July 1, 2022


One of the most common pieces of advice that anyone in pain is given is to use ice or heat applied directly to the area. Treating pain with hot and cold can be extremely effective for a number of different conditions and injuries, and easily affordable. However how do you know if your situation calls for hot or cold? Sometimes a single treatment will even include both.

As a general rule of thumb, use ice for acute injuries or pain, along with inflammation and swelling. Use heat for muscle pain or stiffness.

Heat therapy

How it works

Heat therapy works by increasing circulation and blood flow to the area where the heat is applied. Increasing the temperature of the afflicted area even slightly can soothe discomfort and increase muscle flexibility. Heat therapy can relax and soothe muscles.


There are two different types of heat therapy: dry heat and moist heat. Both types of heat therapy should aim for “warm” as the ideal temperature instead of “hot.”

  • Dry heat (or “conducted heat therapy”) includes sources like heating pads, dry heating packs, and even saunas. This heat is easy to apply.
  • Moist heat (or “convection heat”) includes sources like steamed towels or hot baths.

When applying heat therapy, you can choose to use local, regional, or whole body treatment.

When not to use

There are certain cases where heat therapy should not be used. If the area in question is either bruised or swollen (or both), it may be better to use cold therapy. Heat therapy also shouldn’t be applied to an area with an open wound.

People with certain pre-existing conditions should not use heat therapy due to higher risk of burns or complications due to heat application. These conditions include:

  • diabetes
  • dermatitis
  • vascular diseases
  • deep vein thrombosis
  • Multiple Sclerosis

If you have either heart disease or hypertension, ask your doctor before using heat therapy. If you are pregnant, check with your midwife before using saunas or hot tubs.

Use some common sense, if it feels too hot to bare then its too hot. Do not use heat or cold therapy on an area that has reduced sensation. Don't use heat on an area that is infected. Heat applied directly to a local area, like with heating packs, should not be used for more than 20 minutes at a time.

If you experience increased swelling, stop the treatment immediately.

If using heat isn't helping stop and seek advice.

Applying heat therapy

Heat therapy is often most beneficial when used for a good amount of time, unlike cold therapy, which needs to be limited.

Minor stiffness or tension can often be relieved with only 15 to 20 minutes of heat therapy.

Moderate to severe pain can benefit from longer sessions of heat therapy like warm bath, lasting between 30 minutes and two hours.

Cold therapy

How it works

Cold therapy is also known as cryotherapy. It works by reducing blood flow to a particular area, which can significantly reduce inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain.


There are a number of different ways to apply cold therapy to an affected area. Treatment options include:

  • ice packs or frozen ice gel packs (sold in clinic)
  • coolant sprays
  • ice massage
  • ice baths

Other types of cold therapy that are sometimes used include:

  • cryostretching, which uses cold to reduce muscle spasms during stretching
  • cryokinetics, which combines cold treatment and active exercise and can useful for ligament sprains
  • whole-body cold therapy chambers

When not to use

People with sensory disorders that prevent them from feeling certain sensations should not use cold therapy at home because they may not be able to feel if damage is being done. This includes diabetes, which can result in nerve damage and lessened sensitivity.

You should not use cold therapy on stiff muscles or joints.

Cold therapy should not be used if you have poor circulation.

Applying cold therapy

For home treatment, apply an ice pack wrapped in a towel or ice bath to the affected area. You should never apply a frozen item directly to the skin, as it can cause damage to the skin and tissues. Apply cold treatment as soon as possible after an injury.

Use cold therapy for short periods of time, several times a day. Ten to 15 minutes is fine, and no more than 20 minutes of cold therapy should be used at a time to prevent nerve, tissue, and skin damage. You can elevate the affected area for best results.

Risks of cold therapy

Cold therapy applied for too long or too directly can result in skin, tissue, or nerve damage.

If you have cardiovascular or heart disease, consult your medical professional before using cold therapy.

If cold therapy hasn’t helped an injury or swelling within 48 hours seek advice from a medical professional.


Often the decsision on whether to use heat or cold to manage your pain can come down to your own preferences and a bit of experimentation at home may help you to work out which suits you best. Some situations will require both. Arthritic patients, for example, may use heat for joint stiffness and cold for swelling and acute pain.

If either treatment makes the pain or discomfort worse, stop it immediately. If the treatment hasn’t helped much with regular use in a few days, you can discuss it with your chiropractor at your next appointment.

It’s also important to talk to a health care professional if you develop any bruising or skin changes while using heat or cold.

Our Aspirations

At Cathedral Chiropractic we have three chiropractors and we find that no two chiropractors are the same! What we can assure you is that each of us has our patient’s best interest at heart, that we keep up to date with the literature and keep our therapies evidence led and patient centred. We always Keep your experience in mind and work hard to make it the best we can offer.
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