When Injured do I use Hot or Cold?

By November 26, 2013Pain Info

Written By: Arny Warkentin

Hot vs. Cold Applications

Many clients have expressed confusion about when to use hot versus cold applications. There are many misconceptions flying around and it can be very easy to get confused while reading around online. This post will attempt to alleviate that confusion as easily and simply as possible.

An important concept to understand when considering ice or heat applications is the term soft tissue injury. The term soft tissue refers to tissues that surround bones and organs, serving the purpose of connecting and supporting these structures. Soft tissues include muscles, skin, fascia, tendons, and ligaments. Just to name a few. The term soft tissue injury refers to any damage that occurs to these structures. Damage can be caused by direct trauma, tearing, exercise, or even massage. We will also examine which to use in regards to stretching. With that term explained, let us look at hot and cold applications.


Cold applications (most often ice-packs or bags of ice) are meant to be used after injury to soft tissue. During the first 24-48 hours after a soft tissue injury cold helps to minimize swelling, muscle spasms, and pain (Kisner, 2002). How long cold should be used depends on who you ask. A good rule of thumb is once the area has become numb, you should take off the cold application and let the area warm back up. This takes roughly 5-10 minutes depending on the source of the cold application. Doing this roughly once an hour has been found optimal.

With healthy soft tissues, applying cold to a muscle in a lengthened position (no stretching occurring) after a stretch has been shown to lead to more lasting increases to the muscle length (Kisner, 2002).


Heat (most often a heat-pack or heating pad) is meant to be used after soft tissue injury has moved passed the inflammatory response. Heat helps to increase the extensibility (the ability to be stretched) of soft of tissues, decreases the amount of time and force required to stretch a muscle, and heat can increase the effectiveness of stretching by being used prior to, or during stretching (Kisner, 2002).

Just to clarify, stretching should not be performed with soft tissue injuries while in the acute, inflammatory stages. The exact time frame for this can range from a day to even a week or more. Asking a physician or your RMT about your specific injury can help shed light on more specific time-frames for the healing process.

I hope this short summary helps to clear up some of the confusion behind when to use cold versus hot applications. If you have any questions feel free to give us a call or send me an email at: ArnoldwarkentinRMT@gmail.com


Kisner, C., Colby L. (2007). Therapeutic Exercise: Foundations and Techniques. Philadelphia: Margaret Biblis.

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