Ice or Heat? How to Pick the Right One for Pain (So You Don't Make It Worse)

At Renew Wellness, one of the most common questions our physiotherapists hear is: “Should I use ice or heat for this pain?”

It’s a simple question, but the answer can make a big difference in your recovery. Using the wrong one can sometimes worsen symptoms or delay healing.

Keep reading for our physiotherapist-approved heat and ice guidelines so you can make an informed choice for your body's recovery!

Understanding the Basics: What Ice and Heat Do

Ice (Cryotherapy) reduces blood flow, inflammation, swelling, and pain by constricting blood vessels. It also slows nerve conduction, which helps dull pain signals. Think of ice as a way to calm down acute injury responses.

Heat (Thermotherapy) increases blood flow, relaxes tight muscles, and eases stiffness by dilating blood vessels. It can also improve tissue elasticity. Think of heat as a way to warm up and soothe chronic stiffness or muscle tension.

When to Reach for the Ice Pack

1. It Just Happened (First 48–72 Hours)

This is the golden rule. If you’ve just sprained an ankle, strained a muscle, or had a sudden impact, use ice. Examples include:

• Sports injuries (twists, falls, collisions)
• Post-surgical swelling
• Acute flare-ups of conditions like tendonitis

Why: Inflammation is your body’s initial healing response, but excessive swelling can delay recovery and increase pain. Ice helps manage this.

2. It’s Puffy, Red, or Feels Warm

If the area looks swollen or feels hot to the touch—that’s inflammation talking. Ice tells it to chill out (literally).

3. It’s a Sharp, “Ouch!” Kind of Pain

Post-workout soreness that’s more “burn” than “ache”? Or a tendon flare-up that’s stingy and angry? Ice can take the edge off.

How to Ice Safely:

• Use a cold pack, ice wrapped in a towel, or a bag of frozen peas.
• Apply for 15–20 minutes at a time.
• Allow the skin to return to normal temperature between sessions (at least 1–2 hours).
• Never apply ice directly to the skin.

When to Choose Heat Therapy

1. It’s a Stiff, “I Can’t Move” Kind of Pain

Woke up with a stiff neck? Back feeling like a board after sitting all day? HEAT. It’s perfect for melting away that “rusty hinge” feeling.

2. It’s an Old Ache (We’re Talking Weeks or More)

Chronic low back pain, nagging shoulder tension, or arthritis stiffness that’s been around forever? Heat can make it more manageable.

3. You’re About to Stretch or Move

Stiff before your walk or yoga session? A bit of heat beforehand can help you move more freely and safely.

How to Apply Heat Safely:

• Use a warm towel, heating pad, or hot water bottle.
• Keep the temperature comfortable, never scalding. If it's too hot to touch, it's too hot for your skin.
• Apply for 15–20 minutes.
• Check skin regularly to avoid burns, especially if you have reduced sensation.

Key Exceptions and Cautions

• Never use heat on fresh injuries, swollen areas, or open wounds. It can increase bleeding and inflammation.
• Avoid ice if you have circulatory issues, Raynaud’s syndrome, or hypersensitivity to cold.
• If you have diabetes or reduced sensation, be extra cautious with both ice and heat to avoid skin damage.

What If You’re Still Unsure?

A simple rule of thumb we give our clients at Renew Wellness as a cheat sheet for when to use ice vs heat:

Think ICE if:

• It's a new pain (last 72 hours)
• It shows signs of swelling, redness, or warmth
• Pain is sharp/stabbing

Think HEAT if:

• It's an old pain (lasting more than a week)
• You feel stiff/tight
• The pain is dull, achy, or feels like nagging discomfort

When in doubt, ice is generally safer in the initial stages, as heat on an acute injury can do more harm.

Final Thoughts from Our Clinical Team

While ice and heat are helpful tools, they are only one part of a comprehensive treatment plan. Pain is your body’s signal that something needs attention. At Renew Wellness, our physiotherapists assess the root cause of your pain, whether it’s a movement imbalance, weakness, or tissue dysfunction, then we create a personalized plan that may include manual therapy, exercise, education (and yes, sometimes the appropriate use of ice or heat).

If your pain persists beyond a few days, worsens, or is accompanied by numbness, weakness, or severe limitation, seek professional advice. Book a consultation with one of our physiotherapists to get a tailored recovery strategy.