Hot or cold?

One of the most common questions people ask their massage therapist about any injury is, “Should I use hot or cold on that?”

Neck Pain - Ottawa massage blog

Achy, sore shoulders and neck – use heat

Here are four basic guidelines:

  1. If an area is stiff and achy, and especially if it’s been that way for a while, use heat — heat increases blood flow and relaxes muscle.
  2. If it’s a new injury that happened within the last two days, with throbbing or sharp pain on movement, and especially if it’s swollen or discoloured, use cold — cold reduces blood flow and pain, and may reduce inflammation.
  3. In many cases, you can use several cycles of heat and cold (“contrast temperature therapy”) both to relax muscle fibres and to reduce pain and inflammation.
    1. If it’s an old, achy injury, start and finish with heat in a 3:1 ratio over cold (e.g. three minutes heat, one minute cold, three minutes heat).
    2. If it’s a new, throbbing, sharp, swollen or discoloured injury, start and finish with cold in a 3:1 ratio over heat (e.g. three minutes cold, one minute heat, three minutes cold).

      Sprained foot, courtesy of Wikimedia Commons

      Ankle sprain with bruising and swelling – use cold

  4. If you have a personal preference for hot or cold, based on what usually works best for you, do that. If it doesn’t work in a given case, then do the opposite.

What do hot and cold treatments do?

Heat will bring more blood and lymph fluid to an area to help with repair, and will relax the muscles and other soft tissues. But if you have a bruise or swelling, you don’t want to increase fluid, because that makes the tissues more swollen and impedes their healing.

Ice feet - ottawa massage blog

Rolling foot on frozen water bottle to reduce plantar fascia pain

Cold will reduce blood flow and pain and may reduce inflammation, so in the case of a sprain, strain, or bruise, cold is the treatment of choice. However, cold won’t help to soften muscle fibres and enhance their flexibility as heat will.

Contrast temperature therapy is often a safe way to get the best of both treatments, but it takes more time (and double the number of gel packs!) than using just one type of temperature therapy. Remember that you only need a ten-degree difference between the hot and cold temperatures for effective contrast therapy.

If you have any condition that affects your circulation, your ability to sense temperature changes, or your tolerance to heat or cold, such as Raynaud’s Syndrome or diabetes, use very modified temperatures and pay close attention. Do what is safe for you.

How long does it take to work?

You’ll likely need repeated treatments of temperature therapy, several times a day, if possible, for several days, or until you notice a change.

Usually, we leave heat on an area longer than cold, since it is less likely to damage the skin or other soft tissue: up to 30 minutes for heat, and up to 15 for cold. But you may find you need to remove a cold pack sooner than 15 minutes, and please don’t tough it out with either temperature.

If you’re using contrast therapy, the basic ratio is 3:1 hot to cold: for example, 3 minutes hot and one minute cold, or reversing that if there’s a lot of swelling as outlined above.

What’s the best tool for applying heat or cold?

Hot towel, courtesy of Wikimedia Commons

A hot towel can be used as a compress for a small area

The best tool is the one that makes your life easiest!

Whatever tool you choose, be careful not to burn or freeze your skin, don’t use cold long enough to stop blood flow, and don’t leave any temperature therapy so long on an area that your muscle and other soft tissue is harmed.

You should not lie or sit on your heating pad or ice/gel pack.

For best effect, with either hot or cold treatments, wrap your temperature source in a lightly damp towel to enhance the therapeutic impact. But of course be careful not to expose any electrical pad to water: wrap your electric heating pad in plastic to protect it, for example.

These packs can be used for either hot or cold treatments

These packs can be used for either hot or cold treatments

Here are some easy suggestions:

  • Use ice cubes in a plastic bag wrapped in a small towel (the towel protects your skin from freezing)
  • Use a gel pack that you keep in the freezer and can warm up in hot water as needed
  • Fill one side of a double sink with very cold water, and one side with warm or hot water, to treat forearms, hands, or feet with contrast therapy
  • Get in an Epsom salt bath (about 3 cups of Epsom salts for a full-body bath)
  • Use a “magic bag” style of pack that you heat in the microwave
  • Use a warm towel
  • Use an electric heating pad

At Body Poets we sell a selection of versatile gel packs; many pharmacies, sporting stores, and massage supply stores will have numerous options for both hot and cold therapy. Ask your RMT for recommendations for your particular injury.

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About Body Poets Massage Therapy

Three-time nominee and 2016 winner of Top Massage Clinic in Ottawa! At Body Poets Massage Therapy, we are committed to excellence in client care. We provide therapeutic, sports, pre- and post-natal, wellness, cupping, hot stone, ART, Thai massage, and more in a convenient, peaceful, downtown Ottawa location with free client parking. We are FSCO-registered and can bill your auto insurance company directly for treatment after a motor vehicle accident. We also bill directly to Great West Life and Green Shield. Our flagship office at 504 Kent Street in Ottawa is close to the Queensway and easy to reach by car, foot, bike or bus. Our satellite clinic in Almonte, Ontario is cozy and charming. Our online booking system makes it simple for you to reserve your appointment at any time. And our network of like-minded health professionals means we can refer you to practitioners in other fields who meet your needs for quality care. Step into the circle of care, at Body Poets.,,

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