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When to Use Heat and Ice for Sore Muscles, According to Physical Therapists

Learn about the benefits of heat and ice for sore muscles and how to use them to promote recovery and movement.

Published Date: Jan 18, 2024
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Are your muscles feeling sore, achy, or stiff? Whether you recently took a more challenging exercise class, hit the gym for the first time in months, or started to incorporate more physical activity into your routine after an injury, any muscle soreness you’re experiencing is usually pretty common but it can also be pretty uncomfortable, too. 

Rarely is muscle soreness a sign that something’s wrong — and there’s a lot you can do to manage and reduce it, says Samantha Stewart, PT, DPT, a physical therapist at Hinge Health. 

At Hinge Health, we know the power of movement and exercise to relieve pain and soreness, but we know other treatments can play a big role, too. So when muscle pain or soreness flares up, you may be wondering whether it’s best to reach for an ice pack or a heating pad. It’s a good question, and one that Hinge Health physical therapists field from members all the time. While ice and heat accomplish different things, they can both help relieve symptoms and promote recovery for sore muscles. 

Read on to learn more about what causes muscle soreness and how you can use ice and heat to help relieve the pain. 

Our Hinge Health Experts

Samantha Stewart, PT, DPT
Physical Therapist
Dr. Stewart is a Hinge Health physical therapist with over 8 years of experience. She is certified in myofascial trigger point therapy.
Jonathan Lee, MD, MBA
Orthopedic Surgeon and Medical Reviewer
Dr. Lee is a board-certified orthopedic surgeon and an Associate Medical Director at Hinge Health.
Dylan Peterson, PT, DPT
Physical Therapist and Clinical Reviewer
Dr. Peterson is a Hinge Health physical therapist who focuses on developing clinical exercise therapy programs and member education.

Muscle Soreness: What Is It?

Muscle soreness usually involves a feeling of fatigue, achiness, and stiffness in your muscles. “Soreness is common after working your muscles more than they’re used to, using them in different ways, or when reintroducing movement after an injury,” says Dr. Stewart. 

There are two main types of muscle soreness you can experience: 

  • Acute muscle soreness, which happens right after you exercise and typically goes away in a few hours.

  • Delayed onset muscle soreness (DOMS), which often occurs about 12 hours after activity, peaking 48 hours afterward. 

Ice and heat can be useful in either scenario to reduce soreness. It’s important to understand what ice and heat therapy accomplish and how they help, but ultimately, Dr. Stewart says you can use either one when your muscles feel sore. 

What Is Cold Therapy?

The purpose of cold therapy — also called cryotherapy — is to decrease inflammation and swelling by reducing blood flow to the sore area. Cold therapy, Dr. Stewart says, also provides a temporary numbing effect that can help reduce soreness and pain. 

Cold therapy is often recommended immediately after an injury to calm down the inflamed area, which may also be swollen. But if it feels good, you can use ice in other instances of muscle soreness. For example, you may find it comforting to ice a sore spot a day or two after a tough workout, and that’s okay. 

Typically, Dr. Stewart recommends applying ice or cold therapy for 10 to 15 minutes, a few times a day, on the affected muscles. It’s a good idea to cover the ice with a cloth or paper towel for comfort and skin safety.

Examples of Cold Therapy

Common examples of cold therapy include: 

  • Ice packs

  • DIY cold therapy, such as a frozen water bottle

  • Ice massage with an ice cube

  • A cold bath or shower

Some topical gels and creams can also provide a cooling, numbing effect. 

How Often to Use Ice

There’s no limit to how often you can use cold therapy. “It’s more important to focus on how long you do it in a given session and how intense it is,” says Dr. Stewart. For example, you can use an ice pack multiple times a day, but be sure to give your body a break to avoid harming your skin. Dr. Stewart suggests applying cold therapy for 10 to 15 minutes a few times a day, as long as it feels helpful. 

What Is Heat Therapy? 

While cold therapy reduces blood flow, heat increases blood flow and opens up your blood vessels. “When you bring more blood to an area, you’re also bringing in healing nutrients and relaxing the affected muscles,” says Dr. Stewart. 

Heat is often recommended for chronic pain, as opposed to acute injuries when the initial focus should be on reducing any pain, inflammation, or swelling. But Dr. Stewart notes you can use heat therapy whenever your muscles are sore, as long as it feels comforting. 

Like cold therapy, you can apply heat to any sore muscles. Be sure the heat therapy you’re using isn’t so hot it will burn your skin, and that you use a barrier between a heat pad and your skin. 

Examples of Heat Therapy 

Common examples of heat therapy include: 

  • Heating pads

  • Heat packs or hot water bottles

  • A hot bath or shower

  • Rice socks heated in the microwave

  • Hot wax or paraffin baths

How Often to Use Heat

As with ice, you can use heat therapy throughout the day, but give yourself a break if you’re getting too hot. “Applying heat a few times a day is fine, but be sure you don’t irritate your skin,” says Dr. Stewart. As a general rule, apply heat for 10 to 15 minutes each session, and set a timer so you don’t fall asleep while using it. 

Why You Can Use Both Heat and Cold Therapy 

Heat and cold therapy work in different ways, and both can relieve sore muscles and help you regain function so you can return to activities you enjoy. Dr. Stewart often recommends alternating between both forms of therapy. 

When Not to Use Heat or Ice

While both heat and ice are effective ways to deal with muscle soreness, you shouldn’t use them in certain scenarios. 

Avoid cold therapy if you have:

  • Impaired circulation, such as Raynaud’s disease

  • Cold-induced hives (urticaria)

  • Peripheral vascular disease

  • Neuropathic problems, such as diabetic neuropathy 

  • Open wounds 

Avoid heat if you have:

  • An active infection, such as influenza or COVID-19

  • Neuropathic problems, such as diabetic neuropathy 

  • Open wounds

If you have any questions about what’s safe for you, talk to your primary care provider or a physical therapist. 

The Importance of Movement to Healing

Heat and ice can help relieve uncomfortable muscle soreness, but your treatment shouldn’t stop there. It’s important to keep moving your body, even when you’re sore. Exercise helps address underlying issues that could be contributing to your soreness. By strengthening and stretching muscles you can make them more resilient to pain in the future. 

As a bonus, exercise also helps heal your soreness. “Movement pumps blood and other necessary fluids to your muscles, which helps decrease inflammation,” says Dr. Stewart. A physical therapist can help you target the right kind of movement for you as you move through muscle soreness. You can see a physical therapist in person or use a program like Hinge Health to access a PT via telehealth/video visit.

PT Tip: Alternate Ice and Heat

If you prefer a cold pack or a hot bath when your muscles are sore, it’s perfectly okay to lean into whichever will help relieve your symptoms and keep you moving. For a more strategic approach, however, Dr. Stewart recommends alternating cold and heat therapy. “I like to use heat to loosen up sore, stiff muscles and then use ice to recover after activity,” she says. 

How Hinge Health Can Help You 

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

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References

  1. Ernst, E., & Fialka, V. (1994). Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy. Journal of Pain and Symptom Management, 9(1), 56–59. doi:10.1016/0885-3924(94)90150-3

  2. Freiwald, J., Magni, A., Fanlo-Mazas, P., Paulino, E., Sequeira de Medeiros, L., Moretti, B., Schleip, R., & Solarino, G. (2021). A Role for Superficial Heat Therapy in the Management of Non-Specific, Mild-to-Moderate Low Back Pain in Current Clinical Practice: A Narrative Review. Life, 11(8), 780. doi:10.3390/life11080780

  3. Wang, Y., Lu, H., Li, S., Zhang, Y., Yan, F., Huang, Y., Chen, X., Yang, A., Han, L., & Ma, Y. (2021). Effect of cold and heat therapies on pain relief in patients with delayed onset muscle soreness: A network meta-analysis. Journal of Rehabilitation Medicine, 54. doi:10.2340/jrm.v53.331