What's best for your aches and pains? Hot or Cold?

Navigating life without suffering a headache, straining a muscle, falling over or wrenching your back is extremely unlikely. The more years we’re around, the more susceptible we are to wear and tear and degenerative joint disease, like osteo-arthritis

Whilst many painful conditions can be eased with medication, exercise and natural therapies, we still may need additional relief such as thermography (heat therapy) or cryotherapy (cold therapy).

So, when something hurts, what will make it feel better - ice or heat? When does it make sense to use both?

Acute injuries

Try to avoid heat on acute injuries, because that extra warmth can increase inflammation and delay the healing process. 

The consensus is; it’s best to predominantly choose cooling/ cold applications such as ice if the injury is acute (immediate and up to 6 weeks old in certain cases). The chill constricts blood vessels, numbs pain, helps to reduce inflammation and limits bruising.

Chronic injuries

If you’re dealing with lingering injuries (older than 6 weeks) using heat can be very beneficial.  The increased blood flow relaxes tight muscles and relieves aching joints. Warmth can help ease morning stiffness, improve motion of stiff joints and relax tense muscles.


Use heat to get moving, before stretching or doing exercise and sports. You can still use ice or cold treatment after exercise or activities to prevent any flare up of inflammation. 

Just remember “Warm up, cool down”.

Osteo Arthritis

The inflammation of joints and worn-away cartilage can cause pain and stiffness in all our joints including the spine, elbows, knees, shoulders and fingers, just to name a few. 

For these instances, moist heat, like a soak in a hot bath or a shower feels great. However, If you sprain an arthritic joint and its acutely inflamed and painful – go for cold.


Ice is usually preferred for frontal or temporal headaches, a cold eye mask or wraps over the forehead, eyes and temples can help the throbbing pain of a migraine. 

Heat pads or a heat wrap can relax neck spasms that contribute to headaches – especially at the base of the skull.

Muscle strains and sprains

Muscle strains and sprains usually benefit from a combination of hot and cold. Whether you have pulled a muscle in your back or strained your ankle, it’s usually best to start with ice to ease inflammation (including swelling, redness or tenderness of the injury) and numb the pain. Only after the inflammation resolves is it a good idea to switch to heat; this can help relieve any muscle stiffness at the injury site. 

Tendinitis (e.g. shoulder, elbow, wrist, ankle)

Tendinitis is a painful inflammatory condition that affects tendons (the connective tissues between your muscles and bones). A common cause is repetitive activities, so tendons in your elbow, knee, shoulder, hip and the Achilles tendon are common sites. Initially ice is the preferred method here as it can ease the inflammation and help numb the pain. However, if the tendinitis continues and becomes a chronic tendinosis move onto warmth.

Hot and Cold / Contrast bathing

It’s worth trying this on slow healing injuries where you want to stimulate the healing process. Use warmth and cold (not ice) as the contrast doesn’t need to be extreme. Apply alternate packs for 2 minutes each. Cold, Hot, Cold, Hot, Cold (10 mins total). Twice a day.

Still not sure? If in doubt, try cold first for a couple of minutes - apply something cool from the fridge. If it soothes the area and gives relief use cold therapy.

What you can use: 

Cold – 10 mins max

  • Ice packs: Frozen peas/veg, ice cubes in a bag or frozen gel pack. You can ice beyond 48 hours, until swelling, tenderness or inflammation is gone.
  • Cold masks: Place a cold mask, over your eyes or lay a towel soaked in cold water (in a plastic sealed bag if required) over your forehead and temples.

Warmth – 30 mins max

  • Moist heat: Enjoy a bath, shower, hot tub using warm, not hot, water.
  • Heat wraps: Drape a heat wrap or wheat bag around your neck like a scarf (great for work or travel).
  • Heating pads: we hand these out like sweets at the clinic! They provide 14 hours of warmth and give so much relief!
  • Heat lamp /electric pad: give soothing constant warmth.

How to safely apply ice and heat

  • Always test the temperature first (wrist/ inner arm) and use warm and cold – not hot or freezing, as temperatures shouldn’t be too extreme.
  • Never apply ice or heat directly on the skin as it can burn – always have a protective layer around the pack or over your skin
  • Take great care on areas with decreased sensation or sensitive skin. For example, if you have neuropathy (from diabetes or another condition) or Raynaud’s syndrome. Extreme temperatures can damage skin.


This article is not intended for therapeutic advice. Always consult your health practitioner if you have an injury.

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