The ques­tion often comes up as to when it is best to use cold or hot treat­ment in injuries. Per­haps this can help. When to use ice or heat depends on how long ago the injury occurred.

After you strain a lig­a­ment or mus­cle, it is gen­er­ally best to use cold (ice or a cold pack) imme­di­ately and then for the next day and 1/2. It’s usu­ally wise not to use heat, such as a heat­ing pad, until swelling and bruis­ing has stopped.

Cold is usu­ally used first because it reduces swelling and inflam­ma­tion. Use Ice for the first 48 hours after an injury. Apply for 20 min­utes, remove for 20 min­utes, then repeat. Do not apply directly to the skin — put a thin towel over the skin for pro­tec­tion, or freeze a cup full of water, tear off the top rim and move the ice over the injury. This helps con­trol bleed­ing by con­strict­ing blood ves­sels. Cold acts as a local anes­thetic and so relieves pain. Usu­ally the bruis­ing asso­ci­ated with acute inflam­ma­tion stops within 1 to 3 days. To relieve mus­cle spasms, minor sprains and strains, it’s usu­ally best to apply cold for 20 min­utes inter­vals at a time every 4 to 6 hours for the first day and a half. Com­mer­cial cold packs may be safer than using ice. Pro­longed expo­sure to cold, espe­cially ice, can result in frost­bite to tis­sues. Later in the process, you may relieve pain by apply­ing heat, rather than cold, to your injury.

Use heat 20 min­utes at a time at least 24 hours after a minor injury or 48 hours after a more seri­ous one. Place a heat pack directly on the injured area — do not add pres­sure. Do not apply to bro­ken skin.

Cold reduces inflam­ma­tion. Apply cold to acute injuries, such as a newly sprained ankle or a pulled muscle.

Heat improves cir­cu­la­tion. It’s best for chronic pain, such as from tight mus­cles or a sore back.

Alter­nate Heat and Cold if you have soft tis­sue dam­age and/or stretched lig­a­ments, such as an ankle sprain. Heat aids in restor­ing range of motion. Apply cold for 20 min­utes per hour as desired for the first 24 hours. The next day, apply warmth for 20 min­utes per hour as desired.

Cau­tion: Don’t apply cold for more that 24 to 36 hours or warmth for more than 72 hours, see a doctor.