AT one of my physiotherapy sessions last week, I overheard the woman sitting next to me telling her therapist that she’d applied a hot pack after she had fallen down and hurt her knee and ankle. I instinctively winced because putting a hot pack on a new injury would only make it worse.

Sprains and swelling should have ice packs or cold compress placed on them to help control inflammation and minimise swelling. It would also help control the pain by numbing the area.

It’s so easy to get confused over what to do, especially when you’re overwhelmed in the spur of the moment. Facts get muddled when we panic. Do we apply a cold pack or hot pack? How do we know what to do?

In her panicky state, all she remembered was: If it hurts, put a hot water bottle on it, thinking along the lines of a menstrual cramp. Nothing could be more wrong in her situation. She should have put an ice pack or something cold to bring the swelling down.

“I guess that’s why I’m here today and need treatment,” she said, gingerly rubbing her aching knee.

That was how a lively chat ensued between us— the patients, a few caregivers and the physiotherapists there. Everyone had something to contribute to the conversation, sharing experiences and debunking certain myths.


As a general rule, ice is used for acute injuries, pain, inflammation and swelling, especially when it has just happened. Heat is used for muscle pain and stiffness, most often as post-treatment.

Cold packs or ice treatment is commonly used for acute injuries like ankle, knee or joint sprains, and injuries that have occurred within 48 hours. It’s also recommended for acute pain after intense exercise, and basic pain management for inflamed joints after a workout, especially for those suffering from osteoarthritis.

If you don’t have that neat ice pack, improvise by putting ice cubes in a plastic bag, cloth or towel. We often see slabs of steaks or bags of peas being used on television. These are precious food items and will not exactly be our first choice. But if there’s nothing else around, it would have to do. Putting a cold compress on the injured area is good for repairing tissue damage and inflammation.


Hot packs or heat packs relieve sore muscles. It’s wonderful for relieving soreness, stiffness, cramps and duller persistent pain, especially around the lower back and shoulders. It’s recommended as a relaxing treatment that provides comfort to stiff joints.

Heat tends to bring more blood to the injured area. So if you apply heat when an injury happens, you could increase swelling. Just remember that heat shouldn’t be applied for the first 48 hours after an injury.

There are many products that can provide heat for a warm compress. The good old hot water bottle is still being sold but there are others like microwaveable beanbags and dual-purpose gel pads that can serve as either a hot or cold compress and are very handy to have around the house.


Having established the general features of cold and hot packs, we must also remember to protect the skin. Never apply ice directly on skin. Always remember that both ice and intense heat can burn the skin, especially for children and the elderly because their skin is thinner. Just place a piece of thin cloth as a protective lining when using these packs.

Hotter isn’t always better. It should be hot enough for the skin, but not so hot that it burns. If you can’t bear the heat, adjust it by adding more layers of cloth, or ask for help. For both hot and cold treatments, try not to exceed 20 minutes. Remove the packs and rest. Repeat only a few hours later.

If your loved one is diabetic, or has a heart condition, be extra careful about how you use these packs and where you place them. People with diabetes and certain illnesses suffer from nerve damage and may not feel the pain. Test the pack first and then time the session. Don’t place hot or cold packs over areas with known poor circulation.

Here are some things to remember :-

• Don’t use pack on the left shoulder, around the front and side of your neck if you have a heart condition.

• Don’t use ice packs before a workout.

• Don’t use a heat pack on a wound or infection.

• Never use or leave heating pads or towels for extended periods of time or while sleeping.

•If the hot or cold compress makes the pain or discomfort worse, stop immediately.

Sometimes, both hot and cold compress are applied alternately for certain injuries. But that’s usually under the supervision of a therapist.

Knowing when to use what compress for your situation would significantly help you manage your pain and discomfort. Be alert when you do this at home. If the skin develops bruising or doesn’t look right, or if your problems don’t improve, see your doctor.

Putri Juneita Johari volunteers for The Special Children Society Of Ampang. She can be reached at juneitajohari@

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