In an event of Injury everyone gets confused so as to whether one should apply Ice Packs, Electric Hot Belts, Hot Water Bag or Traditional Warm Water Compresses. Indeed it is confusing. 

On many occasions if happens when you tell your Doc, that you had applied Hot water Bag, the response is totally opposite, that you should have Applied Warm Water compresses or Ice packs in place of hot and vice versa. It mostly happens in my practice and believe me its no ones fault here. 

Basically, the concept behind warm or hot application to any injured tissue has 3 mechanisms or theories behind it:


The Cold and Hot stimulus when applied to an injured part travels faster to Brain thus bypassing the feeling of pain. This is where the brain gets fooled in believing that instead of pain, there is a warm or cold sensation present. 

The gate pathway is primarily used to mellow down most of the acute or chronic pains apart from medicines, thus providing symptomatic relief without actually using Painkillers.

Same mechanism is used by commercially available Gels (Caspasin for making one feel burning, hot or Menthol for making one feel Cold, Icy) ; depending on type of gel.


Cold stimuli has the potential to reduce pain and swelling associated with the Inflammation generally seen post injury, Arthritis or Dislocations by suppressing Inflammation. Along with the medicines, Ice pack actually improves Swelling and Local skin condition quiet significantly. 


Moist Hot Water Compresses have healing potential on strained Muscle Fibers as in a Muscle Injury or chronic conditions like Coccydynia, Tennis Elbow, Plantar Fascitis and Back Pain etc.


ICE PACKS can be applied to any Acute Injury irrespective of Local Skin conditions or wounds. This help control Swelling and Pain.

After 4-5 days of Any Injury, when practically swelling and redness of inflammation have reduced, one can apply Moist Hot Water Compression. 


Practically Ice Can be Applied to any Body Part. Avoid Direct Application on skin rather cover it with a Polybag or Cloth.

Avoid Long Term Application, rather apply in bursts of 2-3 minutes, keep changing spots of application.

Moist Hot Water Compresses can be applied to any body part except KNEE Joint; should be applied 3-4 times a day in 4-5 minute bursts.

Best way to provide Moist Hot compresses is by bucket of water, dip a turkish towel in it , rinse and apply.


1. Knee does not tolerate Hot Stimuli, it causes Synovial Hypertrophy resulting in a heavy feeling with residual swelling and redness of the knee.

2. Never Apply Hot on Knee Joint in any mode or situation.

3. Hot/Cold stimuli can cause Thermal Burns (Avoid Direct Cold contact with skin, Avoid more then 2minutes at one spot)

4. Elderly have thin and brittle skin, be very cautious while applying Hot /Cold Therapy.

5. Electric Belts don't provide any structural benefit, just employs Gate Pathway so avoid it.

6. Hot Water Bags are convineant, but it provides Dry Heat, practically no healing Effect on Soft Tissues, primarily employs Gate Pathway, avoid it.

7. Avoid gels for local application, they can be irritating sometimes and can have serious skin irritating effects.

8. Don't leave a ice packs or hot towel on a specific body part especially in elderly or injured body party which has compromised sensory supply (Paralysed Injured Limb etc) and do other work. Keep checking the skin for burns etc. 

Keep it simple and logical.....Hope this helps!

Dr Nishit Palo.

(MS Orthopedics, Dip Sports Medicine)