Should You Use Heat or Ice?

Traditionally, the RICE protocol—Rest, Ice, Compression, Elevation—had been the standard approach since its introduction in 1978 by Dr. Mirkin and Marshall Hoffman. Cryotherapy, or cold therapy, has been shown to delay or reduce DOMS (delayed-onset muscle soreness after exercise) but in many studies was no more effective than placebo or active recovery for reducing inflammation. Recent research also suggests that while ice can be beneficial immediately after an injury to reduce swelling and pain, prolonged or excessive use may actually delay the healing process.

Heat therapy such as hot packs, warm baths, or saunas is generally most effective if used after the acute phase of inflammation or when DOMS has subsided, although some research suggests that heat therapy after endurance exercise may improve fatigue resistance. Heat reduces inflammation through vasodilation, promoting blood circulation that helps clear any inflammatory byproducts out of the injured areas while also allowing for delivery of oxygen and nutrients for healing. Heat also increases tissue metabolism, improves elasticity of connective tissue, and promotes muscle relaxation. Heat therapy is typically used for the treatment of chronic injuries and can be used passively as a warm-up prior to engaging in activity or during recovery after exercise.(1)

So, when should you use heat? Is there benefit to using ice? Here’s a quick guide to help you decide which to use and when.

Heat Therapy (Thermotherapy)

Best for: Chronic pain, muscle stiffness, joint stiffness, and improving circulation

How it works:

  • Expands blood vessels, increasing circulation

  • Relaxes tight muscles and reduces stiffness

  • Blocks pain signals through thermoreceptors (2)

Common applications:

  • Heating pads, warm baths, heat wraps, saunas

When to avoid:

  • Within 48 hours of an acute injury

  • If there is significant swelling or inflammation

Cold Therapy (Cryotherapy)

Best for: Acute injuries, swelling, inflammation, and numbing pain

How it works:

  • Constricts blood vessels to reduce inflammation

  • Slows nerve conduction to provide pain relief

  • Reduces tissue metabolism to prevent further injury (3)

Common applications:

  • Ice packs, cold compresses, cryotherapy chambers

When to avoid:

  • If you have circulation issues

  • If applied for too long (risk of frostbite or nerve damage) (4)

Heat vs. Ice: Which Should You Use?

  • For recent injuries with swelling → Use ice

  • For chronic pain and stiffness → Use heat

  1. Thermal Modalities Including Hot Baths and Cold Plunges Play a Unique Role in Injury Prevention and Recovery. Vrindten, Kiera L. et al. Arthroscopy Techniques, Volume 0, Issue 0, 103305

  2. Freiwald J, Magni A, Fanlo-Mazas P, et al. A role for superficial heat therapy in the management of non-specific, mild-to-moderate low back pain in current clinical practice: a narrative review. Life. 2021;11(8):780. doi:10.3390/life11080780

  3. He J, Zhang X, Ge Z, Shi J, Guo S, Chen J. Whole-body cryotherapy can reduce the inflammatory response in humans: a meta-analysis based on 11 randomized controlled trials. Sci Rep. 2025 Mar 5;15(1):7759. doi: 10.1038/s41598-025-90396-3. PMID: 40044835; PMCID: PMC11882895.

  4. Garcia C, Karri J, Zacharias NA, Abd-Elsayed A. Use of Cryotherapy for Managing Chronic Pain: An Evidence-Based Narrative. Pain Ther. 2021 Jun;10(1):81-100. doi: 10.1007/s40122-020-00225-w. Epub 2020 Dec 14. PMID: 33315183; PMCID: PMC8119547.