When and why to use an Ice Pack?

When and why to use an Ice Pack?

Article by Adele Ang


Senior Sports and Musculoskeletal Physiotherapist

About the Author : Adele specialize in Sports and Musculoskeletal Physiotherapy.  She also pursued the Polestar Pilates Method, which is a comprehensive method using Pilates as exercise therapy for rehabilitation of injuries.

In Asian cultures, applying cold packs to injured body parts is frowned upon. As there is a belief that it can lead to ‘rheumatism’, which is typically characterised as stiff and achy joints. As a kid, my dad would rub a hard-boiled egg, straight out of boiling water, on a bruise formed on my head or my knees the very moment after sustaining these bruises.

I was told that this is done to improve blood circulation to the bruise, for the bruise to dissolve, as well as to avoid having to cut the bruise out as it will be ‘dead flesh’, should blood permanently fail to return to the bruise. Really frightened that this threat might really happen, I endured the painful hot egg treatment with every bruise I sustained as a kid.

Applying cold therapy to injuries is not common practice in Asian cultures, whether it’s Traditional Chinese Medicine or Ayurvedic Medicine, heat therapy is still a treatment of choice. As such, it’s not common knowledge among some patients when to apply heat and when to apply cold.

Here are 3 pointers to help you decide to reach for ice whenever you sustained an injury.

1.First 72 hours

The basic guideline is that cold therapy should be applied in the first 3 days following an injury. Inflammation which is our bodies healing mechanism happens immediately following an injury, whereby blood flow is increased to that area to commence healing. As a result of inflammation, pain is experienced and the injured area will be swollen and warm to touch.

2.Red, swollen and warm to touch (past 72 hours)

When the area concerned presents with redness, swelling and is warm to touch. These 3 things suggest that the injured structures are still inflamed. Cold therapy may at times need to be continued after 72 hours especially when the injury sustained is extensive and/or it affects parts of our body such as the foot and ankle which usually have more persistent swelling due to continuous load on these areas if weight is placed on then as well as due to gravity pulling more fluid down to those areas.

3.Difficulty moving the injured area due to pain

Usually pain is intense and unremitting and episodic as well. May have been more than a few days, could be weeks or months prior but is episodic. A recurring injury to the same area may result in such a presentation, usually heat therapy is applied but should you feel worse or in more pain after, you may respond better to cold therapy. This may be due to repeated inflammatory responses to the injured area usually resulting from repeated aggravation of the same area as a result of insufficient rest as well as not receiving proper treatment, including physiotherapy and rehabilitation following the injury.

Rehab Mantra
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2 replies
  1. Richa Gupta says:

    Can you please guide me because some patients respond with hot therapy in acute trapezitis while some respond to cold pack..

    • Rehab Mantra says:

      Hi Richa
      Before deciding what modality to use hot or cold, we need to understand the root cause for the trapezius muscle pain. Is it secondary to any cervical condition such as cervical spondylosis or cervical facet joint dysfunction/arthropathy or it is a direct injury to trapezius muscle such as a strain or contusion? If it is an acute injury to the muscle, cold pack should be the choice and if the trapezius pain/spasm is secondary to any underlying neck condition or trigger points, then hot pack should be the choice of treatment.


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