Ice or Heat, To Help My Pain?

This is a great question, I hear this several times per week. Part of the reason this seems so confusing is that different people will tell you different things.

I even know some physical and occupational therapists that still like to put heat on a body part before they work with it.

Well here’s the science behind my answer and then I’ll let you choose which way to go.

HEAT stimulates circulation and is a pain killer (another name you’ll see for something which reduces pain is an ANALGESIC)

COLD reduces circulation and is also a pain killer or analgesic.

YES, THAT’S RIGHT… both HOT and COLD help to reduce pain…. but the difference is in the OTHER result on the body. Heat increases circulation and therefore swelling, whereas cold reduces circulation and swelling.

Therefore, lets say you have decided to work with a well-meaning personal trainer to help get you in shape and they had you do too many squats and ever since, for the last week your knee has been hurting, is stiff and painful and maybe even a bit swollen.

Well, putting on a cold pack or sitting in a hot jacuzzi are both going to make your knee feel better… for the moment. But the Heat will also INCREASE the circulation in your knee which is ALREADY swollen and painful. So the heat will only be a temporary relief from the pain and may actually prolong your discomfort.

The ice will help to reduce the swelling that is actually helping to produce the pain. So when you use ice the ice will start to take away the cause for the pain.

Another comment I hear frequently is… “My shoulder or neck hurts, but I do not see any swelling, so maybe it is not really INFLAMED anyway“.

And I know what you mean.

When I get a sticker in my finger, I may not SEE any swelling, but it is there… and the reason I know this is because INFLAMMATION has 4 basic characteristics:

  • Swelling
  • Redness
  • Pain
  • Heat

Sometimes when a body part has really been injured or irritated, one can see ALL FOUR or these characteristics….

But the truth is that if any ONE of them is present, that area is inflamed.

So why do some therapists, even physicians recommend heat?

A therapist may decide to take a tradeoff of causing a bit more swelling, but be able to move an angry joint after it is warmed up and some of the pain is temporarily gone. They will treat the joint to get it moving and then ask the client to keep moving that joint which can help to pump the swelling out.

But if the person does not do the necessary continued movement to pump the swelling out… then they are left with too much swelling in the area and it stays swollen and painful.

Then some people will ask me, like my mom who is a nurse from the last generation, and who was taught to have people use EPSOM SALT BATHS.

And at the risk of talking out of both sides of my mouth, I will say that an Epson Salt bath MAY be helpful… because the Epsom Salt water is more concentrated than the salt in your skin and tissue so the Salt Bath can pull swelling out of your body, reducing the swelling.

While this does work, sometimes the swelling is so deep the swelling that is being pulled out is less than the increase of swelling that is happening on a deeper level, making the benefit not worth the cost.

SO TO KEEP IT SIMPLE, what I recommend without being able to see, measure and know what the best course of action is for a specific case… I choose to recommend what I know will help the vast majority of people.

So my recommendation to clients is:

  • HEAT is great for things that are stiff
  • ICE is for everything else (stiffness AND swelling AND pain)

I am not saying there is NEVER a time for heat… but to keep it simple and to do something that can really help you a lot quickly… try ICE.

  • 10 minutes ON
  • 20 minutes OFF
  • 10 minutes ON... and repeat as needed

Don’t put ice directly on your skin and just let it set there. Instead, put a layer underneath, like layer of two of a dish towel or T-shirt or thin towel (A thick towel may block the cold from getting to the skin).

I hope this has been helpful for you.

If you still have questions, please feel free to email directly at – I love to get your questions and I always answer them!



Jeff Rau Physical Therapy
Where Your Recovery Is Our Motivation


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