Home / Blog October 23, 2023 Updated on November 16, 2023

7 min read

Your Guide To Using Heat And Cold For Pain Relief

It is not easy to choose between ice or heat for sore muscles. While heat helps with promoting blood circulation, coldness is best for reducing swelling and inflammation. Read on to learn how and when to use heat and cold for pain relief

Using heat and cold for pain relief


Heat treatment improves blood circulation which relaxes strained or pulled muscles.

Cold therapies reduce swelling, especially when applied within 48 hours after the injury.

It is best to avoid extreme heat and not to put ice directly on the affected area. 

Did you know?
Heat and cold therapy have been used for centuries, with ancient civilizations employing methods like hot stones and ice baths for pain relief.

Is heat or ice better for pain? The short answer is… it depends. Heat promotes blood and nutrient flow, which is ideal for stiffness or pre-activity warm-ups. Cold reduces swelling, making it suitable for short-term pain like sprains.

Heat therapy involves using items like hot water bottles, heated pads, or warm baths. Cold therapy utilizes cold water-filled bottles, freezer-cooled pads, or cold water applications. But, how exactly do you know if your muscle pain needs ice or heat? Below is a detailed guide containing this answer and more.

What Is Heat Therapy?

Heat therapy, also known as thermotherapy, involves applying warmth to your entire body or a particular affected area. Heat therapy comes in two main types: dry heat and moist heat, with the ideal temperature being “warm” rather than excessively hot.

  • Dry Heat (Conducted Heat Therapy): This form of heat therapy includes heating pads, dry heating packs, and saunas. Dry heat is simple to apply and can offer quick and effective pain relief.
  • Moist Heat (Convection Heat): Moist heat sources involve steamed towels, moist heating packs, or hot baths. Moist heat is often considered more effective and requires less application time for similar and longer-lasting results. 

In addition to these, professional heat therapy treatments are available, such as ultrasound-generated heat for conditions like tendonitis.

When applying heat therapy, you have options for targeting specific areas:

  • Local Therapy: Ideal for addressing small areas of pain, such as a single stiff muscle. You can use heated gel packs or a hot water bottle for localized treatment.
  • Regional Treatment: Effective for broader pain or stiffness. This can be achieved with a steamed towel, large heating pad, or heat wraps.
  • Full Body Treatment: Includes options like saunas or a soothing hot bath for overall relaxation and pain relief. 


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What Does Heat Therapy Do For You?

Is heat or ice better for muscle pain? It is important to consider the benefits that both of these therapies may give you. Heat therapy offers various advantages when applied correctly. So, if you’re wondering “What does heat do to muscles?”, here are some of the most common ways that heat therapy helps with muscle strains:

  1. Increased Blood Flow: Applying heat brings more blood to the area of application, hence promoting healing and relieving pain.
  2. Reduced Stiffness and Muscle Spasms: Heat effectively alleviates joint stiffness and muscle spasms, especially in cases of tight muscles.
  3. Lessened Painful Symptoms: Heat therapy is valuable for conditions like osteoarthritis and tendonitis because it helps in managing their symptoms.
  4. Pain Relief: It can relieve pain and spasms associated with neck or back injuries, including lower back pain or pain caused by over-exercising.
  5. Headache Management: When applied to the neck, heat can reduce spasms that trigger headaches and migraines

Studies reported by the National Institutes of Health (NIH) have shown that continuous low-level heat wrap therapy (CLHT) can effectively alleviate back pain. So if you're wondering how to heal lower back pain fast, heat therapy may be the way to go.

When Not To Use Heat Therapy

There are several cases where using heat therapy may not be helpful. So before you begin searching for warm packs for pain, you may want to consider when to steer clear of heat therapy. This is because in certain instances, using heat may make the pain you’re feeling worse instead of better. These cases include:

  • Bruised or Swollen Areas: If the area is bruised, swollen, or both, it is better to opt for cold therapy instead.
  • Open Wounds: Heat therapy should not be applied to an area with an open or bleeding wound.
  • Pre-existing Conditions: Individuals with conditions like dermatitis, vascular diseases, deep vein thrombosis, multiple sclerosis (MS), or hypertension should exercise caution and consult a doctor before using regular heat therapy. Pregnant individuals should also consider seeking medical advice before using saunas or hot tubs, particularly if it is on a regular basis. 

Additionally, heat is not suitable for injuries that are already warm, such as infections, burns, or fresh injuries. Therefore, consider steering away from heat therapy if:

  • The skin on the affected area is hot, red, or inflamed.
  • The person in pain has dermatitis.
  • The affected area is numb.
  • The person may be insensitive to heat due to conditions like peripheral neuropathy.
  • The individual has been diagnosed with high blood pressure. 

Lastly, when applying heat therapy, such as when using a hot pack for pain, you may want to consider the following:

  • Duration: Minor stiffness or tension may be relieved with just 15 to 20 minutes of heat therapy.
  • Moderate to Severe Pain: For more significant pain relief, longer sessions of heat therapy, such as a warm bath lasting between 30 minutes and 2 hours, may be beneficial. 

What Is Cold Therapy?

Cold therapy, also known as cryotherapy, effectively reduces pain and inflammation by decreasing blood flow to a specific area, particularly around joints or tendons. This reduction in blood flow helps alleviate swelling and the associated pain. Additionally, cryotherapy can temporarily diminish nerve activity, which further contributes to pain relief.

Various methods are available to apply cold therapy:

  • Ice Packs or Frozen Gel Packs: These are commonly used for localized treatment of an affected area.
  • Coolant Sprays: These are sprays that provide a quick, localized cooling effect without the need for placing something on one’s skin.
  • Ice Massage: This involves applying ice directly to the skin through massaging motions.
  • Ice Baths: These involve immersing the affected area in cold water, such as a leg or arm. 

There are additional forms of cold therapy, which are less popular, including:

  • Cryostretching: Utilizing cold to reduce muscle spasms during stretching exercises.
  • Cryokinetics: Combining cold treatment with active exercises, beneficial for ligament sprains.
  • Whole-Body Cold Therapy Chambers: Chambers that expose the entire body to cold temperatures for therapeutic purposes. 

Why Is Cold Therapy Good For You?

Cold therapy, or cryotherapy, offers several benefits

  1. Pain Relief: It eases pain by numbing the affected area. This is especially helpful for migraines for instance, where applying a cold wrap or mask can be effective.
  2. Swelling and Inflammation Reduction: Cold therapy effectively reduces swelling and inflammation.
  3. Bleeding Reduction: It can also minimize bleeding in the affected area.
  4. Relief From Painful Symptoms: Cold treatment is particularly beneficial for relieving symptoms that are associated with the following conditions: Osteoarthritis, Gout, Tendinitis (irritation in the tendons following activity). For osteoarthritis, for instance, the recommended usage includes an ice massage or applying a cold pad for 10 minutes on and 10 minutes off. 

When Not To Use Cold Therapy

Cold therapy is highly effective for various conditions but should be used with caution and avoided in certain situations:

  • Sensory Disorders: Individuals with sensory disorders that reduce their ability to feel sensations, such as those with diabetes-related nerve damage, should avoid using cold therapy at home due to the risk of not detecting potential tissue damage.
  • Stiff Muscles or Joints: Cold therapy should not be used on stiff muscles or joints.
  • Poor Circulation: Individuals with poor circulation should refrain from using cold therapy.
  • Risk of Cramping: You may want to avoid cold therapy if there is a risk of cramping, as cold can exacerbate this issue.
  • Already Cold or Numb: Consider not using cold therapy if you’re already cold or if the area is numb.
  • Open Wounds or Blisters: Cold therapy should not be applied to areas with open wounds or blistered skin.
  • Vascular Diseases or Injuries: Individuals with vascular diseases or injuries, or those with sympathetic dysfunction affecting blood flow, should also steer away from cold therapy.
  • Hypersensitivity to Cold: Cold therapy is not suitable for individuals who are hypersensitive to cold. This includes people that have frequent experiences of hypothermia.
  • Pre-Activity: Ice should not be used immediately before physical activity, this will make your muscles more tense and therefore, more likely to cramp.
  • Direct Skin Application: You may also want to avoid applying cold items directly to the skin, as it can lead to skin and tissue damage, potentially resulting in frostbite. 

Professional athletes may use various forms of cold therapy to reduce exercise-induced muscle damage (EIMD) and prevent delayed onset muscle soreness (DOMS). Research suggests that cold baths after exercise may help prevent DOMS

When applying cold therapy at home, use an ice pack wrapped in a towel or an ice bath, never directly on the skin, and do so as soon as possible after an injury. It is advisable to limit cold therapy sessions to short periods, typically 10 to 15 minutes, and to avoid exceeding 20 minutes in order to prevent nerve, tissue, and skin damage. Elevating the affected area can enhance the effectiveness of cold therapy.

What Does Hot And Cold Treatment Do?

In some cases, it matters whether you pick hot or cold for swelling or hot or cold for inflammation. However, in other cases, both heat and cold therapy can provide relief for various conditions. These include: osteoarthritis, rheumatoid arthritis, back pain, fibromyalgia, and neck pain.

Also, hot and cold compress benefits may be experienced when you have:

  • Muscle aches, spasms, and pains
  • Lower and upper back pain
  • Stiff, swollen, or tender joints
  • Finger, hand, or wrist pain
  • Knee pain 

Cold therapy constricts blood vessels, reducing circulation and pain. When the cold is removed, blood vessels expand (vasodilation), enhancing circulation and delivering nutrients to promote tissue healing. Alternating between heat and cold can be beneficial for conditions like osteoarthritis and exercise-induced injuries or delayed onset muscle soreness (DOMS).

Contrast water therapy (CWT), which combines both heat and cold, for instance, has been found to effectively reduce exercise-induced muscle damage (EIMD) and prevent DOMS, particularly among elite athletes. However, more research is needed to determine its superiority over other strategies like heat or cold therapy, stretching, or compression.

When To Call A Doctor

If the pain or swelling on the affected area is not relieved after trying either hot or cold therapy, consider seeing a medical professional for a diagnosis.

Also, if you notice any of the following signs after using a hot or cold compress, you may want to see a doctor:

  • New swelling, hives, or blisters
  • Purplish-red or dark red skin on the affected area 


Knowing when to use heat or cold therapy is essential for effective pain relief. Heat is suitable for joint stiffness, while cold is effective for acute pain and swelling. However, these therapies may not be suitable for individuals with certain conditions, such as diabetic neuropathy or Raynaud's syndrome, or for those who are very young, elderly, or have cognitive difficulties.

It’s important to monitor the temperature to prevent burns and cease treatment if it worsens discomfort. Therefore, it helps to invest in heating products that are ergonomically designed, with your well-being and safety in mind.

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While the effectiveness of these therapies varies, they are generally safe when used correctly. If little improvement is seen after a few days of regular use, consult a doctor for alternative treatments, and be sure to contact a healthcare professional if bruising or skin changes occur during treatment.


How Long Do You Alternate Heat And Ice?

Alternating between heat and ice typically involves applying ice for 15-20 minutes, followed by heat for the same duration. It’s important to listen to your body and not exceed these time frames. Some recommend ending with ice for its anti-inflammatory benefits.

Is It Good To Ice Then Heat Right After?

In most cases, it's not recommended to ice and then immediately apply heat right after. It is best to wait for roughly 1 to 2 minutes before alternating. The general guideline is to use ice first to reduce inflammation and swelling, followed by heat for relaxation and improved blood flow. Using them in tandem is usually directed by a healthcare provider for specific conditions.