Ice and heat therapy can provide effective pain relief, but it's important to apply the correct temperature at the right time. People with diabetes, those with active infections or anyone with poor circulation should not apply cold or heat packs unless medically advised.

Ice

Ice is most effective when used within the first 48 hours after an injury. When applied immediately, ice helps to reduce bleeding in the tissues, and prevents and minimises swelling. It can also relieve pain by numbing the affected area. As the injury begins to heal, ice can be applied to further reduce pain and muscle spasms. Various ice products are available that can be stored in the freezer until required. Alternatively, ice packs can be made from ice cubes wrapped in a plastic bag or damp tea towel. Packs of frozen vegetables like peas are a good option as they mould to the shape of the affected area. If using frozen vegetables, note that they are not suitable for refreezing and eating once thawed.

Ice can cause frostbite if the skin is not properly protected. To protect the skin:

• Don't apply ice directly to the skin. Rub a small amount of oil over the area where the ice will be applied and place a cold, wet flannel over the oil before applying the ice
• If the skin is broken or there are stitches, protect the area with a plastic bag rather than applying oil
• After five minutes, check the colour of the skin. If the skin is bright pink or red, remove the ice. If not, replace it for a further five to 10 minutes
• Ice should not be applied for longer than 20 to 30 minutes. Take frequent breaks and reapply when the surrounding skin looks and feels normal (around 30 to 60 minutes).
  OTC products that are designed to cool and provide relief from sprains and sore muscles include Ralgex Freeze Spray and Deep Freeze Cold Spray and Gel.

Heat

With the exception of muscle spasms associated with lower back strains, heat should not be applied until 48 hours after an injury has occurred. Heat causes blood vessels to dilate, bringing more blood to the affected area, which stimulates the healing of damaged tissues. Heat also helps to relax muscle spasms and ease stiffness. To avoid burns or scalds:

• Place a towel between the heat and the skin
• Check the skin regularly
• Apply products that are warm rather than hot
• Don't use a heat pad while sleeping €“ prolonged heat can cause burns if unattended
• Heat should not be applied for longer than 30 minutes.

Heat can be applied in the form of heat pads, hot water bottles or heat lamps, but even a warm bath or shower can be effective. Various heat pads and patches are available OTC for muscle, back and shoulder pain and should be applied directly to the skin over the affected area.