Whether To Use Heat or Ice or BOTH!

 One of the most commonly asked questions from patients is how to know whether to use heat or ice after sustaining an injury. Basically, what we recommend in the clinic depends on whether the pain is acute (new onset) or chronic (recurring). Below is a basic description of what each pain relief modality provides and how to appropriately use them.


Heat therapy is used to reduce chronic, recurring pain. Heat decreases stiffness, increases local circulation, and helps reduce muscle spasms/guarding. Heat can be delivered as a dry or moist application, with moist allowing for greater penetration. Warming a body part in the 105 to 113 degree F temperature range is considered to be therapeutic when applied for 15 to 20 minutes. Safety is of most importance as you need to take great care to avoid burning yourself. Wrapping a hot pack in towels allows you to better gauge the heat and avoid burns. If the hotpack is perceived as being too hot, simply add towels until the temperature is comfortable. People who are diabetic, have swelling or poor circulation, and decreased sensation should not use or be very careful when using heat modalities. Also, those of you who have an open wound or stitches should not be using hot packs as well for the simple fact that the heat will cause more swelling and may compromise the wound.  We also use heat to get the muscle and or joint ready for exercise and stretch when treating injuries. As stated above, heat results in increased blood flow through vasodilation. This increased blood flow gets our targeted muscles ready to be worked on and allows for stretching to be done with less overall pain.



Cold therapy or Cryotherapy is used to help decrease pain and inflammation for an acute injury. It does this by slowing down blood circulation which also helps in decreasing muscle spasm. We recommend using ice for the first 48 hours after initial injury. Ice may be applied by using ice bags or cold packs for 15 to 20 minutes. You should allow the area that has been iced to warm up for 45 minutes before icing the area again. Ice should not be used for more than 20 minutes as it actually may cause a burning of the skin or even frostbite! You can ice as frequently as you wish, as long as the tissue continues to return to normal temperature and sensation continues to be normal. If you have an open wound, you should not use ice as this causes decreased blood supply to the wound which will cause the wound to weaken and delay healing. Also, people with Raynaud's phenomenon, those that have undergone a replantation surgery, or who have peripheral vascular diseases should not use cryotherapy.



Contrast baths combine heat and cold therapy when trying to help patients recover from any soft tissue injury that is causing pain, swelling, and inflammation. I have found that using contrast baths helps my patients with pain management who are suffering from carpal tunnel syndrome, fractures, and arthritis of the hands. These baths can also be used for lower extremity diagnoses such as plantar fasciitis, achilles tendinitis, and fractures of the ankle and foot. To perform this treatment, you will need two buckets/containers to accommodate the affected body part. For example, when treating hand pain, I usually have patients fill up their sink with cold water (50 to 60 degrees Fahrenheit) and a stockpot with hot water (98 to 110 degrees Fahrenheit). The patient is instructed to immerse their hand in the hot water for 10 minutes. After ten minutes, they switch over to the cold water for 1 minute. Then switch back to hot for 4 minutes followed by 1 minute in cold and alternate for one more cycle. Finally, the patient is told to end the treatment with a 4 minute soak in the hot water. The patient is also told to gently move the fingers while soaking to help the pumping action. Alternating between hot and cold soaks promotes dilation and constriction of the blood vessels. This helps pump the inflammatory cells and swelling out of the affected body part resulting in a decrease in pain. You obviously should not submerge your hand in any water if you have an open wound or have stitches being used for wound closure. 



If you have just injured yourself, ice for the first 24 to 48 hours to limit inflammation. Switching to heat after this time frame will help increase blood flow to the injured area which will promote healing. If swelling continues to be an issue, then try contrast baths. They take a little bit of time to set up, but people really do find relief from using them. Please check out our complete line of professional grade ice and hot packs. The Active Wrap line is body part specific and can be used as either a hot or cold pack. The Dr. Cool Wrap is a great product that combines compression with ice. The Elasto Gel Hot and Cold packs and Norco ice packs are all professional grade. If you have any questions, please email us at info@rsmoutfitters.com.


next post →