Therapy	Indications	Contraindications	Prescription
Superficial heat (hydrocolloid packs)	Analgesia Reduction in muscle spasm Increased tolerance for exercise	Impaired sensation, circulation, cognition Edema Bleeding diatheses	Apply to affected area for 20 to 30 minutes; inspect skin frequently during therapy; repeat application every 2 hours as needed.
Ultrasound (deep heat)	Analgesia Increased length of periarticular ligaments and tendons	Same as for superficial heat Never use deep heat near cardiac pacemaker or fluid-filled cavities (e.g., eyes, uterus, testes, laminectomy sites).21 Avoid use of deep heat near open epiphyses, malignancies or joint arthroplasties.21	Apply 0.5 to 2.0 W per cm2 to affected area for 10 to 15 minutes before range-of-motion exercises are performed.
Cold packs	Analgesia Limitation of edema formation in acute musculoskeletal injury	Impaired sensation, circulation, cognition History of cold intolerance	Apply to affected area for 20 to 30 minutes; inspect skin frequently during therapy; repeat application every 2 hours for 48 hours after injury as needed.