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Hot or Cold Therapy? Tips to Help You Decide

Which pain situation calls for hot, and which calls for cold therapy?

As a general rule:

  • Ice is used for acute injuries or severe pain (inflammation and swelling).
  • Heat is used for muscle aches / tenderness, pain or stiffness.
  • If it is new and there is pain, redness, inflammation and swelling, then ice it.  If it is an older, chronic problem or minor sore muscles then use heat.


  • Ice is used to treat new injuries, especially within the first 48 hours.
  • It helps to control the inflammatory response, which reduces swelling and pain, as well as bruising.
  • Ice is ideal for injuries such as sprains or strains.
  • The pain we experience is a result of inflammation and we need to reduce down this inflammation by applying coldness to the area.

What should I use as Cold Therapy?

  • There is no need to rush out and buy gels or sprays.
  • If you have an ice pack at home, then great use that.
  • Alternatively, a bag of frozen veg works just as good to get ice onto the targeted area.
  • You should never apply a frozen item directly to the skin, as it can cause damage to the skin and tissues. Always wrap in a towel first before applying onto the targeted area.

How Should I be using Cold Therapy?

  • Apply cold treatment as soon as possible after an injury.
  • Use cold therapy works best when used for repeated short periods of time.
  • Aim to apply the ice for 10 –15 minutes each time. Wait 40-60 minutes, and repeat again.
  • This can be repeated several times per day, as required.
  • Depending on the injury you can elevate the affected area for best results.

Think of it as similar to a building on fire. 

What do we need to put the fire out?  COLD.  We never think: “You know what this fire needs? More heat!  Bring on the heat!”

Contraindications to Cold Therapy:

  • Please be aware that if you have any sensory disorders that prevent you from feeling certain sensations should either avoid altogether or be extra careful when using cold therapy.
  • You need to reduce the application time, while closely monitoring your skin reaction.
  • This in particular include:
    • Diabetes
    • Nerve damage
    • Poor circulation


  • Heat can be beneficial for non-inflammatory body aches and chronic pains.
  • Heat relaxes the muscles, by increasing blood flow to the area, which therefore promotes healing.
  •  It is beneficial for reducing pain, joint stiffness and can decrease muscle spasm.

What should I use as Heat Therapy?

  • When we talk about heat please remember warm is the ideal temperature, instead of hot.
  • You could use small heated gel packs, hot water bottle or heat pack if you only want to treat an injury locally.
  • Taking a warm bath or shower can help, & pouring a cup of Epsom or magnesium salts into your bath will be an added bonus.
  • You should never apply heat such as a hot water bottle directly to the skin, as it can cause damage to the skin and tissues.

How Should I be using Heat Therapy?

  • Unlike cold therapy, which needs to be limited. Heat therapy is often most beneficial when used over a longer period of time.
  • Minor stiffness or tension can often be relieved with only 15 to 20 minutes of heat therapy.
  • Moderate to severe pain can benefit from longer sessions of heat therapy like warm bath, or shower.

Contraindications to Heat Therapy:

  • Make sure that if using a heat pad be careful when applying directly to skin, and if using a hot water bottle, never apply this directly onto skin, always use a cover or towel.
  • Never apply heat to an infection, open wound or fresh injury.
  • When applying heat if you have conditions such as those below ease on the side of caution and may need to be avoided altogether.  If you are unsure always consult with your medical professional prior to application.
    • diabetes
    • dermatitis
    • Vascular or cardiovascular diseases
    • multiple sclerosis (MS)
    • Any open wound or stitches must not be treated with heat.


  • Knowing when to use cold therapy and when to use heat therapy will significantly increase the effectiveness of the treatment.
  • Some situations will require both. For instance, arthritic patients or people with chronic sore backs, for example, may use heat for joint stiffness and cold for swelling and acute pain.
  • If either treatment makes the pain or discomfort worse, stop it immediately.

Dr Laura Nuttall DC

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