If you apply the wrong modality (for example, if you apply heat when you should be using cold) you could make matters worse.

Heat is best for chronic
and long-standing problems.
Ice is best for acute injuries.

When to treat with HEAT

Heat treatment (or thermotherapy) relieves stiffness and chronic aches, facilitates relaxation, and stimulates circulation. It works by increasing tissue temperatures and blood flow, thereby drawing extra nutrients into the area to assist in the recovery and healing process.

Heat therapy is usually applied with a moist or dry hot pack. Heat can also be applied with diathermy, ultrasound, warm whirlpools, paraffin baths, infrared lamps and fluidotherapy.

When not to use HEAT

  • Heat should never be used on acute injuries until the swelling is controlled. Heat draws fluids into tissues and can increase swelling and inflamation. Do not use heat over swollen tissues or redness except under the supervision of your health care practitioner.
  • Do not use heat before vigorous exercise. Your muscles may be too relaxed for peak performance and safety.


  • Typical treatment times for heat applications are between fifteen and twenty minutes. It takes heat a minimum of fifteen minutes to penetrate tissues to reach therapeutic temperatures.
  • Moist heat penetrates more deeply than dry heat and will not dehydrate tissues so circulation is improved, speeding healing. For moist heat when using dry packs (e.g., gel packs) add a layer of moist toweling.


  • Follow packaged instructions carefully. Heat can burn and damage tissues if used improperly.
  • For steam heat, wrap hot packs in thick toweling to prevent scalding and control temperature. Use additional toweling as insulation if you lie on top of the hot pad.
  • Do not use heat over insensitive skin (e.g., in areas where you have numbness or decreased skin sensation).

Homemade Hotpack

Fill a cotton tube sock 3/4 of the length with plain white rice, beans, flax seeds, or oats, and sew or tie the end shut. Heat this in the microwave on a pie plate (to keep it clean) for 2 minutes. Be careful. It can catch fire if you cook it too long, and we can't be responsible for that! The pack will be very hot at first, so wrap it in a washcloth before you place it on your skin. As it cools, you can remove the washcloth. It will stay warm for about 20 minutes. You can use it over and over. For a pleasant aroma, add some lavender or sage.

When to treat with ICE

Cold therapy (or cryotherapy) is the treatment of choice for acute injuries. When applied immediately after an injury, cold treatment reduces tissue damage by reducing the metabolic rate and decreasing the production of metabolites and metabolic heat which result from the body's inflammatory response to the injury. Cold therapy also relieves muscle spasms, reduces post-exercise soreness, and stimulates circulation in areas of chronic discomfort.

Cold therapy can be applied with ice packs, cold and ice whirlpools, ice massage, or commercial cold sprays.

When not to use cold

  • Do not use over insensitive skin or in the presence of poor circulation.
  • Elderly people, young children, and people with diabetes must be very careful with cold treatments. If you have any questions about cold therapy, ask your health care practitioner for advice.


  • The first 72 hours after an acute trauma or subacute injury, you should onlyuse cold treatments.
  • Treatment time varies depending on several factors, including the size of the treatment area, the type of cold therapy applied, and the size of the individual. For example, a thin person requires less treatment time because the cold does not need to penetrate through as much tissue to lower intramuscular temperatures. You'll know when you've had the cold on long enough, by monitoring the four stages of cold treatment: The first stage is an uncomfortable feeling; the second stage is a stinging sensation; the third stage is burning or aching; the fourth stage is numbness. It takes five to fifteen minutes to reach all four stages.
  • For acute injuries, apply cold immediately for a minimum of 10 to 20 minutes. Some folks keep the cold application on for an hour or more. Repeat the cold application every few hours for the first 4 to 72 hours after an injury.
  • To reduce post-exercise soreness, apply cold immediately after exercise for 10 to 20 minutes.
  • For chronic discomfort, apply cold for a minimum of 10 minutes. Repeat as necessary.
  • If you suffer from "ice burn" or "ice allergy" when you are exposed to cold, wrap the cold pack with a damp towel.
  • Follow packaged instructions carefully. Ice can burns or damage tissues if used improperly.

Homemade Cold Pack

Mix one cup of alcohol with two cups of water, and seal it inside a zip-lock freezer bag. You may want to double-seal the pack with a second zip-lock bag. This mixture freezes at a lower temperature so it stays slushy for good ice pack consistency. Lasts for 15 minutes or longer, and can be used over and over. A bag of frozen peas makes a good ice-pack, too.

When to treat with both Hot and Cold (Contrast thermotherapy)

For chronic problems, alternate cold with heat applications for greater circulatory effect.