Hot and cold therapies are used to manage pain and inflammation, soothe muscles and speed up recovery, but how do you know when to use heat, cold, or when to use both?
What is heat therapy?
Heat therapy, also known as thermotherapy, involves applying heat to a specific area of the body to relieve pain and discomfort. Applying heat increases blood flow and circulation, which helps soothe muscle stiffness and heal damaged tissues. Heat therapy can include using heat packs, hot water bottles, saunas and warm baths.
What are the benefits of heat therapy?
- Muscular pain relief: Heat therapy soothes pain by increasing blood circulation to reduce muscle stiffness.
- Increased flexibility: Heat helps ease tension and relax muscles and may improve flexibility by increasing tissue extensibility.
- Reduced muscle spasms: Heat can help relax tense muscles and reduce spasms.
- Accelerated healing: Heat may help speed up recovery by increasing oxygen supply to tissues.
What conditions may heat therapy help with?
Heat therapy can help with:
- Post-exercise muscle soreness
- Muscle strains and sprains
- Joint stiffness in conditions such as arthritis
- Some types of back pain
- Muscle spasms
- Injury recovery.
How to use heat therapy as a complementary therapy
If you’re managing pain or stiff joints from a chronic condition such as arthritis, here are some recommendations from the Arthritis Foundation1 on how to use heat as a complementary therapy:
- Start your day right by taking a long, warm shower. The heat of the water will reduce morning stiffness, limber up the body, and increase your range of motion for the daily activity ahead. Taking a shower before you work out or go on a long walk can prepare tight joints for exercise and reduce your chance of injury.
- Use an electric heating pad to heat up your hip, back, shoulder, or knee before you stretch or exercise.
- Make a moist heating pad by putting a wet washcloth in a freezer bag and warming it in the microwave for one minute. Rest with the warm compress on the affected area for 20 minutes when you’re doing computer work or reading the newspaper.
- Go for a dip. When you have arthritis, a warm pool is the ideal place to strengthen your muscles and increase your flexibility. The water will reduce the force of gravity compressing the joint and offer 360-degree support for sore limbs that have limited range of motion.

What are the risks involved in using heat therapy?
While generally safe, heat therapy does have some risks:
- Burns: Using excessively hot temperatures can cause skin burns.
- Increased swelling: Applying heat to inflamed areas can exacerbate swelling.
Heat therapy isn’t for everyone. Always consult with a healthcare professional before using heat therapy, especially if you have pre-existing conditions such as diabetes or vascular diseases. Always use a barrier (like a towel) between your skin and the source of heat to prevent burns and avoid using heat on inflamed areas or open wounds.
What is cold therapy?
Cold therapy, or cryotherapy, involves applying cold to reduce inflammation and numb pain. This method works by constricting blood vessels, which decreases blood flow to the affected area. Cold therapy includes ice packs, cold compresses, ice baths and cryo chambers. Cryo chambers expose the body to extremely low temperatures for a few minutes to reduce inflammation and aid in recovery, while an ice bath involves immersing the body in ice-cold water for a short duration. Athletes use ice baths to reduce muscle soreness after intense workouts.

What are the benefits of cold therapy?
- Reduces inflammation: Cold therapy minimises swelling and inflammation after acute injuries.
- Pain relief: The numbing effect of cold therapy may help alleviate discomfort in muscles and joints.
- Slows metabolism: Reducing tissue temperature slows down metabolic processes in injured tissues, helping prevent further tissue damage.
What conditions may cold therapy help with?
Cold therapy may help with:
- Acute injuries (sprains, strains)
- Swelling or bruising
- Inflammatory conditions such as tendonitis
- Post-surgical recovery
- Headaches or migraines.
What are the risks involved in using cold therapy?
While cold therapy is generally safe, there are potential risks such as:
- Frostbite: Prolonged exposure can cause skin and tissue damage.
- Nerve damage: Excessive cold can lead to nerve injury if not applied correctly.
While effective for immediate relief, cold therapy should not be used for prolonged periods and it’s not suitable for people with circulatory issues or certain conditions. Apply heat for 15-30 mins at a time, and only apply cold for 10-20 mins at a time.
Studies that support the use of hot and cold therapies
- A survey from the U.S. Pain Foundation revealed that heat and cold therapy is the most-used relief option for people with chronic pain. Of the 1,581 respondents, 67.8% said they use heat at least once a week, while 44.9% said they use cold therapy at least once a week. More than half of respondents (52.6%) said they found heat more effective, while 18.7% preferred cold, and one-third (28.7%) said they were about equal. A majority said they primarily use heat and cold “while having pain, as a way to manage or reduce it,” (62.5% and 50.6%, respectively), though some individuals used it both as a preventative and while having pain (47.3%).2
- Studies show that patients with arthritis and fibromyalgia who participated in warm water exercise programs two or three times a week could move around better and had as much as 40% less pain.3
- In a study on the mechanisms and efficacy of heat and cold therapies for musculoskeletal injury, cold therapy was shown to decrease pain by 30% and swelling by 25% within the first 48 hours post-injury, while heat therapy improved joint mobility by 40% after two weeks of application. The research emphasises that cold therapy is most effective during the acute phase of injury, whereas heat therapy is beneficial for chronic conditions, with 70% of participants reporting enhanced recovery outcomes when combining both treatments.4
When to use heat therapy versus cold therapy
When considering heat therapy versus cold therapy, it’s important to understand when it’s best to use each one.
Heat therapy is particularly useful for chronic muscle pain, helping ease tension and muscle stiffness and bring overall relaxation. Heat therapy works by dilating blood vessels, which enhances circulation and delivers more oxygen and nutrients to the affected areas. This increased blood flow can help reduce muscle spasms and pain while healing.
In contrast, cold therapy is typically recommended to be pressed against an affected area immediately after an injury to reduce swelling and inflammation. Cold therapy reduces blood flow to the area, which slows down metabolic processes and decreases the inflammatory response. This is particularly useful during the first 48-72 hours post-injury when swelling is most pronounced.
Cold applications can numb sore areas and decrease the perception of pain by slowing down nerve conduction, and may also help manage inflammation associated with flare-ups in conditions like arthritis.
Coaches and athletes often manage muscular pain by alternating between hot and cold therapies – a practice known as contrast therapy. This method creates a pumping effect in the lymphatic system as heat relaxes tissues while cold constricts them. Although there is anecdotal evidence that contrast therapy is effective in post-exercise recovery (Cochrane, 2004), there is a lack of scientific evidence to support the use of contrast therapy for either the treatment of injury or to aid recovery.5
Always consult a healthcare professional before integrating any complementary healing practices into your treatment plan and pay attention to how your body responds.
Written by Stevie Bal
Reviewed by Amber Foley (BNat, Grad Cert EvBCM, MNHAA) on 22 October 2024.
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