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Do I apply cold or heat?

Every day I am asked this question. The answer to this can be complex and based on several variables.

Let me try to simplify things.

In short, the theory behind the application of ice is to reduce blood flow and therefore reduce or inhibit excessive inflammation. Heat will increase localised blood flow, increasing the supply of nutrients to the area. This increase in blood flow may also assist in “flushing out” the site, a theory behind contrast therapy, a technique where the application of ice and heat are alternated.

For acute injuries:

For acute injuries such as sprains, strains, contact blows (contusions) or sudden onset pain, the safest thing is to apply a cold compress for 10 minutes, then reassess and reapply at regular intervals.   Ensure that the cold is not too cold. Direct application of ice or cryotherapy can result in skin or tissue damage when the temperature is too cold. To reduce this risk, have a thin barrier between the ice/ice pack and the body. This barrier should be able to conduct the cold but protect the skin from direct contact. In some cases, a wet towel or plastic barrier may improve the effectiveness of the cold therapy.  

Check the skin at regular intervals to ensure that the person is not adversely reacting to the cold.

Some people can either have a sensitivity to cold application. A reaction to cold can vary from a mild local reaction, blisters, hives to systemic anaphylactic reactions, known as a cold sensitivity or, at higher levels cold urticaria.

Ice should not be used on open wounds or when then sensation to the area is reduced, such as diabetes or peripheral neuropathy.

The ice can be effective for up to 72hours after an injury to help reduce excess inflammation. After that, reapplication can occur at regular intervals, such as every 20minutes. 

It is crucial to still allow the inflammatory cycle to occur at a controlled level. This is because the body’s reaction to an injury is a protective and healing mechanism.

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For non-acute injuries:

If pain or soreness gradually builds up, or you wake up with a sore neck/back, or you are now  greater than 72 hours after an injury, the research shows that it does not make a difference whether you use heat or ice for your injury (French et al 2006)

For pain control of musculoskeletal pains such as knee, neck, back pain, osteoarthritis the application of either heat or cold is appropriate. Each can give you relief from muscle and joint pain/spasms.


what is causing my neck pain

The choice of heat over cold will be personal. However, it is suggested that you may try either and reassess which works the best for you.

When using heat, ensure that the heat source (heat pack, wheat back, electric blanket etc.) is not excessive, as burns can occur. Most burns happen when the heat source is placed under a body area, reducing blood circulation. Therefore, it is recommended not to lay or weight bear on a heat source. Like ice application, heat therapy should also never be used in an area or reduced or absent sensation, such as where diabetes has reduced sensation/blood flow or peripheral neuropathy.

There are occasions where preference of heat or ice will prevail.  In some cases of chronic inflammatory conditions, such as trochanteric or ITB bursitis, patella tendonitis we will preference ongoing icing.   

From clinical experience for muscle aches and spasms heat will effective for 90 -95 % of people, however, don't forget to try ice if you are not getting the relief you require.

This information is generic and should be used in conjunction with advice from your health professional. Please read this advice in conjunction with our generic disclaimer.

If you are unsure about using either heat or ice, please feel free to contact our team for more advice and ensure you have an accurate diagnosis and plan for best managing your condition from your Physiotherapist or medical team.  If pain persists ensure that you seek qualified medical advice for your condition.

We offer a wide range of heat packs and ice packs-  please contact us for more information.