Heat and cold treatment: Which is best?

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:

Here are some key points about cold and heat treatment. More detail is in the main article.

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 therapy

Hot and cold packs can help relieve pain. The choice can depend on the type and cause of the pain.
Hot and cold packs can help relieve pain. The choice can depend on the type and cause of the pain.

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

In the case of an ice massage, ice can be applied directly to the skin, because it does not stay in one place.

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.
A cold compress applied within 48 hours of an injury can help reduce inflammation.

Cold treatment can help in cases of:

osteoarthritis

a recent injury

gout

strains

tendinitis, or irritation in the tendons following activity

A cold mask or wrap around the forehead may help reduce the pain of a migraine.

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

Ice should not be used immediately before activity.

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.

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Heat therapy

Applying heat to an inflamed area will dilate the blood vessels, promote blood flow, and help sore and tightened muscles relax.

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