Building Your Recovery Toolkit: When to Use Heat vs Ice
- Dr Natalie Mackay
- Jun 9
- 3 min read
Cold therapy has long been the go-to for managing soft tissue injuries, helping to reduce swelling, inflammation, and pain. The ‘RICE’ protocol (Rest, Ice, Compression, Elevation) has been widely adopted, but with evolving research, its benefits are now being reconsidered. It’s natural to wonder whether ice supports or hinders your recovery - or if heat might be the better choice. Whether you’re managing an acute ligament sprain, sports injury, chronic back pain, or post-gym soreness, let’s unpack what the current evidence says and recovery using Heat vs Ice.
Ice Therapy: Reconsidering a Long-Held Standard
The RICE protocol, introduced in 1978, has shaped injury management for decades. Since then, research has evolved, highlighting the importance of early movement over prolonged rest. Despite these updates, ice remained central until 2019, when the British Journal of Sports Medicine introduced a new guideline: PEACE & LOVE. Notably, the 'A' in this model advises avoiding anti-inflammatories and ice, as both can interfere with the body’s natural healing process - particularly inflammation.
Inflammation often gets a bad reputation, but it’s a vital part of the body’s natural repair mechanism, working to rebuild damaged tissues and fight infection. However, chronic inflammation can be harmful in autoimmune conditions such as rheumatoid arthritis, lupus, and multiple sclerosis.
While ice can be helpful for short-term pain relief - particularly within the first 24 hours following an injury - current evidence does not support long-term benefits. In fact, extended use of ice may delay tissue repair by constricting blood vessels and limiting the delivery of oxygen-rich blood and immune cells necessary for healing.
Cold Water Therapy: A Complementary Tool?
Cold water immersion (cryotherapy) is gaining popularity, particularly among athletes. While it may offer temporary relief from muscle soreness, its effectiveness in enhancing tissue repair remains uncertain. A recent narrative review suggested potential benefits for chronic low back pain and rheumatic conditions, but further research is needed before definitive clinical recommendations can be made.
Heat Therapy: Supporting Healing Through Circulation
Heat therapy promotes vasodilation, increasing blood flow to injured or stiff areas. This improved circulation enhances the delivery of oxygen and nutrients essential for healing. Heat therapy shows particular promise for chronic pain, especially in the lower back and in conditions like knee arthritis. Evidence suggests that continuous, low-level heat can effectively reduce pain and stiffness by improving tissue elasticity and relaxation. Importantly, heat therapy is safe, non-invasive, and easy to apply at home.
Sauna Therapy: Beyond Topical Heat
Sauna therapy offers benefits that extend beyond localised heating, supporting cardiovascular, metabolic, and nervous system health. A 2024 narrative review highlighted its potential in reducing chronic musculoskeletal pain, particularly in degenerative joint conditions.
DOMS: When Both May Help
For delayed onset muscle soreness (DOMS) - the familiar ache after new or intense exercise - both heat and cold can provide relief. A 2021 systematic review found that both therapies can reduce muscle soreness and improve short-term recovery, particularly when applied within the first hour after exercise.
In Summary
Ice: Helpful in the first 24 hours after an injury to reduce pain and swelling. Prolonged use may delay healing.
Heat: Effective for chronic pain, stiffness, and tight muscles by improving circulation and mobility.
Cold Water Therapy: May help relieve muscle soreness after exercise and some chronic pain conditions.
Sauna Therapy: Can support overall recovery and ease chronic joint or muscle pain.
DOMS: Both heat and ice may be beneficial when applied shortly after exercise.
Written by Dr Natalie Mackay DC
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