There are situations where patients can do much to help themselves, both before they attend treatment, or to help ease symptoms between sessions.

  • Cold packs
  • Hot packs
  • Hot and cold treatments
  • Freeze gel
  • Topical non-steroidal gels
  • Ice cube massage
  • Over the counter analgesics
  • Postural advice
  • Rest or activity?
  • Simple exercises
  • Red Flags – significant signs/symptoms which require urgent medical attention.



Cold packs

The application of cold packs is useful in the first 24 hours after an acute injury (one that has just happened); knocks, bruising, muscle strains and joint sprains.  It takes some courage to apply cold, but once you’re over the initial shock it is very soothing.  Do not apply to broken skin.

  • Effects:  The application of cold has a pain killing effect on the tissues and helps to reduce internal bleeding in the immediate aftermath of an injury through a process of vasoconstriction.
  • Method: Many items can be used as a cold pack – from cold can of beer, to a packet of frozen peas (wrapped in a tea-towel) or a commercial cold pack.  Flexible items are better as these can be wrapped around the injured tissues.  Items used from the fridge can be applied directly to the skin, but items from the freezer must not come in contact with the skin or freeze burn damage will result.  Items removed from the freezer for the purpose must be wrapped eg in a tea towel, which will allow cold to penetrate but protect the skin from injury.
  • Duration: Cold can be applied for 15 minutes in each hour.


Hot packs

Application of warmth is an effective way of relaxing tight muscles, it contributes to feelings of comfort and relaxation and can help to aid sleep.  However, where tissues are inflamed or there is internal bleeding through tissue damage, warmth can make matters worse.  Do not use heat on sore muscles, strains and sprains, knocks or bruises within 24 hours of an injury.  Do not use hot packs on broken skin, where there is inflammation or a risk of internal  bleeding.

  • Effects:  The application of warmth aids muscle relaxation through dilatation of blood vessels, pooling and stagnation of blood.
  • Method:  Useful items for use as hot packs are a hot water bottle (partially filled so it can wrap around the sore area, rather than sit on top of it like a balloon), or a grain or gel filled commercial hot pack, warmed in the microwave.  Take care not to over heat the hot pack and ensure that it is not so hot that it burns the skin.
  • Duration:  Warmth can be applied indefinitely as long as it isn’t too hot.


Alternating Hot and Cold packs

To be used to reduce swelling and improve healing of damaged tissue and for relief of pain.   It is more effective than the use of heat or cold alone.

  • Effects:  The use of alternating hot and cold provides a more powerful treatment; causing alternating dilation and constriction of the blood vessels.   This creates a pumping mechanism which draws fresh blood, oxygen and nutrients into the injured area – promoting healing, and improves tissue drainage – removing inflammatory products and metabolic waste from the injury site.   Alternating hot and cold can be used on old injuries or on recent ones after the first 24 hours.
  • Method:  Using hot or cold packs as described above.  Hot and cold can also be applied by using the temperature of the shower.
  • Duration:  Use a couple of minutes of heat, followed by a couple of minutes of cold.  Alternate for 6-8 alternations (or as long as the packs retain their temperature).  It is important that the last application is one of cold – and this can be applied for 5-15 minutes.  Dry the area thoroughly and wrap the area warmly.  The hot and cold routine can be used 3-4 times a day if required.


Commonly used pain killer medications