Many patients are uncertain if they should use ice or heat. Our recommendation is:

Almost always, start with ice. Ice reduces both pain and inflammation. Many professionals recommend the RICE protocol, which includes rest, ice, compress, and elevate the area involved. Although you can use zip lock bags with ice cubes, we find much better compliance when using gel-filled ice packs. We recommend in the initial stage of care, this is performed at least 3 to 4 times daily, and time can range from 10 minutes to 20 minutes depending on the area. Many people find that ice continues to help them throughout all phases of care, from acute (new injuries) to chronic conditions. If the involvement includes inflammation (arthritis, bursitis, tendonitis, etc) and joint or nerve involvement, ice is usually the treatment of choice. ALWAYS use at least a thin towel between you and the ice pack to prevent burning the skin - if any skin irritation is noted, discontinue use immediately.

Heat can be effective after the first few days in certain muscle injuries. It helps to reduce muscle tightness and relax the area. Bruising is another time we recommend heat. Typically this would begin 3 to 7 days after the initial injury. Some patients find that a heating pad which is designed to be used with a moist cloth is helpful, but others like using a rice pack or gel pack which can be heated in the microwave, then covered with a moist pad, which is just as effective.

Treatment time is usually 15 to 20 minutes. Be cautious not to burn yourself, but if skin irritation does occur, immediately stop usage.