When To Use Heat or Ice on Pulled Muscles and Other Injuries

Do you use heat or ice to treat a pulled muscle? You'll want to opt for ice in that case. Pulled muscles are an acute injury that typically responds to ice. The cold constricts blood vessels, which reduces blood flow to the area. As a result, ice helps alleviate pain and decrease swelling.

In contrast, you might use heat to treat an injury that does not improve after 48–72 hours. Heat dilates (expands) your blood vessels, allowing oxygen-rich blood and nutrients to flow to the affected area. Electric heating pads and hot water bottles also help treat chronic problems like arthritis and menstrual cramps.

You can typically treat acute injuries at home, but you'll want to see a healthcare provider if you have a lot of swelling that worsens over time. Read on to learn when to use heat and ice on a pulled muscle and other injuries.

When To Use Ice

Ice tends to win over heat if you have an acute injury, inflammation, and swelling. Acute injuries are ones that happen all of a sudden, such as a pulled muscle or sprained ankle. Cold slows blood flow to an injury, reducing pain and swelling.

Of note: Check with a healthcare provider if you have circulatory problems like Raynaud's disease. This rare disorder causes the blood vessels to narrow when you are cold, which causes your skin to throb and turn white or blue.

Pulled Muscle

Ice a pulled muscle as soon as possible to stop inflammation. Pulled muscles happen when your muscles stretch so much that they tear. You might notice pain, difficulty moving the affected area, discoloration, and swelling. Apply ice for 10–15 minutes every hour after you pull a muscle. Continue applying ice every three to four hours after the first day.

Avoid jumping into an intense workout if you have a pulled muscle. Instead, move and foam roll the affected areas before exercising to dilate the blood vessels. Gentle exercises warm up your muscles to ensure they have enough oxygen, increase flexibility, and prevent further injuries.

Muscle Spasms

Muscle spasms are brief and uncontrollable contractions that typically occur after exercise. You might have muscle spasms in your abdomen, arms, feet, hands, and thighs. Research has found that applying ice to the affected area for 20 minutes helps reduce muscle spasms and pain.

Sprained Ankle

Ice is the best treatment for a sprain—as well as any new joint pain, swelling, or injury to muscular or soft tissue. You'll want to use the RICE method, which stands for rest, ice, compression, and elevation. Wrap the injured area with an elastic bandage and prop it up on pillows above heart level.

Apply ice 30 minutes on, then 20 minutes off for the first 35–48 hours after the injury, Michael Joyner, MD, an anesthesiologist at the Mayo Clinic in Rochester, Minn., told Health. You might fill a Ziploc bag with crushed ice cubes, use a frozen gel pack, or opt for a bag of frozen vegetables. Just remember to place a towel under the ice to avoid skin irritation.

Stiff Neck

Opt for ice if you slept funny and woke up with a painful crick in your neck. Look for a way to mold the cold to your neck. For example, soak a towel in ice water, wring it out, and then place it on the back of your neck.

Swelling

Fluid build-up in your tissues causes swelling of your body parts, including your organs and skin. Swelling typically occurs with overuse or after injuries. It's important to apply ice to the affected area right away after an injury. Swelling might hinder the healing process. Cold therapy helps slow and reduce swelling.

When To Use Heat

You may choose heat if your injury is a chronic (long-lasting) problem, such as overuse injuries or ones that occur over time. Heat increases the flow of blood and oxygen, which helps repair damaged tissue.

"For an injury that's older than six weeks, heat may help restart the healing process," Evie Vlahakis, a physical therapist based in New York, told Health.

Arthritis

Arthritis, which is inflammation of the joints, generally responds to heat. Not only does heat soothe and relax stiff muscles and joints, but it increases circulation. Heat helps deliver more blood and nutrients to the affected area.

Use a microwavable heating pad or wrap an old-fashioned hot water bottle in a towel. Apply heat for only 15–20 minutes while lying or sitting in a relaxing position, said Vlahakis. You might try moist heat, such as a warm, damp washcloth. Just be careful if you use an electrical heating pad, which can be dangerous if you fall asleep while using one.

Menstrual Cramps

A heating pad helps relax your uterine muscles. Menstrual cramps happen when your uterine muscles contract (squeeze) to expel tissue through the vagina.

Heat also helps stop the production of prostaglandins, or hormone-like chemicals. The uterus produces prostaglandins after ovulation. Those chemicals stimulate the uterine muscles to contract during menstruation.

When To Use Ice and Heat

Some injuries and health conditions might benefit from alternating ice and heat. Ice helps contract blood vessels, reducing blood flow and alleviating pain. The blood vessels expand if you remove ice. Heat helps the blood vessels expand, allowing oxygen-rich blood and nutrients to get to the injured area.

Headaches and Migraines

Ice has a numbing effect, which can help with headache and migraine pain. Place an ice pack on the painful spot in 10-minute intervals for 30–60 minutes. Research has found that applying a frozen wrap to the front of your neck at the onset of a migraine significantly reduces pain. That area targets the carotid arteries, which supply oxygen-rich blood to your brain.

In contrast, heat helps relax tense head and neck muscles in some people. Use a heating pad in 10-minute intervals for 30–60 minutes, Fiona Gupta, MD, director of the Movement Disorders Outreach Program at Mount Sinai Health System, told Health.

Hemorrhoids

Hemorrhoids are swollen veins near your anus. A cold pack will reduce blood flow to hemorrhoids, which helps reduce their appearance.

You may then use heat to soothe hemorrhoids after you have got them under control, Mary Jane Minkin, MD, a clinical professor of obstetrics, gynecology, and reproductive sciences at the Yale School of Medicine, told Health. Try soaking in a sitz bath or using a hair dryer on low heat after a shower or bath. The latter helps keep the area dry and prevents irritation. You might also use an over-the-counter (OTC) hemorrhoidal ointment.

Knee Pain

Knee pain is a common symptom of an acute or chronic injury. Some people develop long-lasting knee pain that results from an acute injury. For example, runner's knee, or patellofemoral syndrome, is a common overuse injury. You'll want to use ice to ease pain and swelling in that case.

Heat is optimal if a long-term problem, such as arthritis, is causing your knee pain. Some evidence suggests that heat therapy helps improve symptoms and walking ability in people with knee osteoarthritis (OA). Knee OA, or inflammation of the knee joint due to aging and wear and tear, causes pain and stiffness.

Lower Back Pain

Lower back pain might occur suddenly after lifting heavy items or sitting for long periods. Opt for an ice pack in those cases.

In contrast, you might have arthritis or another chronic problem if your back always seems to act up in the same spot. Warmth may improve lower back pain in that cause. Check with a healthcare provider if you do not have any relief after icing for 48 hours, said Dr. Joyner.

Neck Pain

This causes discomfort in the muscles, nerves, bones, and other neck structures. You might have trouble moving your neck or feel numbness, tingling, and weakness. Ice is optimal for neck pain that occurs suddenly, such as after lifting items quickly. Use ice for 48–72 hours after you develop neck pain, and then apply heat.

You'll also want to use heat if you have chronic neck pain. For example, fibromyalgia often causes long-lasting neck pain. Fibromyalgia is a chronic health condition that causes pain, fatigue, and trouble sleeping.

Shoulder Pain

This causes pain in or near your shoulder joint. Like back, knee, and neck pain, shoulder pain can be acute or chronic. Use ice for acute shoulder pain, such as rotator cuff problems. The rotator cuff is made up of muscles and tendons that help move and stabilize your shoulder.

Apply ice for 20 minutes, three to four times per day, to treat rotator cuff problems like tendonitis and bursitis. Tendonitis is inflammation of the tendons. Bursitis is inflammation of the fluid-filled sac that cushions the tendons.

Icing your shoulder might also alleviate inflammation and pain from arthritis. Wet heat, such as a hot water bottle, hot bath, or steam towel, may temporarily relieve shoulder arthritis pain.

How To Apply Ice and Heat

You can fill a Ziploc bag with crushed ice cubes, use a frozen gel pack, or mold a bag of frozen vegetables to your skin to treat an acute injury with ice. Apply ice for no more than 20 minutes at a time to avoid skin irritation. Wait at least 30 minutes between icing the affected area. Ice your injury for 20 minutes, three to four times per day, after 24 hours. Make sure you place a towel between the ice and your skin.

You might use dry or wet options to treat a more long-lasting injury with heat. Dry heat includes an electric heating pad or a heat pack. In contrast, you might take a hot bath or apply a steam towel to the affected area to use wet heat. Some evidence suggests that wet heat increases blood flow more than dry heat.

To apply heat safely:

• Apply heat only after icing a new injury for 48–72 hours.
• Remember not to use an electric heating pad while sleeping to avoid injuries.
• Treat the affected area with an electric heating pad before exercising and stretching.
• Use heat for 20 minutes at a time.

When To Contact a Healthcare Provider

Most acute injuries go away on their own with ice, light stretching, nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen, and rest. Still, you'll want to contact a healthcare provider if you have a lot of swelling, notice that swelling worsens over time, or cannot move your limbs or joints.

See a healthcare provider if you have a chronic problem, like arthritis, and have:

• A lot of swelling
• Difficulty moving your joints
• Fever
• Joint pain that lasts longer than three days
• Red skin near the affected joint that is hot to the touch
• Severe joint pain that does not have an obvious cause
• Unintentional weight loss

A Quick Review

Ice helps relieve acute injuries like pulled muscles, while heat alleviates chronic pain. You might alternate ice and heat for some problems, like back, knee, neck, and shoulder pain or headaches. Make sure that you use ice and heat safely. For example, place a towel between the ice and your skin to avoid irritation. Remember not to fall asleep with an electric heating pad, which may be dangerous.

Talk to a healthcare provider if your injury does not get better with ice or heat. Seek medical attention if you have a lot of swelling that worsens over time or cannot move your joints.