Ice vs. heat for pain: a modern guide to healing

For decades, ice was the default treatment for injuries—but modern science tells a different story. Research now shows that inflammation is your body’s repair mechanism, and suppressing it (with ice or NSAIDs) can delay recovery. This guide dives into the PEACE & LOVE protocol, explains when ice or heat is appropriate, and answers critical FAQs about nerve pain, joint pain, and more.

Expert advice

• Skip ice for minor injuries—let inflammation heal you.
• Heat = Stiffness, chronic pain, pre-workout.
• Persistent pain? See if you're already covered by a digital physical therapist.

Why inflammation matters (and when to let it work)

When you sprain your ankle or strain a muscle, your body launches a precise inflammatory response:

1. Blood vessels dilate, allowing white blood cells to reach the injury.
2. Cytokines (repair proteins) remove damaged tissue and stimulate rebuilding.
3. Swelling creates a protective “splint” around the injury.

The PEACE & LOVE protocol: step-by-step guide

For decades, ice was the go-to treatment for sprains, strains, and post-surgery recovery. However, research shows that inflammation is a critical part of healing. The PEACE & LOVE protocol reflects this shift:

PEACE (days 1–3 post-injury)

• Protect: Avoid movements that cause sharp pain (e.g., limping instead of walking on a sprained ankle).
• Elevate: Raise the injury above your heart to reduce fluid buildup.
• Avoid anti-inflammatories: Skip ice and NSAIDs to let inflammation work.
• Compress: Use a bandage only if swelling restricts movement.
• Educate: Understand that short-term pain doesn’t mean long-term damage.

LOVE (days 4+ post-injury)

• Load: Gradually reintroduce movement (e.g., walking 10 minutes daily).
• Optimism: Stress releases cortisol, which slows healing.
• Vascularization: Boost blood flow with cycling or swimming.
• Exercise: Strengthen tissues with guided exercise or physical therapy.

When to use cold therapy (sparingly)

Use ice ONLY If:

• Swelling is severe (e.g., post-surgery, visibly distorted joints).
• Pain prevents sleep or basic movement.

Avoid ice for:

• Minor sprains or stiffness.
• Chronic conditions (e.g., arthritis, old injuries).

How to ice safely

• Wrap ice in a thin cloth.
• Apply for 10 minutes every 2 hours during the first 48 hours.
• Never apply ice directly to skin or bony areas.

When to use heat therapy

Heat widens blood vessels, delivering oxygen and nutrients to damaged tissues.

Best uses for heat

• Chronic Joint Pain: Eases stiffness in arthritis.
• Muscle Tension: Relaxes tight lower back or neck muscles.
• Nerve Pain: Improves blood flow to compressed nerves (e.g., sciatica).
• Pre-Workout Warm-Ups: Reduces injury risk.

Avoid heat for:

• Fresh injuries (first 48 hours).
• Swelling or redness.

How to apply heat safely

• Use a warm towel or heating pad on low/medium settings.
• Limit sessions to 15 minutes to avoid skin damage.

When to seek professional help

If pain lasts longer than 2 weeks, consult a physical therapist. Sword Health’s digital PT program offers:

• Personalized physical therapy programs led by Doctors of physical therapy.
• Custom exercise plans for your injury.
• Real-time form feedback via AI motion tracking.

“I avoided surgery for my herniated disc thanks to Sword Health. Their PTs taught me how to move safely again.” — Emily R., Sword Health Member

Frequently asked questions about ice vs. heat

• Should I use ice or heat for back pain? Back pain is best treated using heat, which encourages blood flow to the area to increase mobility.
• Should I use ice or heat for nerve pain? Heat is better. For conditions like sciatica or diabetic neuropathy, heat improves blood flow to nerves, reducing tingling and numbness.
• What about joint pain from arthritis? Use heat. Apply a warm compress to stiff joints (e.g., knees, hands) for 15 minutes to ease movement.
• Should I use ice or heat for a pulled muscle? For muscle strains, apply heat during the first 24-48 hours. This will facilitate the flow of blood and oxygen to the injured tissue.
• Should I use ice or heat for knee pain? For knee pain, the decision to use ice vs. heat is more dependent on what has occurred than where the pain is located. If your knee pain is because you’ve just had surgery or experienced an acute injury, applying ice within 24-48 hours could be beneficial. If your knee pain is chronic, or if your injury occurred more than 48 hours ago, heat would be the better choice.
• Should I use ice or heat for a sprained ankle? If the injury occurred within the last 48 hours and there is visible swelling, apply ice as mentioned above. This will help reduce excess swelling.
• Can ice help a pinched nerve? No—heat is safer. Ice may worsen nerve irritation by reducing blood flow.
• How long should I avoid NSAIDs after an injury? Follow the PEACE protocol for 3–7 days. NSAIDs block prostaglandins, which aid tissue repair.
• What if heat doesn’t relieve my back pain? Persistent pain may signal a deeper issue. Consult a Sword Health PT to assess your spine and muscles.
• Is heat safe for old injuries? Yes! Heat helps chronic pain by loosening scar tissue and improving flexibility.

If you have questions, or you’re unsure how to properly use heat or ice, please contact your healthcare provider for guidance.

Remember the ice vs heat protocols

• PEACE & LOVE > RICE: Let inflammation heal most injuries.
• Heat = Chronic pain, stiffness, nerve/joint issues.
• Ice = Severe swelling only (e.g., post-surgery).
• Persistent pain? Check eligibility for digital PT.

Empower your recovery with evidence-based care—no ice pack required.