MiTo Healthcare Clinic
Wellbeing Team
Ice and Heat: A MiTo Story

Table of Contents

Are you ready to read a story made of passion, love, and also a little bit of pain and suffering? no it is not a new fantasy story, but our guide on How to use Ice and Heat for treating muscular and joint pain.

An ice pack, hot water bottle, heat pad, deep freeze spray what should you use to feel a little bit better? A truthful answer would be: “ it depends ”.

Before telling you all the specific situations whether you should use ice, heat, or a combination of both, let’s talk about some definitions and effects on both remedies so you will fully understand the mechanism and adapt yourself to your needs.

(Figure 1) Photo by Timon Studler Sc3Iz5nupX4 on Unsplash

Ice and Heat: Definitions

So Ice and heat are a part of non-pharmacological and non-surgical therapies. When they are used together alternatively is called Contrast therapy.

The use of Heat is addressed as Thermotherapy as it increases tissue temperature. Heat has a vasodilatation effect so it expands blood vessels bringing more blood and nutrients to the injured or inflamed area.

Since heat is increasing blood circulation it’s helping with the drainage of waste products created by body cells.

For its nature as a vasodilator, heat can make the inflammation worse as an increase of blood flow will cause you more pain, as more blood flow will bring to your injury more chemicals of inflammation increasing your symptoms, so it is not suggested in the first phases after an injury.

Typical and superficial application of heat involves hot water bottles, electric heat pads, heat pads, heated stones, hot baths, sauna, heat wraps, infrared heat lamps, and hot towels.

Although not fully demonstrated, Heat is generally used for muscle soreness as it can reduce the tension and improve muscle flexibility as well (Malanga et al. 2015). 

It is used by athletes to treat muscles D.O.M.S. (Delayed Onset Muscle Soreness) after the gym or after a competition (Singh et al. 2018).

The use of ice is addressed as a Cryotherapy or cold therapy because it decreases the tissue temperature. Ice, on the contrary to heat, provokes vasoconstriction to blood vessels which become more narrow reducing the blood flow.

Because of its blood flow reduction capacity, ice has an analgesic effect that can reduce pain, slow down tissue metabolism, and decrease the inflammation process.

(Figure 2) Photo by Engin Akyurt on Unsplash.

Ice and Heat: User Guide 

Let me explain a little bit more about what Inflammation is and what are its phases as it will be crucial for you to understand what is happening inside your joint after a trauma or an injury.

Inflammation is a physiological healing response of our body, it helps to protect and heal our body. However, if inflammation lasts for too long it can result in higher pain levels and prolonged recovery; therefore proper injury management will look at keeping to minimum inflammatory processes but not removing them to permit natural and healthy healing.

Generally, the healing process can be divided into several phases:

  • Early phase (0-2 hours): in this time frame our body will experience all the direct effects of an injury or trauma (fracture, pain, bleeding, lack of strength, inability to move, changes in the skin temperature, and color (red).

  • Acute phase (2-48 hours): this time frame is really important as it’s characterized by the beginning of all the inflammatory processes such as edema, swelling, and tissue metabolism.

  • Subacute phase (2 days to 2 weeks): in this step your body starts repairing the damage caused by an injury and scar tissue is starting to develop.

  • Intermediate phase (2 weeks to 6 months): the repairing process is continuing and different metabolic and chemical changes are occurring. I will spare you boring details about all the chemical factors occurring during and after an injury. 
  • Chronic phase ( 6 months+): after 6 months your body should be completely healed, however in some cases, the healing process may not be complete or you may still feel pain. In this phase all the neurological circuits of pain will be altered, so the injured part of your body will be more sensitive to traumas and inflammation. 

Patients can still experience pain,  lack of strength or poor motion performance, recurring swelling, instability, and are more likely to get injured again.

(Figure 2) Photo by Vicktor Malashuk on Unsplash.

Different methods of cold therapy have been used for several years to manage acute injuries, and different acronyms have been created for that; One of the most common protocols for acute injury is R.I.C.E. treatment (Rest, Ice, Compression, Elevation) which has been broadly applied by therapists in the first 48 hours from the injury. Through the years it has been changed into P.R.I.C.E. (Protection, Rest, Ice, Compression, Elevation) which has been added focus to protect and not expose the injury to further traumas (pretty obvious right?). 

This protocol reached its final stage in the past few years where it has been changed again into P.OL.I.C.E. (which is not the description of our law enforcement, but Protection, Optimal Loading, Ice, Compression, Elevation). 

Let me explain to you all the passages

Protection: not much philosophy about this, you just need to prevent unnecessary motions and protect your body from further damage.

Optimal Loading: previous protocol focused on resting, but has been shown by studies that a progressive mechanical load is fundamental to restoring range of motion, and flexibility and speed up the healing process. Always be aware of your limits and your pain as you start to put more pressure on your tissue. If the pain is too severe to move, seek medical advice as you may need to take medications such as ibuprofen, paracetamol, or stronger options.

Ice: as has been said before ice is useful to reduce inflammation and in this protocol will give help for putting the “optimal loading”. 

Remember to not apply ice on open wounds if you have a skin condition or if you suffer from poor blood circulation. Also, pay attention to how long you keep the ice on your joint: apply ice for 10 minutes and then have a break of 2-3 minutes before putting the ice again, this way you’ll avoid frostbites. Generally, you can repeat this process a couple of times per hour. 

Compression: applying pressure on your affected joint will reduce the space where the swelling can spread, doing so you’ll help with drainage. Usually, a good compression can be obtained with an elastic bandage or tape. Do not use too much pressure as you may reduce the blood flow.

Elevation: keeping elevated your joint will take advantage of the gravity as your inflammatory fluid (edema) will be moved towards the lymph nodes. As your joint becomes less swollen, more blood flow will come to it speeding up the recovery process.

From what has been said so far, ice must be applied in the acute phase of injury as it is decreasing the tissue metabolism and will prevent your inflammation from reaching its peak.

On the other side, there are no protocols such as P.O.L.I.C.E. for the use of heat, as it may increase inflammation in acute injury. Generally, it is used in the subacute phase of the injury, so after 2 days. In this amount of time the swelling will be already reduced by ice and the healing process has just begun, so using heat will increase blood flow and provide more nutrients to the affected area without affecting the inflammation phase. 

This is the way to apply ice and heat as a Contrast Therapy. Remember to apply heat on the affected area for no more than 10 minutes to avoid any skin burn, take a couple of minutes of break, and then heat again for 10 minutes. 

Ice and Heat: Curious things


  • In your body, there are more than 4 million sweat glands.

  • Men naturally sweat more than women.

  • Small children and infants are more likely to be affected by health illness conditions.

  • Having shivers is the opposite of sweating, with shivers body produces and conserves heat with the shaking of the skin and the muscles.

  • The coldest temperature ever recorded was -128.6 degrees Fahrenheit in Antarctica. 

Ice and Heat: Conclusions

Ice and heat are different methods that can be used for acute injuries management.

Cold things to remember:

  • Ice should be used for the acute phase of the injury (first 2 days).

  • Ice is good to reduce blood flow to the joints and reduce swelling and pain.

  • You should avoid applying ice for more than 10 minutes as it may cause frostbites.

  • Ice can worsen any muscle spasm so take this into account.

Hot things to remember:

  • Heat should be used for the subacute phase of the injury (after 2 days).

  • Heat is good to promote blood flow to the joints, increase muscle elasticity and release muscular tension.

  • You should avoid applying ice for more than 10 minutes as it may cause skin burns.

  • Heat can worsen inflammation and swelling as it increases blood flow. You should also avoid heat to treat any swelling caused b systemic diseases such as Rheumatoid arthritis.

  • Heat can be used for other conditions apart from acute injuries such as D.O.M.S., general muscle tension, and joint pain not caused by an injury.

The best thing to do is to respect the body’s timeframe healing process, apply correct injury management, and a good rehabilitation plan with different healthcare practitioners to get back in a healthy physical form and of course, get back to the things you love! 🙂


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(Figure 3) Photo by Annie Spratt on Unsplash.
(Figure 4) Photo by Elizeu Dias on Unsplash


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Ice and Heat: Bibliography

All the information on this blog post is made with passion, love, and expertise by the MiTo team, however, we always rely on what science says on this topic so you will find our source of information at the bottom of the page in the Bibliography section. 



1. Petrofsky J, Berk L, Bains G, Khowailed IA, Hui T, Granado M, Laymon M, Lee H. Moist heat or dry heat for delayed onset muscle soreness. J Clin Med Res. 2013 Dec;5(6):416-25.

2. Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015 Jan;127(1):57-65. 

3. Glasgow P, Phillips N, Bleakley COptimal loading: key variables and mechanisms British Journal of Sports Medicine 2015;49:278-279.

4. Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. J Clin Diagn Res. 2014;8(9): LC01-LC4. 

Ice and Heat: Medical Disclaimer

Although the MiTo team is composed of healthcare practitioners, we are not your healthcare practitioners (yet XD). All the content on this website is for informational and educational purposes only and does not constitute medical advice. We always strive to provide an accurate and reliable source of information, but the information on this website does not substitute any professional advice and you should not rely solely on this blog content. Always seek medical-professional advice in the area of your particular needs or circumstances before making any decision concerning your health.




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