Heat vs. Ice

Many people ask me whether heat or ice application is better after a massage or during an injury. The purpose of this blog is to clarify some of the basic principles when dealing with hot and cold therapies, which is also known as hydrotherapy.

Hot Application (HEAT)

While most people assume using heat is the more appropriate application after receiving a massage, this is only true in certain situations. If the session you received was only a Swedish massage, then heat could provide further relief because deep tissue manipulation was not involved. Heat is not recommended to use after deep tissue massages or modalities such as ROLFing or myofascial release because both heat and massages where deep tissue manipulation is involved, create inflammation. If a long heat treatment (longer than five minutes) is performed after a deep tissue massage, (especially to an area where you hold chronic holding patterns), circulation will be decreased and can therefore create secondary tissue damage. One exception that is often suggested by myself and other massage therapists after deeper massages is the option of warm epsom salt baths. This is due to the properties epsom salts hold (magnisium sulfate) and the fact that warm water can be considered as moist heat. Therefore, these baths are more likely to have a decreasing effect on inflammation after a deep tissue massage than applying dry heat would (like a heating pad). When it comes to injuries, massage is not recommended and can be denied up to 72-hours after the initial incident. During the acute phase (48-72 hours), heat is just as important to stay away from. Never use heat where bruising is also present. Doing either of these could create further damage, therefore slowing down or impairing the rehabilitation of your injury. Chronic injuries, on the other hand, benefit greatly from the use of heat, mostly through the use of hot tubs, heating packs or hot baths and showers. Always use caution when using heat before a workout, as your muscles could be more relaxed and could be at risk for further injury. If you must use heat before a workout, use in small intervals.

cold application (ice)

Cold water & ice is known to have many benefits including being a analgesic (pain relief), anesthetic, and for burn management. This is the preferred method to use after a "Susie Smash" massage or workout due to the fact that cold helps to reduce inflammation and muscle spasms. The application of ice has also been shown to help relieve headaches! Ice can be applied in both long and short(under one minute) treatments, however it is never recommended to leave any cold applications on for more than 20 minutes at a time. Doing so could cause tissue damage. In the event of an injury, ice helps to decrease inflammation and swelling by constricting the blood vessels, also known as vasoconstriction. By applying ice on a regular basis during the acute phase, you are allowing your body to heal faster and stronger. Chronic injuries may also benefit from the application of ice, but should not be used before exercising. Examples of crytotherapy include ice baths,cold packs,and ice massages using a Crytocup or a simple Dixie cup.

Contrast therapy

Contrast therapy is hydrotherapy that involves the alternation of hot and cold applications. Not only is contrast therapy great to use on conditions such as carpel tunnel syndrome and tennis or golfer's elbow, but the alternation can also be used to increase immunity! While some contrast treatments should only be done by a licensed massage therapist or other health care professional, basic contrast therapy can be used to control chronic inflammation or increase blood and lymph circulation. A great technique to try at home between massage appointments is as follows: While in the shower, turn the temperature to cold for 10-30 seconds. Next, turn the temperature back to hot for three minutes. Repeat this process for four to eight intervals. As with any contrast or intense heat treatments, always end with cold.


  • Heat is better to use before activities, including exercising and massage
  • Never use heat during the acute phase of an injury (48-72 hours)
  • Moist heat is always better than dry heat because it penetrates through deeper layers of the body, affecting more than just skin and superficial muscles.
  • Ice applications are best to use after massages or activity to decrease inflammation and muscle spasms. Never use ice before exercising.
  • Ice should be the only application used during the acute phase of an injury. Doing so on a regular schedule will allow your body to heal faster and stronger.
  • Massage may be contraindicated up to 72 hours after an injury. More severe cases could involve a doctor's clearance before bodywork is administered
  • Contrast therapy confuses the muscles due to the rapid vasodilation & vasoconstriction of the blood vessels, which stimulates and encourages blood to circulate through local tissues.
  • Contrast therapy should be done in 4-8 repetitions, starting with 30 seconds of cold followed by 3 minutes of heat; repeat. As with any contrast or intense heat treatments, always end with cold.
  • The most important hydrotherapy commandment: when in doubt, whether after a massage, a workout, or an injury, use ice
  • If you have any concern about a recent injury or if swelling (and other symptoms like severe pain) have not subsided after 48 hours of the initial trauma, please visit the ER or your primary care physician. Massage Therapists do not diagnose injuries. Any serious injuries should be brought to the attention of the appropriate health care professional immediately.

Further reading/sources

http://www.massagebywil.com/blog/articles/health-and-wellness-articles-2010/ice-vs-heat/ http://www.cure-back-pain.org/heat-or-ice-for-back-pain.html http://health.clevelandclinic.org/2014/08/should-you-use-ice-or-heat-for-pain-infographic/ http://www.therapeutictouchmassagestudio.com/when-to-use-ice-or-hot/

Utah College of Massage Therapy. Hydrotherapy & Spa Preperation. Utah: FCNH, Inc., 2006