Cold or Hot Treatment: Which Works Best?

Whether you are active in sports or just doing your everyday activities, it’s easy to get injured. Using heat or cold to treat various conditions and injuries is simple, effective and affordable. The trick is knowing what will work best for an injury – heat, cold, or in some situations, both.

The best use for cold therapy, or ice, would be for an acute injury. This would be anything which is a “fresh” injury that generally involves swelling and inflammation as well as any “itis” (which indicates inflammation) such as bursitis or tendinitis. For example, ice is great to use immediately following something like a sprain or strain that has happened in recent days.
Heat, on the other hand, is more appropriate for tight muscles or painful areas which are more of a chronic injury (an injury which has lingered for some time.) These are often overuse injuries or something you might have dealt with for several months to years. Your more common “aches and pains” from day to day tend to respond best to heat.

Cold therapy

You may have heard of RICE (rest, ice, compression and elevation) as a common treatment for sports injuries. Why does the cold help? Cold, like compression, constricts the blood vessels, therefore reducing the increased blood flow, which can lead to swelling, to the injured area. Keep in mind that this blood flow is a natural part of the healing process and it’s important to not overuse the ice. 10 minutes is a sufficient amount of time to reduce swelling without interfering with healing. It can be used several times a day, however allow about 20-30 min between applications. Cold also numbs sore tissues and slows down the pain messages going to your brain. Cold therapy is most effective if applied within 48 hours of the injury. 

Cold therapy is easy to apply at home. Try these simple options:

  • A bag of frozen vegetables works great as a cold compress
  • A frozen water bottle works great for injuries such as plantar fasciitis
  • Be sure to use a layer of protection such as a thin towel or pillowcase to avoid skin burns from the cold
  • Your favorite PT clinic also sells gel packs that can be left in your freezer for easy access in a hurry

Ice should not normally be applied directly to the skin. However, you can use an ice massage, in which the affected area is massaged with an ice cube or ice pack in a circular motion for a maximum of 5 minutes, several times a day.

Cold treatment should not be used if:

  • You have a disease or disorder affecting blood flow
  • You have blistered skin or an open wound
  • You are at risk for cramping
  • The area is already numb
  • You are highly sensitive to the cold

Ice may not be helpful for back pain. Before using cold treatment for back pain, consult a medical professional.

Heat therapy

Applying heat to the injured area increases the blood flow to the area by dilating the blood vessels which in turn relaxes sore and tightened muscles. Improving your circulation can also help reduce the buildup of lactic acid following exercise. And let’s face it, heat is comforting. That’s partly why you feel better after a hot bath.  

Heat should be applied to the injured area for 10-15 minutes, allowing about an hour between applications.

Types of heat therapy:

  • Electrical heating pads
  • Soft heating pads that can be heated in a microwave (often filled with rice or beans)
  • A warm bath or shower
  • A heated paraffin wax treatment

Heat treatment should not be used if:

  • You have a burn or infection
  • You have an open wound
  • The area is numb
  • Your skin is hot, red or inflamed
  • You are insensitive to heat because of peripheral neuropathy or a similar medical condition

Individuals with a non-serious injury or condition may find that one of these treatment methods are helpful. People with high blood pressure or heart disease should consult a medical professional before self-treating. A physical therapist can discuss your concerns and help you learn the most appropriate techniques for pain relief or recovery.  For more information, please contact us.