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Should I use Hot or Cold?

Hot or Cold Therapy. Which to pick and when?

You are most likely aware of the use of hot and cold therapy for pain relief and acute injury management, however can you always remember which to select and when to apply? Hopefully this article can provide a brief recap on the ins and outs of heat vs cold and perhaps give you a few ideas how to implement such therapy at home.

Use of COLD

Why would I apply cold therapy?

The application of cold therapy is usually recommended for recent acute injuries incurred in less than 72 hours as it can help with inflammation and oedema.

What are the positive effects?

One of the main reasons to apply ice to an injury is to provide pain relief as the intense cooling results in a local anaesthetic. The cold also reduces the blood flow and in turn limits the amount of fluid around the injury. Cold can help reduce swelling, another factor contributing to acute pain.

When do I apply cold therapy?

As detailed above, a cold compress or ice should be applied at the onset of the injury and up to 72 hours post. There are ongoing studies surrounding the best area to place the compress. In contrast to the current train of thought advising that ice be applied to the injury itself to reduce inflammation, current research suggests that ice should be applied above the injury to cool the blood flow into the injured area thus assisting the body’s in-built response to the injury. Food for thought…

Alternative popular uses for cold therapy include emersion of cold post exercise to alleviate muscle soreness (DOMS) and application of cold compresses to treat tendinosis (inflammation of a tendon).

How do I apply cold therapy?

The use of ice / cold gel packs is the most popular method of application. Alternative methods include a bag of frozen vegetables, a frozen towel. Precautions are to be taken to avoid further injury.


If applying ICE on to the skin directly, it is recommended to wait until the ice has slightly melted and to make circles on the skin with the ice as opposed to keeping it still. Application of cold compresses / ice should not exceed 30mins at one time and should be removed if the skin turns bright pink or red.

Use of HEAT

Why would I apply heat?

The application of heat can be very effective in the management of chronic pain or muscle tension as well as warming up muscles and joints before undertaking physical activity.

What are the positive effects of heat therapy?

Not only can it makes us feel nurtured, it can have a relaxing effect – a little like melting butter. Muscle tightness can dissipate; blood flow increases allowing fresh blood to circulate the nutrients required for tissue repair; elasticity in fascia increases (fascia is the connective tissue our body is essentially made up of and my favourite thing as a therapist); and overall decreases our pain perception.

When do I apply heat?

Heat can be applied for many reasons. A few of these include muscle stiffness; ongoing pain whether that be lower back, neck, shoulders or wrist etc..; heat can provide relief for conditions such as arthritis, fibromyalgia, frozen shoulder, temporomandibular joint disorder (TMJ) or menstrual pain; and can be really effective when combining with stretching to increase range of movement.

How do I apply heat?

Heat can be applied via means of a hot bath or shower; hot compress or hot water bottle and at any time of the day. (And obviously not scolding. We are not trying to create a new injury).

Have you tried stretching after your shower? Give it a go and compare results with previous sessions, you might be pleasantly surprised. Another idea is to apply heat on your problematic area before going to see your massage therapist. In normal times I work frequently with hot stones and the application of heat really helps me to penetrate muscle tension during the session. You might feel like you are getting a little extra for your ££ by doing so!


It is not recommended to use heat after an acute injury or over an area with swelling or inflammation. Heat packs should not be left on for extended periods of time or whilst sleeping.

If suffering from poor skin conditions, limited sensation, poor circulation, diabetes or if there is an infection, then speak to your clinician first for advice on the use of hot and cold therapy and to decide whether it is appropriate for your condition.

Please do not hesitate to get in touch for advice on hot and cold therapy and how it could help you at home. Meanwhile, with spring around the corner and signs of its arrival popping up everywhere, I personally feel a little uplifted and more energetic. I hope that the same goes for you and the sun popping out gives you a spring in your step (even if it’s only to the shops and back).

Hannah Bellamy is a Level 6 Advanced Sports and Clinical Massage Therapist at Guildford Chiropractic Centre


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