Hot or cold to treat an injury?

Hot or cold to treat an injury?

The application of cold or heat (cryotherapy or thermotherapy) to an injury depends not only on the type of injury, but also on the time that has elapsed since it occurred. If you have ever wondered what is best to apply in each case, below you will find the answer.

The golden rule and popular wisdom tell us that ice is for recent injuries , also known as acute, and heat is applied to chronic discomfort and muscle aches but the important thing, as in everything, are the details.

How cold and heat work against muscle pain

At a physiological level, the use of cold or heat produces a series of different physico-biochemical reactions, and hence the importance of immediate or delayed use of each treatment: cold is usually used immediately after an injury or blow, while heat is usually reserved for long-term injuries , although there are exceptions to both treatments.

Both cold and heat decrease pain and muscle spasm by slowing down the metabolism. However, the cold stands out for producing relaxation and a decrease in blood flow, associating a decrease in inflammation and edema (fluid at the joint or muscle level); meanwhile, the heat also increases the relaxation, but also increases blood flow and wound healing. In fact, by increasing blood flow, heat can help increase edema and local swelling.

Cold application

 In general we will want to apply cold to a pain, just after a blow, fall … The cold relieves the acute sensation of pain and helps if there is swelling (local inflammation due to trauma).

Example of situations in which to apply cold : a fall, blow, sprain (“twist”), muscle “pull”, to relieve muscles and joints after intense training, to relieve some headaches …

Do not forget that the cold alters sensitivity and can cause burns , so it is important not to place it directly on the skin, and monitor the area every few minutes to check the integrity of the skin.

ice cube

Heat application

 We can say that, in general, we will apply heat to muscle or joint pain in which there is no inflammation , swelling of the area. For example, in a muscle contracture , to relieve joint pain (cervical, lumbar, knee osteoarthritis …).

There are doubts in some cases because, for example, cold acts as a muscle relaxant in the short term, but heat is better in the medium and long term . In a muscle “pull” while doing sports, it is better to apply cold at the moment but, after hours, the heat will have a sedative, longer lasting effect, and the sensation of heat is much more pleasant. Likewise, in a muscle contracture the cold can relieve, but the heat will produce a more comfortable and lasting sensation.



In which injuries should I apply cold?

Obviously, not for all the types of injuries that we suffer we can apply cold and heat, since not performing the proper cryotherapy or thermotherapy treatment can lead to problems that aggravate the injury or pain.

Next, these are the injuries, circumstances or pathologies in which it is advisable to carry out the administration of cold or ice to reduce the damage of the secondary tissue and relieve pain or inflammation.

  • Sprains
  • Overloads or shocks
  • Fractures
  • Tendinitis 
  • Fiber breakage
  • Dislocations


Heat application in injury or Thermotherapy

We mainly apply the use of heat in an injury or Thermotherapy, when we find a chronic pathology or in an advanced state, that is, whenever the inflammation phase (72 hours) has passed.

Actually, this therapy is mainly based on the application of local heat that allows lowering blood pressure and increasing blood pressure, causing a sedative and relaxing effect that produces a reduction in pain. 

  • Apply Thermotherapy or heat for maximum periods of 20 minutes / every 2 hours
  • Do not apply directly to the skin (risk of burns)

A quite positive application of Thermotherapy, we can carry it out if you are a sports-active person, is the application of heat prior to exercising, never exceeding 58º of temperature.

If the heat in the injury is not applied correctly or in its proper state of injury, it can lead to an increase in the inflammation of the same or promote bleeding if the area was with an open wound.

In which injuries should I apply heat?

As is logical, not for all types of injuries we suffer we can apply cold and heat

  • Chronic pathologies
  • Muscle contractures
  • Strain / strain injuries
  • Spasms
  • Bad posture
  • Arthritis
  • RigidityThermotherapy

Contraindications of cold and heat

It is important to carry out a series of recommendations when applying heat and cold to an injury to avoid:

  1. Do not directly apply cold to an injury or skin disease ( Raynaud’s Syndrome ) or wound / infection 
  2. Try to put ice directly on the skin (towels, ice packs , water baths …)
  3. Avoid cryotherapy for periods exceeding 20 minutes / every 2 hours
  4. Apply Thermotherapy for maximum periods of 20 minutes / every 2 hours
  5. We should not apply heat if the body temperature is high or with a fever. Risk of dizziness or fainting.
  6. Avoid putting heat directly on the skin due to the risk of burns ( water bags , baths …)
  7. Do not apply heat in people with hypertension or in areas with malignant tumors

Conclusion, hot or cold?

In conclusion, the summary would be that cold should be used immediately after an acute muscle contracture or blow, while heat is reserved for chronic injuries (more than six weeks) where there is no associated inflammation.


Even so, as we have commented, there are exceptions to both treatments and cases where, in comparison, both would have a similar effect.

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