A Blog of Ice and Fire: Evidence-based advice for using heat vs ice to treat injury or alleviate pain

A Blog of Ice and Fire: Evidence-based advice for using heat vs ice to treat injury or alleviate pain. Written By: Alicia Walker, PT, DTP, CMT, RYT

Ok, I know Game of Thrones is old news in this fast paced world of modern pop-culture, (especially after that anti-climactic series finale, right?), but the reference plays directly into the subject of this blog too well to pass up, demonstrating beautifully the divide amongst clinical healthcare practitioners, research, and even down to personal preference. I get the question from my patients often: Do I use heat or ice to treat my injury or alleviate my pain? First, let’s take a look at what the research tells us.

After researching this topic thoroughly, I’ve concluded that there is no one right answer, but rather that it depends on the injury type, acuity, presence of edema or muscle spasm. So, you may be asking how do I choose? In order to help you make an informed decision I condensed down  my research into several images below. The first shows the physiological effects of heat vs cold therapy:

It’s also important to note that different types of heat and cold application as well as safety precautions to avoid damaging tissues. Below is a chart of commonly used heat and cold applications, what conditions/injuries to use them with as well as how to avoid injury while using them. This chart is by no means exhaustive, but is meant to serve as a guide for easy and safe at home heat and cold therapies:

HeatHydrocollator pack; Electric heating pad; Therapeutic ultrasound; Paraffin bath; Low level heat wrapArthritis, chronic pain, muscle spasm, DOMS, Menstrual painConsult a PT or MD if you have: Diabetes Mellitus-Connective tissue disorder-Multiple Sclerosis-You are pregnant-Peripheral Vascular disease-Spinal Cord injury
ColdIce pack; Ice massage; Cold whirlpool/bath; Vapo-coolant sprayAcute injury/trauma, chronic pain, inflammation, -Circulatory condition: Consult a PT or MD before use if you have: Diabetes Mellitus-Nerve damage-Raynaud’s Disease-Cold allergy

If you’re interested in the application of modalities such as therapeutic ultrasound, hydrocollator hot packs, ice massage, or more specific recommendations for your individual injury I’d recommend getting a referral to your local Physical Therapy clinic. At PacificPro Physical Therapy I evaluate patients and recommend a heat or cold therapy regimen backed by research and specific to my patient’s needs that compliments their treatment plan.


Nadler et al. Cryotherapy and Thermotherapy for the Pain Practitioner. Pain Physician Vol. 7, No. 3, 2004.

Tremblay F, Estephan L, Legendre M, Sulpher S. Influence of Local Cooling on Proprioceptive Acuity in the Quadriceps Muscle. J Athl Train. 2001;36(2):119–23

Sellwood KL, Brukner P, Williams D, et alIce-water immersion and delayed-onset muscle soreness: a randomised controlled trialBritish Journal of Sports Medicine 2007;41:392-397.

Gerard A. Malanga, Ning Yan & Jill Stark (2015) Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury, Postgraduate Medicine, 127:1, 57-65, DOI: 10.1080/00325481.2015.992719

Nadler SF, Weingand KW, Stitik TP et al. Pain relief runs hot and cold. Biomechanics 2001; 8:1.

Steiner D, Ersala G. Hengehold D et al. Continuous low-level heat therapy for acute muscular low back pain. In Proceedings of the 19th Annual Scientific Meeting of the American Pain Society 2000; 112

Praemer A, Furner S, Rice DP. In Musculoskeletal Conditions in the United States. 2nd ed., Rosemont, American Academy of Orthopaedic Surgeons, 1999, pp 83,104, 146.

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