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When to use Heat vs Cold treatment

Have you ever been to occupational or physical therapy? Did your therapist use a hot pack or a cold pack on your injured body part? I know I often use heat and cold modalities and many of my patients ask why we use these treatments and if they should be part of their home program. Let’s explore when to use heat versus cold treatment.

Understanding Heat Treatment

Heat treatment modalities can include hot packs, paraffin, and some clinics have a fluidotherapy machine that is like a sand machine that blows hot air. There are two types of heat treatments: moist heat and dry heat.

About 99% of everyone loves heat treatments!! Your injury and your pain is not a one treatment fits all deal though.  Different injuries tend to be appropriate for different types of heat treatment.

  • Moist Heat: 

Ideal for chronic conditions or stiff joints, such as arthritis. For example, the hand and thumb respond well to moist heat like a heat pack or paraffin. Many times, I may use paraffin when I have a stiff finger to wrap it down into a stretched position, then paraffin it, and wrap it in moist heat. Moist heat loosens tissues, making them more elastic and allowing for better stretching and relaxation. However, it’s not suitable for all body parts (e.g., elbows or shoulders).

I can’t use paraffin on an elbow or shoulder, but I can apply heat and use gravity to stretch the elbow, depending on the direction of the motion limitation. For the shoulder, placing it on a table and using body weight to stretch it can be effective. Heat alone isn’t enough, though. Combining heat with stretching or exercise helps loosen the injured area and makes the person less guarded, allowing for better movement.

  • Dry Heat: 

Dry heat, such as fluidotherapy, involves a machine with warm air and soft sand. Once your hand or arm is in the machine and it’s turned on, your hand will warm up in a few minutes. At that point, I prescribe several exercises to do while in the machine. The dry heat, combined with motion, is highly effective—many of my patients love it because they come out with increased motion and reduced stiffness.

It’s great for increasing motion and reducing stiffness, particularly in the hand, wrist, and forearm. This method combines heat with movement, providing effective results, also when the scar or injured body part is overly sensitive. However, it only fits the hand, wrist, and forearm.

Heat treatment isn’t a one-size-fits-all solution. The type of heat and its application depend on the injury and treatment goals. That can also change over time and that can change the type of heat you use or if you even need it at all. Heat on a new injury with lots of swelling can be harmful though, there are contraindications.

Exploring Cold Treatment

Cold treatments include an ice pack or direct ice to the skin. This is my favorite. Does it feel good the first time? Not really. Cold treatments are harder to tolerate at first, but so many of my patients love the cold packs or ice massage after an intense therapy session.  Ice is great when you have a new acute injury, muscle pain or when you have swelling.  I tend not to use it on the fingers too much unless they are really swollen, but for the bigger joints and diagnosis like tendinitis, ice is the best thing. 

  • Ice Packs: 

Best for new injuries, muscle pain, or swelling. Ice packs should be very cold to achieve the desired numbing effect. If you are going to use ice treatments to manage your pain and edema then you need to feel the cold, DO NOT put it around a towel.  You will never feel the cold therefore it is not as effective.  I like to use a gel cold pack, put it in a pillow case, and then place it on the injured body part.  The gel cold pack is wrapped around the injury for about 10 min more or more if you can tolerate it. 

  • Direct Ice Massage: 

Ideal for targeting small areas of pain. My other favorite love of ice is a block of ice in a small paper cup or a frozen bottle of water. This goes directly on to the painful area, massage and rub that area with the ice until it goes numb.  I like direct ice massage if there is one small area we need to target. This method is particularly effective for tendinitis and larger joints.

Cold treatment can have a longer-lasting effect, especially for muscle pain and swelling. It’s a simple and accessible method to manage pain at home.

When to use Heat vs Cold treatment.
paraffin treatment

Combining Treatments for Optimal Results

There are other types of thermal treatment with machines such as ultrasound and laser therapy that penetrate deeper into the tissues but it is not cheap or easy to have at your disposal.  Hot packs and ice packs are easy ways that you can help yourself at home to combat stiffness or muscle pain.  Research does show that heat generally feels good but wears out after the heat is gone, but cold treatment can have a longer lasting effect especially when treating muscle pain and swelling.  

Key Takeaways

  • Heat Treatment: Effective for chronic conditions, stiffness, and relaxation. Use moist heat for joints and dry heat for increasing motion.
  • Cold Treatment: Best for acute injuries, muscle pain, and swelling. Apply ice packs or direct ice massage for effective relief.


Incorporate these treatments into your home exercise program with guidance from your therapist. They can help you combat stiffness and pain effectively. Remember, these treatments should complement other therapy aspects.

For further questions about heat vs. cold treatment, feel free to call or leave a comment below. Thank you for your interest!

Recover Faster: Find Top-Rated Hand Therapy in Miami

Experiencing hand pain, swelling, or limited mobility? Hands on Therapy Services can help! We are a leading Miami clinic with certified hand therapists specializing in the rehabilitation of shoulder, elbow, wrist, and hand injuries.

About Hoang Tran – an expert in occupational therapy

Hoang Tran is a certified hand therapist, the owner of Hands-on Therapy Services, and the author of the book “The Hands-On Approach”. She loves helping people with hand, neck, and shoulder problems because she knows how bad and debilitating they can get if not addressed and treated properly (once and for all!).

The aim of her Miami occupational therapy clinic is to help her clients live active pain-free lives, without pills, injections, or surgery. Occupational and Physical Therapy are offered at Hands-On Therapy by our experienced therapists who provide a comprehensive approach to your care. 

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** If you are an occupational therapist, physical therapist, or certified hand therapist who wants to learn and develop your skills in hand therapy, please visit Hoang Tran’s program.

Hoang Tran offers both online and in-person learning events to help you develop your clinical skills.


Disclaimer:  As with all our pages, this is NOT a substitute for formal medical treatment or occupational therapy.  It is intended to inform only.  Hands on Therapy Services disclaims any liability for the decisions you make based on this information.

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