Ice or Heat?

General Rules and Tips for Hot and Cold Applications

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In general, cold and hot packs may be applied for 15-20 minute intervals with 1 hour between applications.

If the treatment increases the symptoms, discontinue immediately and consult your doctor.

Do not apply cold or heat to a desensitized area (e.g., a region that  was previously frostbitten or affected by diabetes).

Never sleep on a hot or cold pack.  You can get burned by either.

After an acute (new) injury, apply ice for the first 24-72 hours.

Benefits of Cold Therapy

  • Reduces pain and swelling.
    Temporarily reduces local bloodflow

Cold applications are commonly used for management of pain and inflammation from strains / sprains, bursitis, acute arthritis and contusions.

Ice Packs
In order to avoid the sudden cold shock feeling when applying an ice pack, place a warm, damp towel over the region being treated before applying the ice.

A flexible ice pack works best.  If using ice cubes, crush them before placing them in the ice bag.  This will increase the surface area of the ice and provide a more effective treatment. 


Ice Massage
This treatment involves applying ice directly to skin over the injured area.  Fill several wax lined 4-6 ounce paper drink cups with water and place in the freezer.  Since you will be treating the area several times daily, prepare for a few days in advance.

After freezing the cups of water, tear off approximately 1.5 inches of paper from the top of the cup to expose the ice.  Apply the ice directly to the skin in a stroking or circular motion; approximately 4 inches per second.  The cooling effect will occur in four stages, referred to as —CBAN—.  First, it will feel cold, then burn a bit, followed by aching and finally it becomes numb.  After the numbness occurs, continue to ice for approximately one minute.  The area may remain red for several hours.  The entire process should take approximately 6-7 minutes.

Benefits of Heat Therapy

  • Increases blood flow temporarily
    Promotes local muscle relaxation / sedation

Hot Packs
Hot packs are commonly used to relieve pain and stiffness from chronic arthritis and muscle tension.

We recommend using moist hot packs, rather than a dry heating pad.    Moist heat is less dehydrating to the skin and seems to penetrate deeper than dry heat.

Do not apply heat to an acute injury (under 48 hours).  Although it feels good when applied, heat may increase any underlying swelling.  Commonly, heat packs feel good when applied to a new injury, but, several hours later, the pain worsens as the swelling increases.

Heat Wraps
Heat wraps are available at most pharmacies.  These wraps provide continuous low grade heat to the affected area for up to 8 hours.  Many patients find them quite comforting.


Hot and Cold Liniments
Many people find hot or cold topical liniments soothing.  The results are highly variable.

One popular topical liniment that has a heating effect is SOMBRA®.  SOMBRA®contains capscaisin which is an extract of chili peppers that can help block painful nerve endings.  It should be applied twice daily for the best results. Be sure to wash your hands immediately after applying SOMBRA®.  Otherwise, use gloves to apply the cream.

We also recommend Biofreeze®, a topical cooling liniment.

It is important to note that topical lotions do not elicit the same physiological responses as cold and hot packs.  These liniments are not substitutes for hot/cold packs.