Hot versus cold therapy. It’s the age old question when it comes to addressing aches and pains.  “At the highest level, heat therapy works by increasing circulation and blood flow,” says Dr. David Popiel, San Francisco lead doctor at Forward Health. “Combining heat with gentle stretching helps tight muscles recover and ultimately regain flexibility. Cold therapy, on the other hand, works by reducing blood flow and in turn, decreases swelling and inflammation—it may also have a numbing effect on painful joints by stunning overactive nerves.”

An easy rule of thumb to follow? If it’s swollen and painful choose cold therapy, says Dr. Popiel. While an ice pack may feel painful in the moment it ends up being a form of relief. And while heat may be tempting to use on a swollen joint, he says you should avoid it because it can actually make the swelling worse, since it’s tight, sore muscles that benefit from heat.

Caveat—pulled muscles or ligaments can benefit from both types of therapy. Cold comes first, then hot. “For example, if you twist an ankle running or pull a muscle in your back by lifting something heavy, applying ice immediately will reduce pain and swelling. Once the inflammation resolves, switching to heat will help soothe the muscle and restore flexibility and strength,” Dr. Popiel says.

And remember, hot and cold therapy don’t only come in the form of heating pads and bags of frozen peas. “Simply taking a hot bath, using a steamed towel, or even a trip to a sauna are also good heat therapy for sore and tight muscles,” Dr. Popiel says. “Similarly, an ice bath or coolant spray can be effective forms of cold therapy.”

Bottom line: For post-workout soreness that sneaks up on you like Jason Momoa at a movie premiere, go hot; for injuries that swell, go cold. Should you pull a muscle, start with cold to reduce swelling, and then switch to heat. And of course, consult your doctor to determine a treatment protocol.

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