Should you use ice or heat for pain?

How to determine whether to use ice or heat packs for your pain


2/19/2022 0 min read

Should I heat it or ice it? I hear this frequently in my massage work, and I wish it was easier to answer.

For years the loose guidance has been ‘ice for immediate injury, heat for achiness and improved mobility.’

But there are a few nuances to consider and I think it’ll be fun to look at the history a bit.

In 1978 Dr. Gabe Mirkin created and included ‘RICE’ in his sports medicine book as a treatment for soft tissue injuries. Rest, Ice, Compression, Elevation. The idea was to reduce inflammation that can increase pain and slow down healing. It was logical, it seemed to work, so the sports world grabbed hold and medicine soon followed.

Since then, Dr. Mirkin has reversed his support for the RICE method, based on a large number of studies that showed no or mediocre results. And we now know that swelling and inflammation are not the same thing and don’t necessarily correlate to healing time.

So, with the RICE protocol out the window, how do we make this decision?

First and foremost, do what is comfortable for you. If you hate being chilly, ice is a terrible idea. If you are always warm and uncomfortable, do not cover yourself in a giant heating pad.

Next, consider what ice or heat does overall. For many people ice, or just cold, can kick up the nervous system and make the body feel like it’s in danger. Whereas heat, especially in the form of a weighted heating pad, can be really calming and relaxing to the whole body.

With all that in mind, here is my very general stance on Heat versus Ice:

If you have seen a physician, physical therapist, or any kind of medical provider for this issue, do what they suggested. If their approach is uncomfortable or you feel like it makes you worse, read out to them for more guidance.

If you are DIYing your care for something minor I suggest ice very soon after what you feel is an ‘injury’. If you were doing something strenuous and heard a pop, can feel a tender spot, and the area looks a little puffy, go for the cold. Use ice, on for 20 minutes once an hour or so, and be sure to have a protective barrier between your skin and the ice or cold pack. The ice will numb the area and slow down the transmission of pain signals.

I've also found a cold mask on the head or face to be temporarily helpful if you have  a headache or just discomfort for super stuffy sinuses.

For stiffness, general or deep achiness, or feeling straight up ‘tight’, I like heat. And heat with some weight behind it. I’ve found it to be calming to the whole body and demonstrably helpful in encouraging everything to ‘unclench’.

Tension headaches are often relieved with heat to the shoulders and neck. But for migraine sufferers, use whatever feels best for you. 

Inflammation in joints caused by worn-away cartilage (known as arthritis) can cause pain and stiffness in places like your knees, shoulders, back and fingers. For these instances, heat is very beneficial. A warm shower or bath or a soak in a hot tub can be great at relieving symptoms. 

As you can see, there’s a lot of gray area and a considerable amount of trial and error. Reach out if you have questions or want to try massage along with your DIY approach!

DIY Cold Pack

  • 1 quart or 1 gallon plastic freezer bags (depending on how large you want the cold pack)  

  • 2 cups water

  • 1 cup rubbing alcohol  

Directions: Fill the plastic freezer bag with 1 cup of rubbing alcohol or 1 cup dish soap. Add 2 cups of water.  Remove as much air as possible out of the freezer bag before sealing it shut.  To avoid leakage, put the bag and its contents inside a second freezer bag.  Freeze for at least an hour. During use, place a towel between the cold gel pack and bare skin.


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