Cold compresses (ice, frozen foods, gel packs) and warm compresses (hot water bottle, heating pad) are home remedies for bruises, sprains, strained muscles, and back pain. Cold is usually applied for fresh injuries, while heat is used for stiffness and muscle cramps.
In summary: The NHS recommends a cold compress in the first days after a sprain or strain, and heat for stiffness and muscle cramps. Research partially supports this practice, but overall, the quality is poor. The main risks are frostbite from ice and burns from heat packs, especially in individuals with impaired sensation, such as those with diabetes. Emergency services should be contacted if a popping sound was heard at the time of injury, if the limb has changed shape, or if it is numb or discolored.
Origin
Cold and heat have long been used for back pain by patients, physiotherapists, and doctors, as noted by the authors of the Cochrane review. A 2004 review points out that the guidelines for using ice for injuries vary and have developed more from experience than from research. One of the hospitals in the British public health service explains the mechanism: cold temporarily reduces blood and lymph flow, which limits swelling and alleviates pain, while heat improves circulation and helps relax muscles.
What We Know
Label: Weak evidence. The NHS recommends both methods for self-care, but research reviews assess the evidence as limited. The best-documented effect is a small, short-term benefit of warm compresses for fresh lower back pain. For ice in injuries and cold for back pain, studies are few and of poor quality.
What Studies Say
- Cochrane Review 2006 (French et al.) included 9 studies with 1117 participants suffering from back pain. Moderate-quality evidence from several studies indicates that warm compresses slightly and temporarily reduce pain and disability in individuals with fresh or ongoing pain for several weeks, and adding exercise further reduces pain. Only three low-quality studies were found for cold compresses, and no conclusions could be drawn. It is also unclear whether cold or heat is better.
- Systematic Review 2004 (Bleakley et al., American Journal of Sports Medicine) included 22 studies on ice for fresh soft tissue injuries. Their quality was low. Weak evidence was found that ice combined with exercise works best after ankle sprains and surgeries. It was not determined how and for how long it should be applied.
- Burns in Diabetic Patients (Katcher and Shapiro, 1987): among 37 diabetic patients treated in the hospital for burns, 10 (27%) had preventable leg burns related to loss of sensation. Most were caused by heat applied at home, including hot compresses or heating pads.
- England and Wales (Chu et al., 2024): from 2014 to 2023, 5944 burns from heat packs were recorded. Burns occurred, among other reasons, during water pouring and from leaking or bursting heat packs. In winter 2022, cases increased by 43.4% compared to the previous year, with the highest rise in burns among children and individuals over 65.
- Hanover, Germany (Milewski et al., 2025): in one hospital over 10 years, 88 individuals were treated for burns from heat packs. 81.8% had second-degree burns, most commonly on the lower abdomen, thighs, and forearms.
- Frostbite from Ice (O'Toole and Rayatt, 1999): a 59-year-old woman experienced frostbite on her calf skin after applying an ice pack. The authors suspect such injuries may be common.
Safety
Neither ice nor a heat pack should be applied directly to the skin. Always use a towel or cloth and only where sensation and circulation are normal.
Risks
- Frostbite from ice. The NHS recommends wrapping the ice pack or frozen food in a cloth and holding it for up to 20 minutes.
- Burns from heat packs: when pouring boiling water, if the heat pack leaks or bursts. Sherwood Forest NHS Hospital warns not to leave the compress on during sleep and to monitor the skin.
- Heat for fresh injuries. The NHS advises avoiding heat (hot baths, heating pads) for the first few days after a sprain or strain, as well as alcohol and massage, as these may exacerbate swelling.
- Compress on a wound. Neither cold nor heat should be applied to an open wound or abrasion.
Who Should Avoid
- Individuals with impaired sensation or poor circulation in the affected area. Sherwood Forest NHS Hospital recommends using cold and heat only where sensation and circulation are normal.
- Individuals with diabetes and nerve damage in the feet (neuropathy), which reduces their ability to feel pain. According to doctors from Rabat, burns from heat packs in this group are deep and difficult to treat.
- Children and the elderly: this group saw the highest increase in heat pack burns in England and Wales during winter 2022.
- Individuals with frostbite from exposure to cold: the NHS notes not to warm the frostbitten area with a heat pack.
Interactions with Medications
- Sources do not describe interactions between compresses and medications. If gels or painkillers are used for an injury, it is best to ask a pharmacist whether they can be combined with compresses.
When to See a Doctor
The NHS advises calling emergency services or going to the emergency department (without driving yourself) if after an injury:
- a popping sound was heard at the time of injury,
- the injured body part has changed shape or is oddly bent,
- it is numb, tingling, or prickling,
- the skin around it has changed color (turning blue or gray) or feels cold to the touch.
These may be signs of a fracture. Urgent advice is also needed in situations where:
- the pain is very severe or worsening,
- the swelling or bruise is large or increasing,
- it is impossible to stand on the leg or walk more than a few steps,
- the area is very stiff or difficult to move,
- the injury is not improving despite home treatment,
- high fever or chills occur, which may indicate an infection,
- a very large or deep burn has occurred from the heat pack, or it involves the face, genitals, or buttocks.
Sources
Compiled by the editorial team of informacja.com based on sources. Status as of October 24, 2026. This is not medical advice.