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Ice Pack or Hot Pack - What Should You Choose for Pain Management?

Dr. Ahmed Alhamdan, BSc, DC - Doctor of Chiropractic

cold therapy

One of the questions I get asked a lot during practice is “what should I use, a hot or cold pack?” The short answer is that it depends. Generally, if you have an acute injury (i.e. an ankle sprain) or acute pain, it is recommended to use an ice pack. On the other hand, with chronic muscle pain or stiffness, it is recommended to use a hot pack. Knowing the ‘why’ behind this general rule of thumb makes it easier for you to make the decision.

Heat Packs work by increasing blood flow to a certain area by increasing the temperature. There are many indications for the use of hot packs. They increase extensibility of collagen, decrease joint stiffness, relieve muscle spasm, reduce chronic edema, reduce exudates, and decrease pain. However, there are many contraindications to using heat. Things to avoid include:

  • Applying a hot pack immediately after injury

  • Applying over the eyes or genitals

  • Applying heat over the abdomen during pregnancy

  • Applying heat over areas with diminished sensation

  • Late stages of Diabetes Mellitus

  • Regions of decreased arterial circulation

  • Over infection

  • Multiple Sclerosis (MS)

When applying heat therapy, ensure that there is an adequate amount of towel layers between the pack and the skin. Each session is typically 10-20 minutes. Be sure to check the application site for blisters or excessive redness every 5 minutes.

Ice packs on the other hand are used to treat acute pain and decrease inflammation. It is also used to reduce swelling, muscle spasms, and fevers. This is achieved because ice therapy decreases circulation and causes local vasoconstriction in the region. Just as in heat therapy, there are many contraindications to cold packs. So, be sure to avoid it should you have any of the following:

  • Cold hypersensitivity

  • History of Raynaud’s phenomenon

  • Poor circulation

  • Neurological deficit, Diabetes

  • Peripheral vascular disease

  • Open wounds

  • Local infections

When applying an ice pack, always wrap the pack with a towel and never apply directly to skin. Applying an icepack directly to skin may cause tissue damage. Cold therapy can be used multiple times a day in short sessions. Icepacks are applied for 15 minutes with re-application occurring no sooner than one hour from the previous treatment. In the first 1-3 minutes it is expected to feel cold, followed by a sensation of slight burning through roughly 2-7 minutes. Aching and numbness is typically felt between minutes 5 to 15.

Knowing when to apply each method is key for treatment to have a positive outcome. If either treatment worsens the pain you’re feeling, then stop. It is important in this case to call or make an appointment with your practitioner to discuss treatment options.


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