Hot or Cold?
The Ultimate Guide to Using Heat and Cold Therapy for Effective Pain Management
When it comes to managing pain, speeding up recovery, easing sore muscles or promoting relaxation, two simple tools have stood the test of time: heat and cold therapy. You probably have used both at some point (e.g. icing a sprained ankle, applying a heat pack to a stiff joint), however there are many misconceptions and it can be confusing about which to use when.
Let’s break it down…
Cold Therapy (Cryotherapy)
What happens?
Cold therapy induces vasoconstriction (narrowing of blood vessels), which decreases local blood flow to the affected tissue. This process helps to limit oedema (swelling) and reduce the inflammatory response. Cooling also slows down nerve conduction velocity, thereby producing an analgesic effect by dulling pain signal transmission.
When to use?
Due to the effects of cold therapy, it is most useful for acute injuries or for pain and inflammation. This can include:
Acute sport injuries
Due to the effects of cold therapy, applying cold therapy immediately to an injured area can help slow and reduce the severity of pain and inflammation.
Example: Applying ice immediately to a recently rolled ankle with immediate swelling and difficulty walking.
Application: immediately following injury, 20mins on, 60mins off, limit placing ice onto bare skin (use a cloth or tea towel for example), compression with cold therapy is most effective.
Inflammatory conditions
As cold therapy reduces inflammation and dulls pain signals, apply cold therapy to inflamed joints.
Example: Applying ice to arthritic knee post exercise/day of work.
Application: ice pack or cold with compression for up to 1hr on 1hr off.
Acute pain management
Cold therapy produces an analgesic effect by reducing the efficiency of nerve conduction therefore it makes cold therapy perfect for acute pain management.
Example: Post operative care (e.g. post knee replacement surgery).
Application: ice pack or cold therapy machine (iceman) up to 1 hr on 1hr off.
Quick note: It is important to take into consideration the way in which you apply your cold therapy. Greater compression and a longer duration allows for deeper penetration of the cold temperatures into the body’s tissues, and can therefore be more effective.
Heat Therapy
What happens?
Application of heat promotes vasodilation (blood vessel widening), increasing local blood flow and enhancing the delivery of oxygen and nutrients to tissues. This process facilitates metabolic activity, accelerates the removal of metabolic waste products, and promotes tissue healing. Heat also reduces muscle spindle activity, resulting in decreased muscle tone and spasm, while improving connective tissue elasticity. Collectively, these effects help alleviate stiffness and promote relaxation.
When to use?
Due to the effects of heat therapy, it is most useful for stiff/tight muscles, chronic conditions, stress-related tension and promoting relaxation post exercise. This can include:
Chronic Musculoskeletal Pain
Heat-induced vasodilation increases blood flow which promotes additional cells to reduce inflammatory markers which can facilitate in decreasing pain.
Example: Applying a wheat bag to a sore osteoarthritic knee. Taking a warm shower or bath.
Application: 1hr on, 1hr off, repeating as needed.
Prior to or during activity
Due to the increase in metabolic processes through exercise or activity, applying heat before you start can help promote appropriate muscle readiness. Increases in blood flow means an increase in cells to facilitate muscle performance. Raising tissue temperature increases tissue extensibility, reducing the risk of a strain.
Example: Applying heat rub to muscles, using heated blankets at the side of the field.
Application: 20-30mins prior to activity, as required to maintain body temperature.
Muscle Tightness/Spasm & Stress-related Tension
As heat reduces muscle spindle activity, this leads to a decrease in muscle tone and spasm which can help alleviate stiffness and improve connective tissue elasticity.
Example: Applying heat pack/bag to lower back.
Application: 20mins-1hr duration.
Hopefully this guide helps you confidently choose between heat and cold for pain relief. Using the right method at the right time can speed up your recovery and ease discomfort!