The Ground Rules
- Acute new injuries with pain, swelling, internal bleeding should be treated with cold therapy for the first 48-72 hours. Never apply sustained heat therapy. Examples of acute injuries include ankle sprains, back injuries or waking up with a sharp pain and spasm in your neck.
- Chronic arthritic pains typically use heat therapy. (a flare-up of an existing condition should be treated as an acute injury)
- Subacute conditions (3-5 days post injury) will benefit from both heat and cold therapy. Heat will provide oxygen and nutrients for cell repair while cold will settle any inflammation, drain swelling, provide pain relief and relax muscle spasm. You can apply heat and cold therapy separately.
- When in doubt use cold therapy. It will rarely exacerbate a condition (as heat can) and will help most problems. Clinically many patients who report improvement the day after using cold packs even though heat packs feel better at the time of application.