The Hot and Cold Therapy Debate

By Amy Rogerson & Karine Tcholkayan

 

A common question is whether to use hot or cold to treat injury and how to use them properly for pain relief. Here are some details that may help you make your decision. Following pain and injury, ice or heat compresses remain cheap, easy and safe to use at home.

Let’s start by explaining how cold and heat may help alleviate pain. Whether it be an ice pack, cool gel pad, frozen peas or a even a bag of snow, cold is an effective way to help manage pain; a cheap analgesic! Firstly, the cold constricts blood vessels, reduces blood flow and slows down cell metabolism in the tissue under the skin where applied. Secondly, icing will reduce the speed at which nerve impulses are carried to and from the tissue and may decrease muscle spasms through a mechanism called gate control. The gate control theory suggests that pain management can be achieved by stimulating large nerve fibers that carry non-painful sensations (like hot and cold and light touch) to the brain. Non-painful sensations reach the brain faster than the painful ones and, in doing so, will temporarily block out your perception of the pain. A good example is when one bumps their elbow on a sharp edge and eases the pain by rubbing the aching area of skin.

Ice is mainly used to calm down red, hot, swollen tissues after an acute injury. Even though inflammation is the natural process for healing tissues, it can be painful and stubborn. Along with protecting the injured tissue or joint, ice is a good way to numb the pain associated with inflammation in the few days following the incident. We will often recommend icing a freshly sprained ankle or pulled muscle for 10 to 20 minutes. Beware that damage can be done (frostbite!) if the ice remains in contact with the tissue for longer periods of time or in areas where you have reduced circulation or sensation.

Otherwise, people generally seem to appreciate the relief they feel from getting into a warm bath or whirlpool, applying a microwavable bean bag or an electric blanket to their sore, stiff or aching muscles and joints. The resulting therapeutic benefit is due to the relaxation of muscle tension or spasms and through increased blood flow and metabolic rate. Pain relief using heat is also thought to be beneficial through the same gate control mechanism mentioned above. It also seems to encourage people to move more which in itself, has very potent therapeutic value.

Heat is best used when you suffer from aching and stiff muscles or joints that do not show clear signs of inflammation (RED, HOT OR SWOLLEN). Typical cases where heat may be more beneficial than cold would include tight muscles from poor movement strategies, stress, anxiety or chronic pain. A good example would be a sore, stiff neck or back that you have been feeling for a few days after overdoing it with snow shovelling. Beware, if you have just twisted your knee on the ski slopes and it is hot or swollen, using heat might flare things up. Just like the ice, there is risk of burning your skin if you have impaired sensation or circulation where the heat compress is applied. One would also want to steer clear from heat if you suspect any local infection.

As in life, nothing is black and white when it comes to this debate. The way we perceive pain in the brain is extremely complex and relies on processing an enormous amount of information from several sources. An interesting point is that both cold and warm compresses can be useless if you don’t like them. If one is told to use ice after an acute injury but is particularly averse to cold, the therapeutic value can easily be negated by the brain. The same would apply to using warm compresses if you don’t particularly enjoy being hot (imagine 30+ degree weather in July!). Your personal experiences and beliefs regarding the subject also influence the result. If the medium used to manage pain feels somewhat threatening to you, your brain may amplify the painful signal instead of decreasing it.

Hot or cold therapy may be an easy avenue to begin addressing pain, but neither has a particularly potent effect. Stronger effects can be achieved from understanding how to progressively load your tissues and in some instances, medication may be necessary to help you return to your activities. Hot and cold treatments are only a small piece of the puzzle to help manage injury. It is always best to consult a medical professional in order to have an individualized plan for your specific condition and to maximize your recovery.

KarineTcholkayan and Amy Rogerson, registered physiotherapists at Clinique Amy Rogerson in Knowlton, both hold a Master’s degree in Physiotherapy and Bachelor of Science in Exercise Science.