20/10/15, by Sandrine Vatinelle, Physiotherapist

Here at Wisdom Physiotherapy, we often get asked whether a heat pack or cold pack should be used on a particular injury. The first step prior to choosing between heat or cold is to reflect on the reason why you are using it and what kind of injuries/pain you have.

Heat therapy

Use heat if you have stiff joints, chronic muscles or joint pain. Don’t apply it directly to skin, wrap the hot device in a thin towel and don’t lie on it.

One common mistake is to use heat on a long lasting injury that just flared up. If you see swelling and the area is warm to touch and appears reddish, use cold first, followed by heat when the inflammation settles.

Another important point is to avoid heat therapy in the case of an open wound, stitches or if you have poor circulation such as diabetes.

While using a heat pack, you will see that the area that you are warming up becomes reddish, not because it is painful but due to the increased blood flow as the blood vessels open up. As the blood rushes into the area there is an increase in oxygen supply and nutrients helping to improve the range and reduce pain from joints, muscles, ligaments and tendons. Heat is great at helping to decrease muscle spasms.

How to use it?

Choose a moist warmth instead of dry since it penetrates better and does not dry up your skin. Here are some examples of the different options you may encounter:

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  • a microwavable heat pack
  • gel packs
  • hot water bottle
  • hot water baths


It should be at a comfortable warmth – not too hot – so you don’t burn yourself, and if possible try to keep it at a constant temperature.

Cold therapy

Cold acts in the opposite way to heat by slowing down the blood flow in order to decrease inflammation and pain.

When do you use it?

Any cold treatment should be used for 24 to 48 hours after an injury. Cold therapy is recommended for sprains, strains, bumps, and bruises. The four signs that will tell you it’s the right time to use cold therapy are:

  1. if the injury happened recently (within 48 hours),
  2. if the area is reddish or;
  3. swollen or;
  4. warm.

How can I use it safely?

Same as heat therapy, wrap the ice or ice packs in a thin towel to protect yourself from an ice burn and don’t lie on it.

For swollen fingers using a cold pack or ice can be challenging, the trick is to fill up a cup with a mix of water and ice so you can dip your finger easily in it.

When using cold therapy you need to feel comfortable, so avoid using it more than 20 minutes at a time.

We sell a variety of cold and heat packs in store.