The 15 Rules of Hot & Cold

Our bodies have an incredible ability to heal themselves when we give them the right conditions.

A bit like planting vegetables. If you put the seeds down at the right time of year, give them the right amount of water and feed the soil, you will get a crop.

Recently I was asked by one of our readers (Joanna) to explain the rules for using Hot and Cold as a therapeutic tool to help with pain or following injury.

We’ve probably all been told at some point “oh, just put an ice pack on that”, “have a hot bath, you’ll feel better”, “you need put that in a bucket of cold water followed by a bucket of hot water”…  But what is the right thing to do and why?


When we apply hot or cold therapies, also known as thermotherapies, we are typically trying to achieve one of two things:

1) Decrease pain

2) Increase or decrease circulation

Depending on what type of tissue you have injured and what stage of recovery you are at, the choice of hot or cold can vary.

Here are some rules to follow to guide your application of thermotherapy.

I. Use cold, ie: ice packs for acute injuries (first 0-72hrs) to ligaments, muscles, tendons.

II. Apply ice packs for 10 minutes on, 20 minutes off, 10 minutes on, 20 minutes off, etc for approx 2 hrs 3-4 times per day for up to 72hrs after the injury occurred.

III. Don’t apply ice (or heat) to a suspected bone fracture.

IV. Do not apply ice (or heat) to an open wound. This will slow down healing and potentially cause more damage.

V. Using cold immersion baths for sprained ankles, such as an ice slurry (bucket of icy water) produces a much more penetrating cold and a stronger effect. This is useful when there is a lot of swelling, bruising or pain over a large area of the body, but if you don’t like the cold, it will obviously be more uncomfortable than an ice pack.

VI. Ice baths following exercise are excellent for aiding in the removal of waste products from your muscles and speeding up recovery. Although, research shows that the water does not need to be all that cold to have the desired effect. Typically a temperature in the low teens (similar to the ocean) will do the trick. The best method is to do some easy movement such as walking in the water to get the best results. Sitting passive for a long period in an ice bath may end up just making your muscles tighter.

VII. If you use ice instead of a gel icepack, be sure to wrap the ice in something to create a barrier from the skin. The only time this rule does not apply is if the ice is used in a massaging manner where it is slid along the skin. This will prevent ice burns, but should only be done by somebody trained in the safe application of ice massage.

VIII. Heat packs (wheat bags, etc) are best used for chronic muscle tension and soreness, joint stiffness or in other situations where there is no immediate signs of inflammation from trauma.

The signs of inflammation are Heat, Swelling, Redness, Pain and loss of Range of Motion or Function. Note – not all 5 signs need to be present for there to be inflammation, but you would expect at least two.

IX. Wet heat penetrates more than dry heat, so hot baths, towels soaked in hot water or similar will produce a deeper effect.

X. Heat is great to use for arthritic pain, as a pre-exercise circulation booster (best used in conjunction with an active warm-up) and as a muscle pain reliever for a tight lower back, neck, etc.

XI. If heat is applied to an acute injury, it will cause vasodilation (expansion of the blood vessels) and result in more swelling and/or bruising and increase the amount of inflammation present. So no heat (or massage) to the site of a trauma for at least the first 72 hours.

XII. The use of hot and cold in conjunction is a fantastic tool for speeding up healing in a non-acute injury and also for a quick recovery from hard exercise. Known as ‘Contrast Baths’ or ‘Vascular Flushing’, this method generally involves applying cold for approx 30 seconds, followed by heat for approx 2 minutes and then repeating the process, finishing with cold. For a sprained ankle, this can be done with a bucket of icy cold water, and a bucket of hot (but tolerable) water. The process is continued for about 20-30 minutes twice per day. Other ways of achieving this is with a hot-cold-hot-cold shower or applying ice and heat packs interchangeably.

XIII. Whenever using hot or cold therapy, it is important to remember that if at any point you lose sensation in an area due to the application, that you stop and remove it immediately. Losing sensation may lead you to cause a heat or ice burn and result in injury.

XIV. The use of hot and cold on or around the spine can be confusing. In situations that would normally call for a heat application, some people find more relief from cold packs or vice versa. Some experimentation may be called for with this region – checking with someone qualified to advise you on this is always a good idea.

XV. Using liniments or medicated rubs are another way to produce a therapeutic affect through heating tissues. Some contain camphor or peppermint or other constituents that act as a chemical irritant and produce an increase in circulation.

Keeping these 15 rules in mind, it is also worth noting that there is a gradual shift away from the way in which we have used ice for many years now. Research is telling us that slowing down the inflammatory process may in fact be slowing down our healing. This does follow logical thinking in that inflammation is our body’s way of kick-starting healing in the tissues. Applying ice for hours on end does tend to halt that process. However, in some cases we have a tendency to produce too much inflammation or for too long, and in these situations, ice may be used to moderate the process.

Chinese Medicine has been against the use of cold for thousands of years now. They believe nothing lower than room temperature should be applied to or consumed by the body. This does make a lot of sense, but the jury is still out on the final word from a western scientific point of view.


For now, using hot and cold therapies for reducing pain and swelling, improving circulation and speeding recovery from exercise is all very much achievable.

Just follow these rules and if you are unsure, just send me an email and I’ll do my best to guide you in the right direction.


Run long,

Shaun Brewster.

Leave A Reply (2 comments so far)

  1. Gareth Parker
    4 years ago

    Great info as usual Shaun
    Trust all is well
    Speak soon

  2. Shaun
    4 years ago

    Thanks Gareth. Glad you found it useful. Feel free to suggest topics for future articles. I’m always open to good ideas.


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