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When an injury occurs, that often means time off from your favourite activities and often time off from work as well. Timely and proper treatment of an injury is crucial for recovery. But just how do you deal with those activities related strains and sprains?”Should I use hot or cold?” is one of the questions we get asked most frequently. If used correctly following an injury or when beginning a rehabilitation or exercise program, hot and cold can help to reduce pain, assist with tissue healing, control swelling, and increase flexibility. If used incorrectly, however, they can worsen an injury or slow recovery times. Here is some timely advice on the use of hot and cold.

Cold Therapy

Cold is applied in the acute stage of an injury (the first 24-72 hours) to prevent tissue damage. It can be used after the first 72 hours if inflammation persists. The “PRICE” protocol (Protection, Rest, Ice, Compression and Elevation) should be used to manage an injury in this early stage when swelling and pain are at their peak.

Cold may also be applied after an exercise program to prevent or reduce pain, or to ease muscle spasms. When applying ice to the skin, it is important to use a damp towel between the ice and the skin to increase effectiveness and decrease the risk of nerve or skin damage which could lead to frostbite.

Cold therapy may be applied periodically throughout the day for approximately 15 to 20 minutes at a time. When using ice packs or other cooling agents, it is important to visually check the area that is being treated every five minutes or so.

While there may be discomfort and redness initially, treatment should be discontinued if these symptoms persist. It is recommended that people with certain medical conditions not use cold therapy. Ask us if you are unsure.

Heat Therapy

Heat is often used in the chronic phase of an injury. It may also be used prior to therapy or exercise to decrease muscle tension and increase flexibility and range of motion. It also plays a role in pain management and reduction of muscle spasms, muscle tension, and joint stiffness.

Moist heat such as the hot packs is preferred over dry heat such as cloth beanbags, because damp heat penetrates deeper. To create moist heat at home when using a non-electrical heat source, first wrap a damp towel around the hot pack, cover with dry towelling and apply it to the treatment area.

No matter what type of heating agent you use, several layers of towelling should be used as a barrier between the skin and the hot pack to help prevent skin irritation or burns. Hot packs should be applied for 15 to 20 minutes. Visually check the skin every five minutes and discontinue treatment if there are persistent abnormal changes in skin colour or you experience increased discomfort.

Do not lie on a hot pack or apply heat at bedtime since it increases the likelihood of burns resulting from close or prolonged contact with the heat source. Heat therapy should be avoided in the acute phase of an injury when swelling is present and the skin is hot to touch. In addition, people with certain medical conditions should not use heat therapy.

A Third Option: Try Movement Instead

While using ice or heat after an injury is common, a third and possibly more effective option is gentle movements. Much of recent research is showing that gentle movements of an injured area may sometimes be more helpful in terms of pain control and speeding up your recovery.

Gentle, simple movements can stimulate tissue healing. Resting may actually delay healing as it can shut down muscle activity and reduce circulation to your injury site.

Hold off on the gel pack

Ice may in some cases delay healing. This is due to constriction of your blood vessel which can reduce the amount of restorative oxygen being delivered to the injured area. Some suggest using ice may in fact prevent the necessary inflammatory response which is often required for healing. If you do choose to use ice, consider using it only for short periods and for temporary pain relief.

When there is significant swelling and deformation of the injured area, then ice may be a good option in these cases.


Some gentle movements include:

  • Neck strains: shoulder rows
  • Shoulder or rotator cuff injuries: shoulder pendulum rotations
  • Lower back pain: walking, yoga or swimming
  • Knee sprains: using a stationary bike with minimal tension
  • Foot and ankle sprains: drawing the alphabet with your toes

So instead of immediately reaching for the ice gel pack or heat pack, try a few easy movements instead. You may find this more helpful for your recovery.

Talk To Your Physio Or Chiro

If can be confusing sometimes on what to do after you have an injury. Should you get some rest? How about using ice or heat, which is better, or both? Or should you keep active, and if so, how?

Your team of physiotherapists and chiropractors can help you make the right choice. Have your questions answered and learn the most effective treatment approach to help you recover quickly. Get pain relief safely and effectively

Phone 604-738-1168

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heat or ice?

Frequently Asked Questions

Q: What is better for my injury: heat or ice?

A: Heat can help relax tense muscles and bring more nutrients and oxygen to your injured area. However, if you have a cut or scrape avoid heat as it may increase the bleeding. If you have considerable inflammation or tissue damage, ice may be considered.

An even better option may be to simply do some gentle movements of the affected area. For example, if you have sprained your ankle, try drawing out the alphabet or 1 to 10 with your toes

Q: When should I not use ice for my injury?

A: You can generally use ice up to 15-20 minutes, depending on the area being injured. Try to avoid using ice for more than 20 minutes at a time. If you notice any signs of frostbite such as numbness, skin colour changes or more soreness in the area then immediately stop using ice.

Q: How do I use ice for my injury?

A: The best way to use ice for your injury is to first wrap the reusable gel pack in a wet towel then put it on the area you want to ice. If you do not have a reusable gel pack, a bag of frozen vegetables can be a good substitute. Do not put ice packs or ice cubes directly on your skin.

Results will of course vary from person to person