Heat, Ice and Compression With Massage: Combining Comfort Measures Safely

Urgent Signs First

• Leg pain with chest pain or breathlessness: the NHS (UK) says that DVT symptoms such as pain and swelling together with shortness of breath or chest pain need emergency help. [1] In the US, call 911.
• A fresh injury that looks wrong: the NHS says to call 999 (in the US, 911) if you heard a crack, the body part has changed shape or points at an odd angle, it is numb, tingling or has pins and needles, or the skin has turned blue or grey or feels cold. [2]
• A burn or frozen skin: the NHS says to hold a burn under cool running water for 20 minutes, and not to put creams, oils or butter on it. [3] It describes frostbite as skin that freezes in very cold temperatures and says to get medical help. [4]

What This Page Covers

Heat, ice and compression are comfort measures people often use before or after massage, or instead of it. They are not massage, and we found no trial that tests them combined with massage. Proper evidence not found for combined use; we searched PubMed for heat, cold or ice with massage and found trials of each on its own. This page gathers what is known about each and how to keep the combination safe. For packs and compresses in general, see hot and cold compresses and packs.

After a New Injury, Wait

For the first 2 to 3 days after a sprain or strain, the NHS recommends protection, rest, ice, compression and elevation (PRICE). [2] It advises applying an ice pack, or frozen vegetables wrapped in a tea towel, to the injury for up to 20 minutes. [2] It also says to avoid heat (such as hot baths and heat packs), alcohol and massage for the first couple of days to help prevent swelling. [2] For longer-term timing, see massage after surgery or injury.

Ice and Cold

• For soreness after exercise: a 2012 Cochrane review of cold-water immersion included 17 small trials of 366 people, and study quality was low. [5] It found some evidence that cold-water immersion reduces delayed onset muscle soreness compared with rest or no intervention. [5] Most trials did not actively track adverse events. [5] Label: promising but limited. See cold-water immersion.
• For low back pain: the Cochrane review of superficial heat or cold said no conclusions can be drawn about using cold for low back pain. [6]
• Ice massage: a 1999 trial in 100 people with knee osteoarthritis reported ice massage, TENS and electroacupuncture each beat placebo. [7] It is old and short-term, and the abstract does not describe how the ice was applied, so we describe no method.
• Use a barrier. NHS pages describe packs wrapped in a tea towel. [2] For neck pain it gives an example of frozen peas in a tea towel for 5 minutes, three times a day. [8] Those are the NHS's own examples for common aches, not universal limits.

Heat

• For low back pain: the Cochrane review found moderate evidence from a small number of trials that heat wrap therapy gives a small short-term reduction in pain and disability. [6] Label: promising but limited, for a mix of acute and sub-acute back pain.
• Everyday use: the NHS says a heat pack or hot water bottle wrapped in a tea towel can relieve joint stiffness or muscle spasms. [9] For neck pain its example is a wrapped hot water bottle for 20 minutes, 2 to 3 times a day. [8]
• Burn risk: a pharmacology bulletin warns that heat devices can cause severe burns, and that microwave-heated gel packs can quickly reach dangerous temperatures. [10] It adds that burns can come from long contact with something not hot enough to cause pain, because the heat you feel does not match the heat transferred. [10] So do not rely on feeling pain as your warning.
• Heat before massage: hot stones and heated oils are covered with their cautions on hot stone massage.

Compression

Compression means a bandage, sleeve or stocking that presses gently on a limb. The NHS lists a wrapped bandage as one step of sprain care. [2] A hospital leaflet on anti-embolism stockings lists suspected or proven peripheral arterial disease among reasons not to be given them, and lists numbness, tingling, pins and needles, pain or soreness as signs they are too tight. [11] That leaflet is about hospital stockings, not massage wraps, but it shows why a tight wrap that numbs a limb should come off. Compression for lymphedema is clinical care; see lymphedema care.