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Should you apply heat or ice to a muscle injury?

Accueil » Ankle pain » Should you apply heat or ice to a muscle injury?

  • 29/05/2022

Hot or cold? Ice or no ice? The perennial questions!

How many times do we hear these questions… Hot or cold on a lumbar sprain? Neck or cervical pain, hot or cold? Heat or ice for muscle pain (muscle strain, soreness)? Should you put ice on a sprain? Is cryotherapy effective for chronic inflammation? Which condition for which symptoms?

Who hasn’t treated a soccer player by resting his leg with ice, wrapped in a bandage on his sprained ankle? Or who hasn’t held their breath watching a footballer take a cold water dip?

In this article, we will try to answer all the questions you may have on the subject!

If you experience muscle pain, make an appointment for a physiotherapy consultation.

The properties of hot and cold

The first thing to know is that hot and cold have their own properties. As such, we won’t look for the same effect from one or the other, and shouldn’t use them for the same conditions.

If misused, both hot and cold can aggravate an injury. That’s why they should be used with care.

How does cold calm the pain?

On the one hand, cold is an analgesic and anaesthetic and reduces local pain: it only has an effect on the area to which it is applied. Cryotherapy, cold therapy, will slow down blood circulation and reduce cellular activity.

How does heat relieve pain?

Heat has a relaxing and relieving effect. Unlike cold, which slows it down, heat will facilitate and increase blood circulation. Thermotherapy, heat therapy, will relax muscles, increase cellular activity and promote tissue healing.

Knowing when to use hot and cold for your pain

As mentioned above, cold and heat are not used in the same conditions. Applying cold will be effective on an inflammation, like after a strain, a sprain or any violent impact.

Hot will be effective for relieving muscle tension, cramps or menstrual pain.

It is worth noting that the use of heat can be effective once the acute phase of the inflammation is over and the healing process begins. Applied for periods of 20 to 30 minutes, heat reduces persistent pain, and facilitates and accelerates healing.

When applying cold, the best technique is to use a “magic bag”, an ice pack or a bag of frozen vegetables (peas). Do not apply the ice directly to the skin, as this may irritate it.

To apply heat, which is harder to maintain, a hot compress or a hot-water bottle will do the trick! As with ice, it is not recommended to apply heat directly to the skin to avoid burning it.

How to relieve muscle pain?

Before applying either heat or ice to relieve muscle pain, give your body a rest. Muscle pain is often caused by the intense pace of our daily lives.

It can be associated with poor posture (prolonged sitting or standing), or an unusual load. Muscle pain related to remote work is particularly common.

Rest and relaxation are the first remedy for muscle pain.

If the pain persists, identify it. If it is acute and was caused by a recent impact (e.g., during sports training), it may be due to inflammation. For running-related pain, such as a knee sprain, applying ice is recommended.

It will help to reduce the pain as well as the inflammation.

However, if your muscle pain is chronic and happens regularly when performing the same movement (at work, for example), apply heat to relax your muscles.

Why should you apply ice to a sprain or inflammation?

As explained above, one of the properties of ice is to decrease inflammation and reduce pain. Let’s take the example of a lumbar sprain, where muscle pain can lead to a loss of mobility, especially in the first few days.

A lumbar sprain can be the result of a number of different things. It can be caused by a false movement, repeated efforts (especially at work) or a too heavy load.

Following the principle of rest, ice, compression and elevation for 20-25 minutes on a sprain helps to reduce the pain. This lower pain intensity can make it easier to gain mobility and strength during healing.

Tendinitis: hot, cold, or both?

If you suffer from tendinitis, an injury that affects many athletes and is caused by the repetition of one or more movements, applying both cold and heat will be helpful.

If the symptoms of tendinitis (acute pain) appear in the middle of physical effort, do not push the painful area.

Apply an ice pack to help manage and reduce the inflammation on the spot and during the first few days. After three days, you can start to apply heat to facilitate the healing process.

What about torticollis, hot or cold?

Neck stiffness, difficulty turning the head and severe neck pain are symptoms of torticollis. In this case, the effectiveness of the heat application will depend on the severity of the torticollis, a neck trauma.

Indeed, if the contracture of the neck muscle is only the result of a bad sleep position, applying a hot-water bottle should help to relieve the pain. Heat fights against contractures and relaxes the muscles.

However, if the symptoms persist, these two conditions will not be enough. The injury will require the intervention of a healthcare professional.

Is a hot and cold bath really effective?

If your injury causes swelling around the affected area, a hot and cold bath, called a contrast bath, will be effective. Alternating between the two conditions over several periods of time will relieve pain, manage inflammation and restore mobility to the affected limb.

To go further: the limits of using ice to reduce pain

To get a clearer picture, we need to understand what happens in the hours following a musculoskeletal injury such as an ankle sprain, lumbar sprain or tendinopathy.

An inflammatory process occurs after a trauma. This is a normal response of the body to an injury or infection. It can cause redness, warmth, swelling and pain.

This inflammatory response is a complex reaction that involves several types of immune cells, coagulation proteins and signal molecules.

Inflammation is essential to the healing process of injured tissue. The acute pain experienced is an important warning signal that prevents us from aggravating the injury.

While some studies seem to show that inflammatory cells can induce tissue damage that may delay the healing process, other recent studies tend to contradict these observations.

Applying ice packs or taking non-steroidal anti-inflammatory drugs would decrease lymphatic pumping, maintain edema, and thereby decrease the rate of tissue healing.

Certain mediators of the inflammatory response are essential for organizing the tissue repair process (Bleakely et al. 2012, Tagagi 2011).

Although some scientific studies have shown that inflammation may induce collateral damage, new evidence is accumulating in favour of a critical role of certain inflammatory cells for injured tissue regeneration.

In conclusion, if the pain following an injury is bearable, ice and anti-inflammatory medication can be avoided. But if the pain is severe and disabling, applying ice is a good option.

Regardless of your condition, if the symptoms persist and worsen over time despite the application of heat or cold, make an appointment with one of our therapists.

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This article was written under the supervision of Sylvie.

Sylvie is a physiotherapy technologist, graduated in 2010 from the Cégep de Sherbrooke and works with both CNESST and private clients.

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