This is a classic debate and has been going back and forth for decades. Ice for swelling, heat for tension, ice for inflammation, heat for soreness, and on and on. This blog will dive into what the research tells us, and I’ll sprinkle in some clinical pearls from my years of experience as a chiropractor in Kanata.

When do we use ice & heat?

For a long time, ice & heat were really only talked about in the context of injuries. They were considered tools to help with healing and pain. In the last few years I’ve seen an explosion of interest in saunas (I know these have been around forever - as a teenager I’d spend many post-workout protein shakes sitting in the sauna), and an incredible growth of ice baths and cold plunges. To me, this indicates the conversation has moved past simply pain, and now we are seeking additional health benefits from ice & heat.

I’ll touch on ice baths/cold plunges, as well as saunas in this article. We’ll also discuss the use of ice/heat in a clinical setting and at home.

Let’s make it cold.

If you go on Instagram and enter the world of FITFLUENCERS, it’s impossible to avoid half-naked men & women explaining to you how the ice bath improves literally everything (this is a mild exaggeration, but not really). I’ve had many patients tell me about their own positive experiences with cold water immersion, and I believe it can be very beneficial for some people - I’m not trying to knock it.

The research is a bit mixed on cold water immersion. It seems that immediate post-workout, it can help with the sensation of pain/fatigue but may actually impeded muscle repair. This means it may actually have a negative effect on recovery if used improperly.

However, for decades athletes have been using cold water immersion (ice baths) to help with fatigue and recovery, and many swear by it. I suspect that the negative physiological effect on muscle repair and synthesis is probably small enough, that ice baths qualify as one of those things that we can keep in the mix if we like how it makes us feel. Chances are, if we are eating well, sleeping well, maintaining a good social life, and consistently lifting in a reasonable way, an ice bath will not derail our progress in any sense.

I think you could make the case that an ice bath would be helpful for an athlete who has multiple sporting events in a short period of time. Cold water immersion does have research (and millions of anecdotes) supporting the idea that it drastically reduces Delayed Onset Muscle Soreness (DOMS) post-exercise. So, while it may not be the best for muscle growth, it really seems to make people feel better within the first 24-48 hours post-exercise. If DOMS is becoming an issue and effecting performance for an athlete, perhaps a well-timed ice bath could help with that.

For injuries, ice is very effective at reducing pain. By literally numbing the affected area with cold, we can take the edge off and get a break from painful issues. There is some evidence that ice is good for acute swelling also, but typically we don’t use it longterm. Post-surgery is a bit of a different story, and it’s best to listen to your surgeon in these situations. Our chiropractor, physiotherapist and registered massage therapist all recommend ice on occasion for patients who find it helpful.

HOT HOT HOT

I (dr. josh) am extremely biased toward heat. I love it. I’ll take a good sauna over a cold plunge any day. I even had a TCM practitioner tell me one time I had too much fire in my belly, so clearly I prefer heat.

Alas, the research on heat is not very conclusive (just like ice). Saunas, hot packs, and hot tubs are basically universally loved by our chiropractic and physiotherapy patients. Anecdotally, they are great for tight and sore muscles and joints. Nerve issues are a bit more hit and miss (sometimes they make them pissy).

The theory on why heat is effective for reducing pain is that it will increase blood flow, keep tissues warm (and supple), and improve clearance of inflammatory products which should have a positive impact on pain.

Talk to any older person with osteoarthritis and they will tell you how a sauna, a warm day, or a heat pack helps their hips, knees, elbows, and shoulders move easier and more comfortably. As well, heat can have a calming, soothing effect.

Conclusion

So there you have it. As with many things in the world of painful backs, necks, muscles, nerves and joints, the effectiveness of heat or ice depends on the context in which we use it. More often than not, I find myself telling patients to try both and see which they respond better to.

We never rely on ONLY heat or ice to help us overcome an injury, and since it’s just one of many tools we may utilize, it’s really not too important which one we decide to use. It’s like Goldilocks and the Three Bears out here - we’re just trying to find the solution that is JUST RIGHT for you.

Pain sucks. We can help! Our team can provide chiropractic care, physiotherapy, and registered massage therapy to help you get back to the activities you love.

Research

Ice

Xiao F, Kabachkova AV, Jiao L, Zhao H, Kapilevich LV. Effects of cold water immersion after exercise on fatigue recovery and exercise performance--meta analysis. Front Physiol. 2023 Jan 20;14:1006512. doi: 10.3389/fphys.2023.1006512. PMID: 36744038; PMCID: PMC9896520.

Heat

Wang Y, Lu H, Li S, Zhang Y, Yan F, Huang Y, Chen X, Yang A, Han L, Ma Y. Effect of cold and heat therapies on pain relief in patients with delayed onset muscle soreness: A network meta-analysis. J Rehabil Med. 2022 Feb 8;54:jrm00258. doi: 10.2340/jrm.v53.331. PMID: 34636405; PMCID: PMC8862647.