
• For chronic tendinopathies, heat is more beneficial than ice because these conditions involve degenerative changes rather than acute inflammation 1

Proper Heat Application Technique

• Apply heat for 20-30 minutes at a time, 3-4 times daily 5
• Ensure the heat source is approximately body temperature or slightly warmer—not too hot 5
• Avoid direct contact between heat source and skin to prevent burns 5
• Do not apply heat for more than 30 minutes at a time to avoid tissue damage 5

Contraindications for Heat

• Avoid heat if there are signs of acute inflammation such as significant swelling or redness 5
• Do not use heat in individuals with impaired sensation who may not feel if the heat is too intense 5

Condition-Specific Algorithm

For Acute Sprains and Strains:

• 0-72 hours: Ice wrapped in damp cloth, 10-20 minutes, 3-4 times daily 1
• Consider adding compression wrap after application to promote comfort 1
• After 72 hours: Transition to heat if inflammation has resolved 1

For Acute Low Back Pain:

• Heat wrap is more effective than ice even in the acute phase, with moderate-quality evidence showing improved pain relief and disability compared to placebo 4, 1
• Heat plus exercise provides greater pain relief than exercise alone at 7 days 4

For Muscle Spasms:

• Heat therapy is recommended for active muscle spasms, applied 20-30 minutes at a time, 3-4 times daily 5

Critical Pitfall to Avoid

Relying solely on ice or heat without incorporating active rehabilitation and progressive exercises will hinder recovery. 1 Prolonged immobilization leads to muscle atrophy and delayed recovery, so passive treatments should be combined with appropriate movement and strengthening as tolerated. 1