For muscle pain (myalgia), should I apply ice or heat compression?

Ice for Acute Myalgia, Heat for Chronic Muscle Pain

For acute muscle pain (myalgia), use ice compression during the first 48-72 hours; for chronic or persistent muscle pain, use heat therapy instead. 1

Acute Myalgia (First 48-72 Hours): Use Ice

The American Academy of Family Physicians and American Heart Association both recommend ice as the primary treatment for acute muscle pain and injuries. 2, 1 The rationale is straightforward: ice 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

• Use ice mixed with water in a plastic bag, wrapped in a damp cloth—this achieves superior tissue cooling compared to ice alone or commercial gel packs. 2
• Apply for 20-30 minutes per session (10 minutes is acceptable if 20-30 causes excessive discomfort). 2, 1
• Repeat 3-4 times daily during the acute phase to sustain reduced muscle temperature and provide better pain and swelling control. 2
• Never apply ice directly to skin—always use a barrier such as a thin towel or damp cloth to prevent frostbite and cold injury. 2, 1
• Continue for 48-72 hours after injury when inflammation and swelling are most active. 1

Important Caveats About Ice Therapy

While ice provides effective short-term pain relief, the evidence shows it does not accelerate functional recovery or return to activity—the main benefits are acute pain and swelling reduction only. 2 Additionally, reflex activity and motor function are impaired for up to 30 minutes following ice treatment, potentially increasing susceptibility to reinjury during this window. 3

Chronic or Persistent Myalgia: Use Heat

The American College of Physicians recommends heat therapy as more effective for chronic or persistent muscle pain. 1 Heat works by increasing blood flow to the affected area, which helps deliver nutrients and remove waste products. 1

Evidence Supporting Heat for Chronic Pain

• Moderate-quality evidence shows that a heat wrap moderately improves pain relief and reduces disability compared with placebo. 1
• Heat wrap provides more effective pain relief compared with acetaminophen or ibuprofen after 1-2 days (low-quality evidence). 1
• For some conditions, heat plus exercise provides greater pain relief compared with exercise alone. 1

Clinical Decision Algorithm

Timing of injury determines the modality:

1. 0-48 hours post-injury: Ice compression (acute inflammatory phase)
2. 48-72 hours post-injury: Continue ice if pain persists with ongoing signs of inflammation 2
3. Beyond 72 hours or chronic pain: Switch to heat therapy 1

Red Flags Requiring Medical Evaluation

Seek medical evaluation if the patient: 2

• Cannot bear weight
• Has severe or worsening pain
• Shows no improvement after 3-4 days of appropriate ice therapy and rest

Common Pitfall to Avoid

Do not rely solely on passive treatments (ice or heat) without incorporating active rehabilitation with progressive exercises—this can hinder recovery and lead to muscle atrophy with delayed recovery. 1 The evidence consistently shows that functional treatment with early mobilization is superior to prolonged immobilization. 4