Heat, Ice, or Contrast Therapy for Pain?


The application of heat, ice or contrast therapy has long been used for pain relief. There is often confusion on how long and how often to apply such therapies. The article will describe the therapies and provide instructions on how to safely administer them.

Cryotherapy (ice therapy) is a commonly used treatment for acute soft tissue injury but many therapists have different ideas about the duration of the ice application and many argue that heat is better for certain injuries. Also, alternate applications of hot and cold and heat alone is often recommended. This adds to the general public confusion on the different forms of hydrotherapy.

Cryotherapy involves cooling muscle below a certain temperature using applications such as ice packs in order to numb nerve endings temporarily, create vasoconstriction, subsequently reducing inflammation and pain.


A popular argument against icing is that “inflammation is healthy” or “inflammation is essential for healing so why would you want to ice something to suppress this natural process?”
The reason for you this is: not all natural inflammation is good. When it comes to a sterile injury (one where the skin isn’t broken) inflammation is pointless. So ice and even ibuprofen can help and although it doesn’t promote healing – no evidence concludes that it impedes it.
Icing provides pain relief which is important in recovery.

When to use ice

Ice should be used for injuries that have occurred in the last 48 -72 hours. These types of injuries are usually accompanied by swelling, redness and heat. These are called acute injuries.

You can use ice for chronic injuries that have flared up such as an overuse condition but avoid icing a chronic problem before activity.

How to apply ice

You can make homemade ice packs by putting ice cubes in a plastic bag or tea towel. You can also use a pack of frozen peas. Never put ice directly on the skin and keep ice moving to prevent injury. Ice ideally should be applied for 10 minutes and then again after a 10 minute break. This can be done every hour.

Do not use ice on the shoulder or neck if you have a heart condition.

Conditions where ice is required:

  • Ligament sprains
  • Muscle strains
  • Tendonitis
  • Bruising
  • Rheumatoid arthritis
  • Ankylosing spondylitis

Chronic overuse/tissue fatigue such as:

  • Tennis elbow
  • Carpal tunnel syndrome
  • Plantar fascitis

What ice is not for:

According to research, most back pain is caused by muscles, in particular tight knots called trigger points which are soothed by heat and aggravated by ice.

However, if there is redness, swelling and heat in the back – then ice is indicated.

Heat therapy

Heat is used for muscle pain and stiffness that has been present for more than 6 weeks, which isn’t red, swollen and red. If an area is bruised or swollen, ice is indicated.

Heat works by increasing blood flow to an area. This can relax muscles and increase flexibility.

There is dry heat and moist heat. Both should be warm instead of hot.

Dry heat includes saunas, dry heating packs and pads.

Moist heat includes baths, moist heated towels or moist heated packs. Moist heat can work better, and quicker.

People with certain diseases or conditions should consult a doctor before using heat therapy. These include:

  • Diabetes
  • Hypertension
  • Multiple sclerosis
  • Deep vein thrombosis
  • Skin conditions such as dermatitis

If you are with child – please contact medical help before entering a sauna or steam room.

15 -20 minutes of heat therapy 3 times a day can relieve mild muscular stiffness. 30 minutes may be needed for a more severe pain. This can be repeated every hour.

Contrast/hot and cold therapy

With hot and cold therapy you can reduce inflammation, yet also reduce muscular tension, increase blood flow and therefore, reduce pain.

The easiest way to use contrast therapy is with a pack of frozen peas and a hot water bottle.

Immersion therapy

Contrast therapy can also be carried out by switching between a sauna/steam room and a pool or cool shower. However, if you have hypertension or heart conditions – it’s best to consult your doctor first.


When you’ve selected your method – you’ll need a clock or watch. In general, it’s best to use the contrast therapy ratio which is one minute of cold to 3 -4 minutes of hot.

Alternate approximately 3-7 times – commence and end on cold to reduce inflammation.

Here is the best way to use contrast therapy:

  • Start with 1 minute of cold
  • Apply 3 minutes of heat
  • Apply 1 minute of cold
  • Apply 3 minutes of heat
  • Apply 1 minute of cold
  • Apply 3 minutes of heat
  • Finish with 1 minute of cold

The process can be carried out up to three times a day. It may take 3 days to work.

There are some conditions which are contraindications for contrast therapy. These are:

  • acute injury
  • open wounds
  • diabetes
  • hypertension
  • heart conditions
  • raynauds syndrome
  • cold urticaria


Ice therapy is useful for reducing pain in an acute injury that has occurred with 3 days. As a rule stick to ice if there is redness and swelling. Heat should be used for chronic conditions that have been present for longer than 6 weeks. It can decrease muscular tightness and pain. Contrast therapy is best for acute injury after 3 days or any chronic conditions.

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