By Chrystin Schultz
Physical Therapist Assistant
Insight Comprehensive Therapy

Growing up, it seemed like every person over the age of 65 owned a heating pad. Every reclining chair had a heating pad plastered to the back of it – and they all looked like they could start a house fire at any moment with their aged, yellowed cords and black and red buttons. As I got older, I realized that heating pads were not standard issue supplies from Medicare, but were just one of the many tools people use to ease their pain. Now, at the ripe old age of thirty-something, I find myself a very grateful owner of one such heating pad.

As a physical therapist assistant at Insight, I have daily conversations with patients that go something like this: I ask “are you using heat or ice when you’re at home to help with your pain?” Generally, they reply with “I’m using heat and it feels so good!” To which I say, “I really want you to try using ice. You have a lot of inflammation around your joint and the heat could actually be causing more harm than good.” 

After either a skeptical look or a long awkward pause, we further the ice versus heat discussion to weigh the pros and cons of each, and agree to a plan on which modality will be best to achieve their overall goal of less pain. Since I’ve had this discussion probably over 100 times, I decided we should all get on the same page about when to use heat and when to use ice for injuries and pain management. 

First, it’s important to know what happens in your body when you use heat or ice. Applying heat to a part of your body causes a process known as vasodilation, which is the widening of blood vessels. Vasodilation increases good, oxygenated blood flow into the muscle tissue, helping to relax tight muscles and ease aching joints. The application of cold triggers vasoconstriction, the constricting or narrowing of blood vessels that results in a decrease of blood flow into the muscle tissue. So in short, heat increases blood flow to an area, and cold decreases blood flow, sending blood away from the area.

If your pain is acute (within about six weeks), ice is going to be your choice. The main goal with acute pain is to reduce swelling, inflammation, and bruising. The application of heat to an acute injury can actually cause increased inflammation and delay the natural healing process, which is why it is important that heat is not used within the first 48-72 hours after an injury. Ice should be applied for no longer than 20 minutes at a time to prevent tissue damage and other negative side effects. I advise my patients to wait 30-40 minutes after applying ice to an injured area in order to give time for normal blood flow to return to the tissue before icing again.

I’m not going to lie and say icing will always feel good. In fact, there are four stages of mild discomfort associated with icing, which are summed up in the acronym CBAN. CBAN stands for Cold, Burning, Aching, and Numbness. It’s easy to call it quits during the burning stage of icing; however, it’s very important to tough it out past the burning stage in order to get the full physiological effect. Effective ways to apply cold or ice to an injury are through the use of gel ice packs, towels wet with cold water, ice baths, or an ice massage if you really want to target a specific area. 

Ice is also best to reduce inflammation and ease joint pain from gout. Headache pain can be treated with cold as well by placing a cold towel or wrap around the forehead, temples and eyes to reduce pain and throbbing sensations. Since tendinitis is inflammation in the muscle tendons, usually due to overuse or strain, ice is also recommended over heat.

Heat is most commonly used for chronic pain, or pain that has lasted for longer than six weeks. Heat is generally preferred for osteoarthritis pain as it eases achy or stiff joints and muscles. Since heat increases blood flow into muscle tissue, it is also recommended for headache pain caused by tight muscles at the base of the head or neck, as well as for treating muscle spasms. Heat can be applied through the safe use of an electric heating pad, warm towels, rice packs, and warm showers or baths.
A combination of heat and ice can also be used for muscle strains and sprains. Always make sure to ice first to reduce inflammation before applying heat to ease muscle tightness. 

Caution should always be used with both heat and ice when there is impaired sensation, such as with neuropathy or other health conditions in which the use of heat or ice is contraindicated. Frequent skin checks should be done when using either modality in order to ensure there is no tissue damage, burning, or permanent changes in skin color or integrity.

Treating pain with heat or ice can be a very simple and effective option for a number of conditions and injuries. However, knowing when to use heat and ice therapy will significantly increase the effectiveness of the treatment. If you have questions about how to treat your particular situation, our team at Insight Comprehensive Therapy is happy to answer your questions. Contact us today at 810-275-9610 to schedule an appointment. 


Ernst, E. and Fialka, V., 1994. Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. Journal of Pain and Symptom Management, 9(1), pp.56-59. 2022. A Road Map to Effective Muscle Recovery. [online] Available at: <> [Accessed 8 April 2022]. 2022. Ice Packs vs. Warm Compresses For Pain. [online] Available at: <> [Accessed 8 April 2022].

Cleveland Clinic. 2022. Should You Use Ice or Heat for Pain? (Infographic). [online] Available at: <> [Accessed 8 April 2022].

Ibrahem Abd elFatah, M., 2019. Effect of Cold Application Versus Contrast Hydrotherapy on Patients Knee Osteoarthritis Outcomes. American Journal of Nursing Science, 8(4), p.151.

Bélanger, A., 2015. Therapeutic electrophysical agents : evidence behind practice [3rd ed.]. 3rd ed. Baltimore, MD: Wolters Kluwer, pp.69-105.