General Use of Heat
Heat can help relax tight muscles, increase circulation, and make stiff areas feel more comfortable before stretching or gentle movement. It is often most helpful for ongoing muscle tension, stiffness, or soreness after the initial swelling from an injury has settled down.
Use heat in short sessions, typically 15 to 20 minutes at a time. The area should feel comfortably warm, never hot, burning, or painful. Keep a cloth barrier between your skin and the heat source, and do not fall asleep with a heating pad, hot pack, or heat wrap in place.
Avoid heat on a new injury that is swollen, bruised, red, or warm to the touch. During the first 48 to 72 hours after many strains, sprains, or acute injuries, cold therapy is often the better choice.
Moist Heat Packs
Moist heat packs provide gentle, comfortable warmth that may help loosen tight muscles and reduce stiffness. During an in-office treatment, the heat should gradually build over the first several minutes and should never feel uncomfortably hot or cause burning. Let your clinician know right away if the temperature feels too intense.
For home use, a warm, moist towel or a heating pad used over a damp towel may be an option when appropriate. Always follow the manufacturer’s instructions and use a barrier between the heat source and your skin.
Warm Whirlpool
Warm whirlpool therapy may be used to help relax muscles, improve comfort, and support gentle movement of an affected joint. The warm water and water movement can make it easier to move an area without placing full weight on it.
Whirlpool treatment should feel comfortably warm, not hot. If you feel light-headed, dizzy, nauseated, weak, or uncomfortable at any point, stop the treatment and notify a clinician immediately. Follow staff instructions for entering and exiting the whirlpool, and never operate equipment or electrical controls while in the water.
Cold Therapy (Cryotherapy)
Cold therapy, or cryotherapy, is commonly used after a new injury or a flare-up of an existing injury to help manage pain, muscle spasm, and swelling. Applying cold can temporarily reduce blood flow to the area and may help limit swelling in the first 24 to 72 hours after many strains, sprains, bruises, and other soft-tissue injuries.
What You May Feel
A normal cold treatment often progresses through several sensations:
- Cold
- Aching or increasing discomfort
- Brief burning or stinging
- Numbness or a noticeable reduction in pain
The first few applications can feel uncomfortable. Stop treatment if pain becomes intense, the skin becomes unusually pale or blotchy, or numbness continues after the treatment ends.
Home Application
For most home use, place ice cubes or a cold pack in a sealed plastic bag and wrap it in a thin, damp towel. Apply it to the affected area for up to 15 to 20 minutes at a time. Do not place ice or a commercial cold pack directly on bare skin, as this can damage the skin. Allow the area to return to normal temperature before reapplying; a general rule is to wait at least 30 to 60 minutes between sessions.
Ice massage can also be useful for smaller, localized areas. Use an ice cube or a frozen paper cup of water and move it in small circles over the painful area for no more than five minutes.
Important Safety Notes
Talk with your clinician before using cold therapy if you have poor circulation, reduced sensation, Raynaud phenomenon, diabetes-related neuropathy, or a condition that affects how your skin responds to temperature.
Seek medical attention for severe pain, visible deformity, inability to bear weight or use the injured area, significant swelling, numbness that does not improve, or symptoms that are getting worse rather than better.
Heat or Ice: Which Should You Use?
Heat and ice can both be useful for managing pain, but they are generally used at different times and for different symptoms. For a new injury—especially one with swelling, bruising, redness, or warmth—cold therapy is usually the better starting point. Ice can help reduce pain and swelling during the first 48 to 72 hours after many sprains, strains, bruises, or flare-ups. Apply a cold pack for about 15 to 20 minutes at a time, with a cloth barrier between the pack and your skin.
Heat is often more helpful after the initial swelling has improved, particularly for muscle tightness, stiffness, or ongoing soreness. Gentle heat may help relax muscles and make movement or stretching more comfortable. Use a heating pad, warm pack, or warm towel for about 15 to 20 minutes at a time, and never use heat that feels hot, burning, or painful.
A simple rule of thumb: use ice for a fresh injury or swelling, and use heat for stiffness and muscle tension. After the first few days, either heat or ice may provide relief depending on how the area feels. Some people find that alternating heat and cold is helpful, but this should be done only when it has been recommended for your specific condition.
Do not apply heat or ice directly to bare skin, and check with your healthcare provider before using either if you have reduced sensation, circulation problems, Raynaud phenomenon, or certain other medical conditions. Seek medical evaluation for severe pain, a visible deformity, inability to use the injured area, significant swelling, or symptoms that are getting worse rather than improving.