Heat or Cold? The Definitive Guide on How to Use Them for Pain or Injury. - .

Heat or Cold? The Definitive Guide on How to Use Them for Pain or Injury.

Heat or Cold ?                                                 By Kelly Milan, BMR, PT ©

Let’s stop the confusion. Please use the information below as your definitive guide.

The purpose of cold is to decrease pain, swelling, and muscle spasm. It reduces the amount of tissue damage and inflammation in the area substantially.

When to use:

  • Immediately after an injury and every 1-2 hours for the first 48 to 72 hours
  • During rehabilitation programs. For example, after exercising
  • With longstanding overuse or repetitive strain syndromes like tennis elbow or rotator cuff syndromes.
  • Whenever an area is swelling provided that the cause is known.

When not to use (unless under direct supervision of a healthcare professional):

  •  Reduced circulation and sensation to an area such as with diabetes or blood vessel disease in a limb.
  •  Cold hypersensitivity
  • Anemia

How to apply cold

1) Frozen gel packs: place a wet cloth between the skin and the gel pack and wrap the area with a tensor bandage to secure it. The wet cloth allows for the best cold transmission. Leave it on for 15-20 minutes. Make sure the entire gel pack with the wet cloth is contacting the skin. This is the most recommended method by Corydon Physiotherapy.

2) Ice packs: crushed ice or snow wrapped in a wet towel or placed in a plastic bag and secured with a tensor bandage. Leave it on for 15-20 minutes.

3) Ice massage: freeze water in a paper cup and rub it directly onto the skin for 10-15 minutes.

4) Ice bath: immerse the body part (hand, foot/ankle) into ice water for 10-15 minutes.

Other cold hard facts

During cold treatment expect to feel a burning sensation, followed by some aching and finally numbness. The area should be pinkish, not white when you take off the cold. White indicates that the cold is too extreme. Check the area after ten minutes to make sure you are not frost biting it.

If the area is not pinkish then it has not cooled enough and the treatment is far less effective.

After an injury within 72 hours always use cold along with the PRICE principle. Protection like using a splint, crutch, or brace, Rest, Ice, Compression with a tensor bandage, and Elevation of the area above heart level.


The purpose of heat is to

  • Decrease pain
  • Decrease muscle spasm and tension
  • Increase blood circulation and tissue nutrition
  • Help increase the stretching length of muscle, ligament and tendon

When to use

  • After 48 to 72 hours has passed from an injury
  • Longstanding painful conditions for example: neck and back pain, muscle and joint tightness.
  • Before exercising to loosen up a tight joint or muscle

When not to use

  • Reduced sensation to an area
  • Open or infected areas
  • Within 72 hours of an injury
  • The area is visibly swollen or red 

How to apply heat

Microwavable heat packs: There are many different gel packs or packs filled with “magic” material that can be heated. We recommend gel packs or the Therabeads ™ brand of heat packs. Therabeads packs are microwaved and give off a moist heat which is more effective than dry heat. Gel packs can be wrapped in a wet towel to give a moist heat. 

Heated water immersion: hands or feet can be immersed in water heated to 38-42 degrees celcius (100-105 degrees F)

Electric heating pads: These work best for middle and low back problems as you can lay on them easily. Use for 20 to 30 minutes on low or medium setting. Do not sleep with them on!

Paraffin heated wax baths: These are great for hand and foot problems as the wax perfectly surrounds the area with heat and retains the heat for at least 20 minutes. They are, however, somewhat expensive to purchase.

The old hot water bottle in the back of your closet can be used to. Wrap it in a towel and apply. This is not usually recommended because of the risk of bursting or hot water leaking.

The above guidelines are perfectly safe and effective, but if you have any other questions regarding your condition please contact us.