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Heat vs Cold: What to Use and When

Last updated on October 25, 2021 By Kira Davis MPT Leave a Comment


When seeing new patients the same confusion comes up. They don’t know when to use a heating pad versus an ice pack. This article should help explain the theory of when to use what and will give you some easy guidelines.

heat pack on hurting knee

Physiological Response to Heat

When the body temperature increases, the blood vessels become dilated, therefore increasing blood flow. With this effect comes tissue extensibility and increased joint comfort. However, heat can increase metabolic rate and neural excitability.

heat pack on sore neck

Physiological Response to Cold

Typically when temperature drops, the blood vessels become constricted, and this is the general thing that decreases inflammation. As mentioned in a previous article (Addressing the Inflammatory Process of your Injury), inflammation is typically the primary cause of the pain response. Cold therapy, also known as cryotherapy, helps decrease nerve conduction velocity and muscular spasm (except for upon initial contact).

When to Use What

Below are the basic guidelines that I explain to my patients to make it easy for them to know when to use what.

Use a hot pack if:

  • You have low level pain rated between 1-4 out of 10
  • You have joint stiffness that is limiting your mobility
  • You have muscle tightness that is limiting your mobility

ice pack on hurting knee

Use a cold pack if:

  • Your injury is less than 48 hours old
  • You have visible swelling
  • You have numbness and/or tingling in the extremities related to neck or low back pain
  • You have pain rated between 1-10 out of 10

ice pack on hurting foot

There are many other times that use of cold or hot packs are acceptable and recommended. If you are unsure, contact your friendly physical therapist at PhysioDC.

Filed Under: Featured



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About Kira Davis MPT

Kira Davis has been practicing as a licensed physical therapist (license #PT870656) in the outpatient orthopedic setting since 2006 in the metropolitan Washington, DC area. She received her Masters of Physical therapy in 2005 from Howard University and her Bachelor of Science with a concentration in the Pre-Physical Therapy program in 2003 from Howard University. She has experience addressing many types of sports injuries and is herself an avid soccer player. Trained in classical dance since the age of 3 and an active dance student, she strives to be one of the area's elite physical therapists for the dance community.

FTC Compliance Disclaimer: PhysioDC.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com; proceeds from product sales help cover the operational & maintenance costs for the site.

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DISCLAIMER: The information on this site is for Educational Purposes Only and is not designed to diagnose, treat, mitigate, prevent or cure any health conditions. The U.S. Food and Drug Administration has not evaluated statements about these health topics or any suggested product compositions. Answers to questions submitted are merely the opinion of the physical therapist and should not be taken as a prescribed course of action. Any advice given by the therapist must be cleared with the treating physician involved in direct patient care. The person posing the question absolves the responder of any liability in regards to opinions given. PhysioDC insists that all patients receive approval from a prescribing physician prior to starting a structured exercise program involving any of the exercises included on this site. PhysioDC.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com; proceeds from product sales help cover the operational & maintenance costs for the site.