Registered Massage Therapist
Member of the Massage Therapists' Association of Nova Scotia since 2000

The Halifax Professional Centre
5991 Spring Garden Road • Suite 577
Halifax, Nova Scotia • B3H 1Y6
902 • 580 • 2708


Heat or Cold For an Injury?

It's important to know when to use either hot or cold hydrotherapy for an injury. 

Sometimes when a person has back pain, they apply a heat pack to the area, only to find themselves hours later in a great deal more pain. Do NOT put a heat pack on an acute injury. 

Here is a basic definition of the stages of injury healing - and what kinds of hydrotherapy you can use during each stage. 

ACUTE (the first 3 days after an injury): use COLD
Symptoms of an acute injury: sudden severe pain, swelling, heat, bruising, inability to put weight on a lower limb, decreased mobility, weakness, visible dislocation or break of a bone.
Examples of cold hydrotherapy: 
  • ice cubes in a plastic or ziplock bag, a cold gel pack or a bag of frozen peas or corn. Wrap in a cold, wet towel or dry cloth (a pillowcase does nicely). Do not apply directly on the skin.
  • a cold towel compress -  a hand towel or cloth soaked in cold water, wrung out and applied to the injured area, covered with an insulating towel.
Apply any of these modalities for 15-20 minutes. Remove and wait until the injured area returns to normal temperature. Repeat cold hydrotherapy. If the injury occurs in an area with little fat or muscle beneath the skin, like fingers or toes, take the cold off after 10 minutes maximum.

SUBACUTE (3 days to 3 weeks after an injury) : use CONTRAST HYDROTHERAPY
Alternating heat and cold hydrotherapy. The ratio used is 3:1 (3 minutes of heat: 1 minute of cold - or 30 seconds, depending on your tolerance level.). Always end with the cold application. 
Contrast hydrotherapy can be awkward and impractical for certain parts of the body, but immersive contrast hydrotherapy is the solution. Immersive contrast hydrotherapy is especially effective for repetitive strain injuries of the arms, hands, legs and feet since recovery from repetitive strain injuries involves lots of rest and stimulating the soft tissue (muscle & tendons) without stressing it. Contrast hydrotherapy is especially effective for:
  • plantar fasciitis
  • Achilles tendinitis
  • shin splints
  • carpal tunnel syndrome
  • tennis elbow
Examples of contrast hydrotherapy are contrast foot bathing and contrast hand bathing. Follow this link to Hydrotherapy

CHRONIC (any time after 3 weeks): use HEAT
Examples of hot hydrotherapy: 
Apply any one of these modalities for up to 10 minutes. Do not lie on top of any of these heat sources.
  • thermaphore (moist electric heating pad)
  • hyrdocollator (gel filled heat pack)
  • a hot water bottle (wrapped in a towel)
  • a hot compress (towel or cloth soaked in hot water, wrung out and applied. Cover with an insulating towel) 
ACUTE FLARE-UP (any time): use COLD
It's possible to have an acute flare-up of a chronic (old) injury. For example: Say you had a car accident five years ago and had whiplash and pain down the left side of your neck. Five years later, the pain is minimal, but yesterday you turned quickly to back your car up and now you have that familiar pain in the left side of your neck. This is an acute flare-up of an old injury and you should treat it as you would an acute injury - apply cold hydrotherapy.

NOTE: Use this information as a basic guideline, but remember the most accurate way to define your stage of healing is by the symptoms you see and feel. If your ankle injury still feels warm after three days and your mobility hasn't improved, continue using cold hydrotherapy. 

People who have sensory changes, poor circulation or any sort or cardiovascular (heart or blood circulation) condition should check with their doctor before using any kind of hydrotherapy.