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woman holding an ice pack to the back of her neck
woman holding an ice pack to the back of her neck
woman holding an ice pack to the back of her neck


by Joon Nah    BScPT
Registered Physiotherapist
updated July 18, 2020

I get this question a lot.  Hot and cold packs can be great as it can reduce the need for medication and is an easy to apply home remedy.  But which one to pick?



Heat can reduce pain.  It also decreases muscle spasm, improves tendon and ligament flexibility, and increases blood flow.  Researchers aren’t quite sure how most of these benefits work, though it seems that heat releases endorphins that help block the communication of pain signals, and can shut down the nerves that make muscles uncontrollably spasm.

Heat temporarily increases the size of your blood vessels which allows more blood to flow to the area.  So when a joint or muscle is inflamed and swollen, it makes sense to avoid adding more fluid to the area with heat.



Interestingly, ice reduces pain too!  It’s also very effective for decreasing inflammation and swelling.  Studies seem to indicate that cold slows down the activity of the nerve cells for pain.  It’s super-powers for fighting inflammation occurs because of its ability to narrow the size of blood vessels, preventing excess fluid from building up in the injured area, which keeps swelling at bay.



There’s a ton of research on the effects of both, and for the most part the results aren’t conclusive.  Based on what we do know and from working with patients for years, here’s my advice:

  • If your injury feels warm and swollen, ice it.
  • If your injury is less than 3 days old, RICE it (rest, ice, compress, elevate).
  • If your injury is more than 3 days old, use heat or ice (try both and see what works better).
  • If your injury is more than 3 days old, and the effect of ice/heat has diminished, try both! (heat for 2 min, ice for 2 min, repeat 5x).
  • For muscle spasms or tightness, try heat.
  • Heat can applied for 15-20 minutes, keep ice on for 10-15.  Check the area often to ensure you’re not getting a burn or frostbite.


CAREFUL!  The advice above should only be considered as a part of a proper medical evaluation.  Everyone is unique and so are your injuries.  Get assessed by a professional so you don’t make things worse.

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