When you injure yourself or are suffering from aches and muscle pain, you know what to do, right? Just apply ice. Or use a heating pad. Wait a minute… which one is it? It’s sometimes hard to tell which treatment will make you feel better – and which may only exacerbate your pain.

How Ice Works

Ice constricts your blood vessels and numbs the area, so therapeutic ice treatment is most effective when used for injuries that are new. If you injured yourself within the last 48 hours and inflammation is a concern, then you should be using ice. Ice packs can help to minimize superficial swelling and pain around the injury, as well as reduce any bleeding into the surrounding tissues – which lessens bruising. A cold wet towel, ice pack, or cold compress can all provide fast relief for recent injuries.

How Heat Works

Heat increases blood flow, so heat treatment works best for joint stiffness, muscle pain, tension, and spasms. Heat also serves to soothe and relax you, which is one of the reasons why hot tubs and warm soaks are so beneficial. A warm, wet towel, a heating pad, or a hot water bottle can also provide much-needed relief. Heat should not, however, be used within the first 48 hours after an injury.

Why It Matters

Using the wrong treatment can actually make an injury or pain worse instead of better. Treating a new injury with heat may well increase inflammation. Treating sore muscles with ice can increase the intensity and pain of muscle spasms and tension. Knowing which treatment to use when does make a difference – both in how you feel and how quickly you’ll heal.

Why It’s So Confusing

While what you’ll find below covers the general, rule-of-thumb advice for icing and heating, there are quite a few exceptions. For arthritis in the joints, heat works best – but for chronic, inflammatory arthritis and gout, ice is better for calming flare-ups and numbing pain. For headaches, a throbbing headache may do better with an ice mask or wrap, while a tension headache may respond more quickly to moist heat.

For pulled muscle pulls and strains, icing is best initially, but after 48 hours, you should switch to heat therapy. The same holds true for ligament injuries. Acute injury of your tendons responds better to ice, while chronic tendonitis usually needs heat.

General Rules

Most of the time, doctors and other medical professionals agree on the following advice.

Ice is best for:

  • Sprains during the first 48 hours
  • Pulled muscles during the first 48 hours
  • New lower back injuries (first 48 hours)
  • Recent hemorrhoid flare-ups
  • Throbbing headaches and migraines
  • Inflammatory arthritis
  • Gout
  • A stiff neck

Heat is best for:

  • Sprains after the first 48 hours
  • Pulled muscles after the first 48 hours
  • Chronic lower back pain
  • Hemorrhoids after more than 48 hours
  • Menstrual cramps
  • Tension headaches
  • Joint arthritis

Even with these guidelines, you may find that in a particular instance, heat or ice makes you feel worse when it should make you feel better. Don’t be afraid to try the alternate treatment if the suggested one doesn’t work for you. Ultimately, the goal is to make you feel better – and you know your body better than anyone.