Heat and cold therapy are often recommended to help relieve an aching pain that results from muscle or joint damage.
Basic heat therapy, or thermotherapy can involve the use of a hot water bottle, pads that can be heated in a microwave, or a warm bath.
For cold therapy, or cryotherapy, a water bottle filled with cold water, a pad cooled in the freezer, or cool water can be used.
In some cases, alternating heat and cold may help, as it will greatly increase blood flow to the injury site.
Fast facts on cold and heat treatment:
- Cold treatment reduces inflammation by decreasing blood flow. Apply within 48 hours after an injury.
- Heat treatment promotes blood flow and helps muscles relax. Use for chronic pain.
- Alternating heat and cold may help reduce exercise-induced muscle pain.
- Never use extreme heat, and never put ice directly on the skin.
Cold treatment reduces blood flow to an injured area. This slows the rate of inflammation and reduces the risk of swelling and tissue damage.
It also numbs sore tissues, acting as a local anesthetic, and slows down the pain messages being transmitted to the brain.
Ice can help treat a swollen and inflamed joint or muscle. It is most effective within 48 hours of an injury.
Rest, ice, compression and elevation (RICE) are part of the standard treatment for sports injuries.
Note that ice should not normally be applied directly to the skin.
Types of cold therapy
Some ways of using cold therapy include:
- a cold compress or a chemical cold pack applied to the inflamed area for 20 minutes, every 4 to 6 hours, for 3 days. Cold compresses are available for purchase online.
- immersion or soaking in cold, but not freezing, water
- massaging the area with an ice cube or an ice pack in a circular motion from two to five times a day, for a maximum of 5 minutes, to avoid an ice burn
Ice should not be applied directly to the bony portions of the spinal column.
A cold compress can be made by filling a plastic bag with frozen vegetables or ice and wrapping it in a dry cloth.
What is ice useful for?
A cold compress applied within 48 hours of an injury can help reduce inflammation.
Cold treatment can help in cases of:
- a recent injury
- tendinitis, or irritation in the tendons following activity
For osteoarthritis, patients are advised to use an ice massage or apply a cold pad 10 minutes on and 10 minutes off.
When not to use ice
Cold is not suitable if:
- there is a risk of cramping, as cold can make this worse
- the person is already cold or the area is already numb
- there is an open wound or blistered skin
- the person has some kind of vascular disease or injury, or sympathetic dysfunction, in which a nerve disorder affects blood flow
- the person is hypersensitive to cold
It should not be applied directly to the skin, as this can freeze and damage body tissues, possibly leading to frostbite.
Professional athletes may use ice massage, cold water immersion, and whole-body cryotherapy chambers to reduce exercise-induced muscle damage (EIMD) that can lead to delayed onset muscle soreness (DOMS). DOMS commonly emerges 24 to 48 hours after exercise.
A study published in The Cochrane Library in 2012 suggested that a cold bath after exercise may help prevent DOMS, compared with resting or doing nothing.
The participants spent between 5 and 24 minutes in water between 50 and 59 degrees Fahrenheit, or 10 to 15 degrees Celsius.
However, the researchers were not certain whether there may be negative side effects, or if another strategy might be more helpful.
Cryotherapy is primarily a pain-reliever. It will not repair tissues.
Ice and back pain
Ice is best used on recent injuries, especially where heat is being generated.
It may be less helpful for back pain, possibly because the injury is not new, or because the problem tissue, if it is inflamed, lies deep beneath other tissues and far from the cold press.
Back pain is often due to increased muscle tension, which can be aggravated by cold treatments.
For back pain, heat treatment might be a better option.
Applying heat to an inflamed area will dilate the blood vessels, promote blood flow, and help sore and tightened muscles relax.
Improved circulation can help eliminate the buildup of lactic acid waste occurs after some types of exercise. Heat is also psychologically reassuring, which can enhance its analgesic properties.
Heat therapy is usually more effective than cold at treating chronic muscle pain or sore joints caused by arthritis.
Types of heat therapy
Types of heat therapy include:
- applying safe heating devices to the area. Many heat products are available for purchase online, including electrical heating pads, hot water bottles, hot compress, or heat wrap.
- soaking the area in a hot bath, between 92 and 100 degrees Fahrenheit or 33 and 37.7 degrees Celsius
- using heated paraffin wax treatment
- medications such as rubs or patches containing capsicum, available for purchase online.
Heat should normally be applied to the area for 20 minutes, up to three times a day, unless otherwise indicated.
Single-use wraps, dry wraps, and patches can sometimes be used continuously for up to 8 hours.
What is heat useful for?
Heat is useful for relieving: A hot bath can provide comfort and relief from some types of pain.
- strains and sprains
- tendonitis, or chronic irritation and stiffness in the tendons
- warming up stiff muscles or tissue before activity
- relieving pain or spasms relating to neck or back injury, including the lower back
In 2006, a team of researchers found that patients with lower back pain who exercised and use continuous low-level heat wrap therapy (CLHT) experienced less pain than those who did not used CLHT.
Previous studies had shown that, for some people, CLHT relieved pain more effectively than oral analgesics, acetaminophen, and ibuprofen.
However, the effectiveness of heat treatment may depend on the depth of the tissue affected by the pain or injury.
Some people use heat treatment, often in the form of a hot bath, to stave off DOMS.
There is some evidence that this might help, but heat that is applied for only 5 to 20 minutes may be less effective, as does not have the chance impact the deeper levels of tissue.
Some researchers have suggested that moist chemical heat packs, which can be used for 2 hours, may be the best way to prevent DOMS through heat treatment.
When not to use heat
Heat is not suitable for all injury types. Any injury that is already hot will not benefit from further warming. These include infections, burns, or fresh injuries.
Heat should not be used if:
- the skin is hot, red or inflamed
- the person has dermatitis or an open wound
- the area is numb
- the person may be insensitive to heat due to peripheral neuropathy or a similar condition
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