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  • Dr. Ponkhi Sharma

Hot or Cold packs after injuries

Pain is an unpleasant sensation that can be mild, moderate to agony. The first most important and easy thing to do is just apply…. ice or hot packs. Now the confusion starts. Some advice hot packs while the others says cold packs. What is going to help you! We treat everything from arthritis to pulled muscles to inflammation with ice packs or heating pads. Treating pain with hot and cold can be extremely effective for many different conditions and injuries, and easily affordable. The tricky part is knowing what situations calls for hot, and which calls for cold. Sometimes a single treatment will even include both.

Generally of thumb, use ice for acute injuries or pain, along with inflammation and swelling. Use heat for muscle pain or stiffness.

So, to crack the puzzle we need to know the effect of hot and cold, how it works on our body mechanism.

How does Heat Therapy Works?

Heat helps the blood vessels to dilate which in turn increases the flow of oxygen rich blood to the affected area. This helps with better healing as well as quick regeneration of the damaged tissues. In addition, this increased flow of blood also provides lots of nutrients, oxygen and proteins to the area. Heat acts as a pain reliever by successfully stimulating the specialized pain receptors within your skin. This decreases the frequency of pain messages that are sent to the brain. Heat therapy also helps when it comes to relaxing and loosening the tissue surrounding the area being treated. The ligaments, tendons and muscles can then move more easily which further reduces the chances of injury.

How does cold therapy work?

Cold therapy is also known as cryotherapy. When we apply ice to an area the blood vessels constrict (vaso constriction). It works by reducing blood flow to a area, which can significantly reduce inflammation and swelling that causes pain, especially around a joint or a tendon. As inflammation and swelling sets down, area starts the recovering process. It can temporarily reduce nerve activity also, which gives you a soothing effect.

Now after knowing how cold and heat therapy works on our body we can decide which need to be used in what situation. Now let’s discuss and analyze the points of using Hot Vs Cold.

What are the main criteria’s for deciding which packs to use:

1.Which phase are we treating acute, chronic or are rehabilitating the area

2.Localise the painful area and look for the nature of the injury.

3.Last but not the least we need to be very careful about the contraindication of both the therapies.

Analysing the points

Phase of injury

Acute injury

Injuries which is fresh and immediate is called acute injuries. During acute injuries blood rushes to the area and so the area turns red and sometimes swells.

In this condition, our first aim will be to reduce the reaction of the body towards the injury. To reduce the reaction, we need to reduce the swelling and the redness to the area. So, if we need to do this we must produce vasoconstriction and reduce the blood supply to the area.

In this case, Ice will help better as it reduces the blood supply to the area. It will also make the area numb by reducing the stimulus and thus producing a soothing effect to the area.

Chronic injury:

Chronic injuries usually do not present with a sudden onset. They tend to gradually build up over a period of days, weeks or longer and are often caused by overuse or biomechanical abnormality. A chronic injury can also be caused by an acute injury which fails to heal due to a lack of, or inappropriate treatment.

During chronic injuries swelling and inflammation will set down with own body immune system. In this condition our aim will be to increase the blood circulation to the area.

In this case HOT packs will work better as the oxygenated blood with nutrients will reach the area regenerate the dead cells and improve the healing process. It will also reduce the stiffness which generally occur after a long-term injury.

Rehabilitation phase

Rehabilitation phase comes after the acute and chronic treatment. Once the signs of inflammation settle down and we reduce the pain of the area we rehabilitate the muscle so that we prevent the reoccurring of the injury again and same time increase the mobility and flexibility and increase the function of the area to the optimum.During rehabilitation, we give a set of exercises to be performed for the specific injured muscles or the surrounding muscles. Before performing the exercises its good to apply the Hot packs so that the circulation to the area improve and make the joint or muscle flexible and mobile and reduce the will prevent the muscle to get further injured.

After performing the exercise applying ICE pack will be preferred so that it reverse the action and reduce the sensation of the area which was increased because of the set of exercise and produce a soothing effect to the area.As the muscles are used after a period of time there is a chance of getting sore muscles.Ice packs helps to reduce the soreness of a muscle. It will also prevent the re occurrence of the pain again by subsiding the process of inflammation.

Nature of injury

We can decide applying hot packs or cold packs by seeing the nature of the injury also

  • If the Injury is open wounded then hot packs are contraindicated

  • If the injured area has swelling and redness then also hot packs are contraindicated

  • If the area is bluish in color then ice pack is contraindicated.


Ice pack should not be used for people with sensory disorders that prevent them from feeling certain sensations This includes diabetes, which can result in nerve damage and lessened sensitivity.

You should not use cold therapy on stiff muscles or joints.

Cold therapy should not be used if you have poor circulation.

There are certain cases where heat therapy should not be used. If the area is either bruised or swollen (or both), it may be better to use cold therapy. Heat therapy also shouldn’t be applied to an area with an open wound.

People with certain pre-existing conditions should not use heat therapy due to higher risk of burns or complications due to heat application. These conditions include:

  • diabetes

  • dermatitis

  • vascular diseases

  • deep vein thrombosis

  • multiple sclerosis (MS)

At last I would like to mention few conditions where we can use either hot or cold packs or even both like a contrast bath

  • Muscle spasm-both ice packs and hot packs can be used for a muscle spasm. Contrast bath is always a better option here where we alternate between hot and cold.

  • Plantar fasciitis-Ice packs can be used but best use is the contrast bath alternating between cold and hot.

  • Pulled muscle-Both hot packs and cold packs can be used. Hot packs will make the muscle relax,flexible and reduce the stiffness. If you use ice pack it reduces the spasm, reduce the inflammation and restrict the process of inflammation. Reduce the sensation of pain giving a soothing effect.


Neither of these is better than the other. Both Cold and hot packs help to reduce pain and injuries. We need to understand what’s happening to our body and what to use in the situation. Cold packs reduce circulation and thus reduce inflammation and so we feel a soothing effect where else hot packs increase the blood supply and improve the healing process.

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