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Heat or ice: which is better?

Ice or heat for injuries

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Heat and ice are some of the most common non-invasive, inexpensive and harmless ways of managing pain. Some people swear by one or the other, whereas others notice no difference.

From an academic point of view, both cryotherapy (icing) and thermotherapy (heat) have been called in question in recent years.

It’s difficult to design a study to prove if, how or why these treatment interventions work. The best evidence that I personally have in this case is the information that has been reported to me by my patients.

What we do know is that it probably isn’t imperative to do either, as both therapies are unlikely to speed up recovery by much in most injuries. That said, many people find that applying heat or ice can significantly decrease their pain and improve their ability to cope with their pain whilst the injury is present.

Heat seems to be a god send for a lot of people with muscular pain.

In my clinical experience, there are a few conditions that seem to prefer heat over ice, and vice versa.

When I’m referring to heat and ice, I am talking about applying radiant heat or cold such as an icepack or heat pack/hot water bottle. The gels and creams are separate and this advice is not intended to be talking about them.


Heat seems to be a god send for a lot of people with muscular pain. Tight, sore muscles after a long day on your feet or at a desk often respond quite well to a heat pack/hot water bottle or hot shower.

There has been a study that showed significant decrease in low back pain for patients using heat wraps around the affected area.

I usually suggest that my patients try heat for anything that’s stiff/cold/tight, such as achy neck or low back pain.

The theory about heating an area is that it improves blood and lymphatic flow to the affected area. This has (sort of) been proven, and is certainly worth a shot, particularly as it’s non invasive and non pharmaceutical based.


We usually get anyone with a hot/angry/inflamed/acute injury to try ice. Quite often people who are suffering from a rolled or sprained ankle will report a decrease in pain after using ice. Often I’ll get people to ice severe muscular strains as well, or jarred fingers/wrists.

We usually get anyone with a hot/angry/inflamed/acute injury to try ice.

We used to think that ice constricted blood vessels, thereby reducing swelling at the affected area. Recent research is suggesting that maybe this isn’t the case and that ice doesn’t affect swelling as much as we thought. However, ice is still useful for superficial injuries (close to the skin) as it acts as a numbing agent, reducing pain at the area. For something angry and sore, again, it’s worth a shot if it can reduce the amount of pain killers needed to manage the pain of the injury.

One thing that I will note from my own observations in clinical practice – very rarely will ice be the best thing for low back pain. Even in cases of acute and sudden low back pain, the structures causing the pain are usually too deep in to be at all affected by ice, and thus heat is usually more helpful as it will affect the overlying muscles of the injured area.

Either way, heat and ice therapy are both non-invasive, non-harmful and cheap. If they can help manage your pain, then why not try them?

What have your experiences been with heat or ice? Feel free to comment below.

Until next time,




Dr Claire Richardson loves what osteopathy offers her patients and how it can help people of all different ages and backgrounds. Claire treats a wide range of patients, from the young through to the elderly, including office workers, athletes, pregnant women and tradesmen. Claire enjoys treating all musculoskeletal ailments, from sports injuries to postural problems. She employs a wide variety of techniques in her treatment, including soft tissue massage, dry needling, and joint and muscle manipulation where appropriate. As part of her treatments, Claire advises on contributing lifestyle factors such as activity and diet which enables her patients to have an optimal and speedy recovery.