Ice packs and heating pads are both commonly used to treat orthopedic injuries, but people are often confused about which one to use. Moreover, there is often uncertainty about how to use them safely and whether they may cause more harm than good.

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Ice Treatment

Ice treatment is most commonly used for acute injuries to reduce swelling, pain, and inflammation.

Inflammation is the body’s natural response to an injury or infection. Blood vessels and tissues swell so immune cells can get closer to the damage. While vital to healing, inflammation left uncontrolled may cause extreme pain and disability.

If you have experienced a physical injury within the past 48 hours, an ice pack can help minimize swelling, reduce bleeding within tissues, and alleviate muscle spasms and pain.

Ice treatments may also be used to routinely treat chronic conditions, including overuse injuries in athletes (such as tendinitis, tendinosis, or bursitis). The pack would be applied immediately after physical activity to preemptively treat inflammation.

How to Safely Ice an Injury

Ice packs are commercially available as freezable gel packs. You can also make them with ice cubes in a plastic bag or tea towel. A pack of frozen peas is also a good option.

To safely ice an injury:

• Never place ice directly on the skin. Always use a cloth barrier like a thin bath towel.
• Keep the ice pack moving to avoid frostbite. Never keep it in one place for more than a couple of minutes.
• Never ice an injury for more than 15 to 20 minutes. It is better to ice an injury several times a day than all at once.
• Remove the pack if you experience prickly pain or the skin appears bright pink or red.
• Do not use an ice pack on the left shoulder if you have a heart condition.

Heat Treatment

Heat treatment is used to treat chronic conditions. It helps to relax tissues and stimulates blood flow to the affected joint or muscle. Heat is typically used to treat overuse injury before an action is performed.

Heat can be an effective form of pain relief if muscle tension is the cause. Heating can help relax tissues and loosen stiff joints, making it appropriate for musculoskeletal conditions such as arthritis and old muscle strains.

Steamed towels or moist heating pads may intensify the penetration of heat into the muscles. Some people find that that moist heat provides better pain relief than dry heat.

How to Safely Heat an Injury

Heat application can be accomplished with an electric heating pad or even a heated towel removed from the dryer. If using an electric pad, choose one with a temperature control to prevent overheating and burns.

There are even microwaveable bags filled with wheat, rice, or other natural or synthetic ingredients. Use these with caution, however, as they can cause burns if overheated. Wheat bags especially have been known to catch fire.

To use heat application safely:

• Do not use heat treatments after activity.
• Do not use heat to treat an acute injury.
• Always use moderate heat. The heat should never cause sweating or discomfort.
• Do not heat a towel with boiling or scalding water.
• Never use heat where there is swelling of any kind.
• Never use heat on broken or damaged skin.
• Never use heat for extended periods of time or while sleeping.