Does Heat or Ice Work Best for Sore Muscles?
Delayed Onset Muscle Soreness (DOMS)
When you first begin a new exercise routine, it’s quite common to experience a type of muscle soreness known as delayed onset muscle soreness or DOMS. This is a common phenomenon that isn’t serious but makes your muscles feel stiff and sore for a few days.
Delayed onset muscle soreness happens because you work your muscles in a manner they’re unaccustomed to. If you just started exercising, every movement you do is unfamiliar, so DOMS is almost a given. As you progress in your training, you typically won’t experience muscle soreness unless you increase the resistance or volume of your routine or add new exercises. This is due to the “repeated bout effect,” muscles adapt to repeated stress placed on them so they’re more resistant to injury.
Delayed onset muscle soreness is more pronounced after workouts that emphasize eccentric contractions, contractions where the muscle lengthens against resistance. An example is when you bring the weights back down to the starting position during a biceps curl. You’re lengthening the muscle in a controlled manner with weight in your hands.
In most cases, the muscle soreness associated with DOMS comes 24 to 48 hours after a workout your muscles are unaccustomed to. When delayed onset muscle soreness strikes, your muscles feel stiff and movement causes discomfort, especially when you first get out of bed in the morning. However, the soreness often eases a bit when you move and the muscles warm up a bit. That’s why it’s best to do a light workout when you have DOMS rather than skipping exercise entirely. The soreness and stiffness usually last from four to seven days, but during that time, it feels uncomfortable. That’s when some people whip out a cold or hot pad to get relief. You might wonder whether it’s best to apply heat or ice to those sore muscles. What does science say?
It’s not clear what causes DOMS, but research suggests that tiny tears in muscle fibers may play a role. According to some studies, the tears create an inflammatory response that triggers muscle soreness. The inflammation is most pronounced in the first 24 to 48 hours after a DOMS-inducing workout. That’s when the application of cold is most effective. Why does cold work? Ice or a cold pack constricts the blood vessels. This constriction reduces the number of inflammatory cells that reach the injured areas. This diminishes the release of inflammatory chemicals called cytokines that cause swelling and soreness.
Does science support the use of cold for delayed onset muscle soreness? A review of 17 studies published in the Cochrane Database, an esteemed site built around evidence-based medicine, found immersion in cold water reduced muscle soreness at one day, two days, three days, and four days after exercise that induced delayed-onset muscle soreness. However, they point out that the quality of the studies wasn’t high.
Another Variation on Cold – Cryotherapy
Another “cold” approach, whole body cryotherapy also may also reduce delayed onset muscle soreness, although studies are limited. The evidence, thus far, isn’t strong enough to recommend it. Cryotherapy consists of repeated exposure to very cold, dry air in a special chamber for a few minutes at a time. Athletes sometimes use this approach, but it’s not practical for the average person. However, you may get benefits from using ice packs or taking cold baths the first 48 hours after a workout that causes muscle soreness. If you don’t have an ice pack, grab a bag of frozen vegetables from the freezer!
What about Heat?
After 48 hours or so, there’s evidence that heat may help muscle soreness. Most studies suggest that moist heat works better than dry heat as it penetrates the tissues better. Why does it work? Applying heat opens up the blood vessels to the muscle so that nutrients and oxygen can reach the tissue. Plus, it helps to relax and relieve muscle spasms.
What’s the best way to apply heat? A heating pad, a hot water bottle, or a special pad you heat in the microwave are options. Sitting in a warm sauna, if you have access to one, or a hot bath can be beneficial as well.
Depending on the timing, cold or heat can modestly make sore muscles due to DOMS feel better. Be careful though. Avoid using temperature extremes that can damage your skin. Also, if you have certain medical conditions like peripheral artery disease, Raynaud syndrome, or diabetes, don’t use hot or cold packs without talking to your physician.
Fortunately, whether you use a hot or cold pad or just wait it out, DOMS is self-limited. It’ll subside in less than a week. But don’t be surprised if it shows up again the next time you do a challenging strength-training workout.
Cochrane Database. “Cold-water immersion for preventing and treating muscle soreness after exercise”
J Clin Med Res. 2013 Dec; 5(6): 416-425.
Medical News Today. “Heat and cold treatment: Which is best?”