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Hot or Cold Therapy – Which is Best?

Patients often ask is there anything that they can do at home to help with their complaint. A common question is: hot or cold? Will heat or a cold gel work?

The application of heat or cold to an injury or area of pain is a traditional remedy. The rationale for both the use of heat (thermotherapy) and cold (cryotherapy) has developed over the years, resulting in advanced treatment options for a wide range of conditions.

Hot and cold are typically used to treat muscle-related pain. However, it can be confusing to decide which is more appropriate at any given time. These basic rules may help:

• Use cold for acute pain or a new swollen/inflamed injury.
• Use heat for chronic pain or an injury that is a day or more old and inflammation has reduced.

Ultimately, you need to choose what works best for you. If icing feels unpleasant, then heat may provide more comfort.

However, it is important to take the type of injury into account. Different types of injury need different treatments to heal properly. Ice and heat are not substitutes for medical evaluation and treatment and should be used with caution by patients with circulatory problems or diabetes.

Thermotherapy

IMAGE - Hot water bottle Thermotherapy is the application of any substance to the body that increases tissue temperature. This results in improved blood flow, tissue metabolism and connective tissue extensibility. Increased blood flow facilitates tissue healing by supplying protein, nutrients and oxygen at the site of injury.

An increase in metabolism helps the healing process by increasing both the catabolic and anabolic reactions needed to degrade and remove the metabolic by-products of tissue damage.

Skin warming has also been shown to activate the thalamus and the cerebral cortex, and some of the pain relief provided by topical heat therapy may be mediated directly by the brain.

While the overall qualities of warmth and heat have long been associated with comfort and relaxation, heat therapy goes a step further. It can provide both pain relief and healing benefits for many types of lower back pain.

In addition, heat therapy for lower back pain – in the form of heating pads, heat wraps, hot baths, warm gel packs, etc. – is both inexpensive and easy to do.

Many episodes of lower back muscle strain result from strains and over-exertions, creating tension in the muscles and soft tissues around the lower spine. As a result, this restricts proper circulation and sends pain signals to the brain.

Muscle spasm in the lower back can create sensations that may range from mild discomfort to excruciating lower back pain. Heat therapy can help relieve pain from the muscle spasm and related tightness in the lower back.

Heat is relaxing. That’s why overworked muscles respond best to heat. Heat stimulates blood flow, relaxes spasms, and soothes sore muscles.

How it works:

Overworked muscles become sore because of a chemical called lactic acid. Lactic acid accumulates when the muscles are put under stress and deprived of oxygen. When there is decreased blood flow to a damaged area, the lactic acid gets stuck. This build-up creates painful muscle ache. Heat therapy can help to restore blood flow and speed the removal of lactic acid from muscles

  • Heat therapy dilates the blood vessels of the muscles surrounding the lumbar spine. This process increases the flow of oxygen and nutrients to the muscles, helping to heal the damaged tissue.
  • Heat stimulates the sensory receptors in the skin, which means that applying heat to the lower back will decrease transmissions of pain signals to the brain and partially relieve the discomfort.
  • Heat application facilitates stretching the soft tissues around the spine, including muscles, connective tissue, and adhesions. Consequently, with heat therapy, there will be a decrease in stiffness as well as injury, with an increase in flexibility and overall feeling of comfort. Flexibility is very important for a healthy back.

There are several other significant benefits of heat therapy that make it so appealing. Compared to most therapies, heat therapy is quite inexpensive (and in many circumstances it’s virtually free – such as taking a hot bath). Heat therapy is also easy to do – it can be done at home while relaxing, and portable heat wraps also make it an option while at work or in the car.

For many people, heat therapy works best when combined with other treatment modalities, such as physical therapy and exercise. Relative to most medical treatments available, heat therapy is appealing to many people because it is a non-invasive and non-pharmaceutical form of lower back pain relief.

When to Use Heat Therapy

Thermotherapy is indicated for relief of a variety of painful conditions, including muscular and rheumatic pain, sciatica, fibrositis and lumbago. It can be used as a replacement or adjunct to pharmacological pain relief options. It can also be used to help healing of sports or similar injuries. Heat therapy can be superficial or deep, and provides analgesia and relaxes muscles. However, because it increases blood flow to the affected area it should only be applied to injuries once any inflammation has reduced.

Heat is best for treating chronic pain. Chronic pain is persistent or recurrent pain. Heat increases blood supply. It stimulates the elimination of toxins. It also relaxes soreness and stiffness to bring relief.

If you suffer from an ongoing injury, apply heat before exercising. Applying heat after exercise can aggravate existing pain.

Types of Heat Therapy:

There are two types of heat therapy: local and systematic.

Local heat is applied to a specific area with a:

  • hot water bottle
  • heating pad
  • moist heat (hot, damp towel)
  • heat wraps

Systemic heat raises your body temperature with a:

  • hot bath
  • sauna
  • steam bath
  • hot shower
Tips for Applying Heat
  • Protect yourself from direct contact with heating devices.
  • Wrap heat sources within a folded towel to prevent burns.
  • Stay hydrated during systemic heat therapy.
  • Avoid prolonged exposure to systemic heat therapy
Complications of heat therapy

Thermotherapy should be used with caution for patients with diabetes, peripheral vascular disease, multiple sclerosis and rheumatoid arthritis because it may increase disease progression. It should also be used with caution for patients with burns, skin ulceration and areas of inflamed skin.

Cryotherapy

IMAGE - Ice cubesGenerally, ice is used to help fresh injuries. When your body is injured, the damaged tissue becomes inflamed. This can cause pain, swelling, or redness.

 Swelling is your body’s natural response to injury. Unfortunately, local swelling tends to compress nearby tissue leading to pain.

Evidence for using ice to treat pain isn’t as strong as evidence for using heat.

Simple application of a cold pack or ice placed in a plastic bag and wrapped in a towel or other protective barrier (to protect the skin from ice burn) is one of the most effective pain relief treatments available.

Ice or a cold pack should be applied for no more than 20 minutes at a time and can be applied several times a day (e.g. up to eight or ten times in a twenty-four hour period).

 
How it Works

Ice numbs the injury. The cold narrows blood vessels and slows down blood flow. This can reduce fluid build up in the affected area.

Ice is believed to aid in the control of inflammation and swelling. It relieves pain, but does not treat the underlying cause.

When to Use Cold Therapy

Cold is best for acute pain caused by recent tissue damage (acute inflammation). Ice is used when the injury is recent, red, inflamed, or sensitive.

Cold therapy can also help relieve any inflammation or pain that occurs after exercise; this is a form of acute inflammation. However, unlike heat, you should apply ice after going for a run. Cold treatment can reduce post-exercise inflammation.

Cold therapy can sometimes also help relieve pain in chronic injuries.

Types of Ice Packs and Cold Packs

There are many types of ice packs that can be used for relief of lower back pain. All of the options are effective, and patients can select which works best for them based on personal preference, budget, and convenience.

Common types of cold packs that are effective for lower back pain include:

Reusable Cold Pack or Ice Pack

Many types of reusable ice packs (such as those filled with gel) are available at drug stores and general merchandise stores. These cold packs can be kept in the freezer ready for use when needed, and re-frozen after each use. For an inexpensive alternative, reusable cold packs can be made at home.

Homemade Ice Pack

To make an ice pack, simply put the desired amount of ice in a plastic bag (baggie) and squeeze the air out of the bag before sealing it. Some people like to add a little water to the ice so that the bag is not so lumpy. The bag should be wrapped in a towel or pillow case before applying it to the painful area to protect the skin from ice burn. Additional alternatives include:

  • A frozen towel. To make a towel into a cold pack, place a folded, damp towel in a plastic bag and put it in the freezer for ten to twenty minutes. Then take the towel out of the bag and place it on the affected area.
  • Sponge. Wet a sponge and put in the freezer. After it is frozen, take it out and put it in a baggie, then wrap it in a sock or a towel before applying it to the sore back.
  • Rice. Another alternative is to fill a sock with rice and place it in the freezer, as rice will get as cold as ice but does not melt when used.
  • Gel-type pack. Still another alternative is to fill a baggie with liquid dishwasher detergent and freeze it, which gives it a consistency of a gel pack.
  • Frozen bag of peas. If ice is needed quickly, it is easy to grab a bag of frozen peas or other vegetables out of the freezer, wrap it in a towel or pillow case and apply it to the painful area.
Disposable Ice Packs/ Instant Ice Packs

Single use cold packs have the advantage of becoming cold almost instantly through a chemical reaction that takes place once the pack is “cracked”. Because they are ready at any time, prior planning in terms of putting the ice pack in the freezer is not needed. Another advantage is that the chemical reaction in the pack allows it to stay cold for an extended period of time while being used at room temperature.

The main disadvantage of instant ice packs is that they can only be used once, making them more expensive than reusable ice packs or homemade ice packs. A variety of disposable, instant ice packs are available at most drug stores and general merchandise stores.

Cold should only be applied locally. It should never be used for more than 20 minutes at a time. You can apply cold using:

  • an ice pack
  • an ice towel—a damp towel that has been sealed in plastic and placed in the freezer for about 15 minutes
  •  an ice massage
  • a cold gel pack
  • a bag of frozen vegetables
Tips for Applying Cold
  • Apply cold immediately after injury or intense, high-impact exercise.
  • Always wrap ice packs in a towel or pillow case before applying to an affected area.
  • It’s alright to repeatedly ice painful or swollen tissues. However, you should give your body a break between sessions.
  • Do not use ice in areas where you have circulation problems.
  • Never use ice for more than 20 minutes at a time.
Ice Application Precautions

To avoid getting an ice pack burn, be sure to limit application of ice to no more than twenty minutes and do not fall asleep lying on an ice pack.

As with all pain relief treatments, there are some cautions with applying ice and using ice therapy.

  • Never apply ice directly to the skin. Instead, be sure that there is a protective barrier between the ice and skin, such as a towel or pillow case.
  • Limit the ice application to no more than fifteen or twenty minutes at a time.
  • Ice application should be avoided by patients with certain medical conditions, such as for patients who have rheumatoid arthritis, Raynaud’s Syndrome, cold allergic conditions, paralysis, or areas of impaired sensation.
  • Ice massage and ice application is generally most helpful during the first 48 hours following an injury that strains the back muscles. After this initial period, heat therapy is probably more beneficial to the healing process.
  • Excessive use of cold can cause tissue damage.
In summary:

There is limited evidence about the use of heat and cold, especially the use of topical pain relief products. Using heat for pain relief has more evidence to support that this works with cold therapy requiring more research. Out of the topical products, the aspirin-like ones seem to have the best outcome with the research done so far, however you are more likely to be prescribed one with Ibuprofen or Voltarol.

Using the guidelines above, the best is to try what works for you. Finding hot or cold whilst out and about can be quite tricky, so I would suggest that you use topical creams only when you have no other alternative way of generating hot or cold and the rest of the time use a good old fashioned hot water bottle and a soft freeze pack wrapped in a pillow case.