Hot or Cold?

One of the most common questions I get asked at the end of a treatment is “What can I do at home to help, should I be using a heat pack or an ice pack?”

Both are useful tools when it comes to assisting in recovery and today I’m going to cover when you should use heat or ice to get the best results and avoid potentially making the injury worse.

Cold Therapy

When a soft tissue injury occurs there are 4 stages to the recovery process. The initial stage is the “Acute phase” in which the body aims to protect the site of injury. During this stage you will experience pain, bleeding and swelling.

This is when you want to be using a cold/ice pack. By applying cold to the area you are causing localized vasoconstriction which is a narrowing of the blood vessels. This will help reduce the swelling; it can also temporarily desensitize the nerve endings providing pain relief.

The application should be for a maximum of 20 minutes repeated every 2-3 hours over the next 48-72 hours.

Keep in mind ICE is only one of the steps when treating an acute injury, follower R.I.C.E.R for best results. Rest – Ice – Compression – Elevation – Referral. Seeking professional assistance is always advised with any injury.

Do not use cold therapy if the area in question suffers from;

  • Poor circulation
  • Sensory disorders
  • Stiff muscles or joints

Heat Therapy

After the “Acute Phase” of an injury you will enter the “Sub-Acute Phase”, during this phase the body starts repairing the injured tissue by laying down new soft tissue also known as scar tissue. This phase lasts usually around 6 weeks.

During the start of this phase you want to continue using cold therapy till swelling has completely subsided. If 2-3 weeks pass and there is still swelling present you can move onto contrast bathing. This is when you apply heat for 1 minute then cold for 1 minute repeating the process for 10-15 minutes finishing on heat. This dilates and contracts the blood and lymph vessels and helps pump the fluid away from the area.

When no more swelling is apparent you can switch to using a heat pack.

Applying heat therapy works in the exact opposite way to cold therapy by causing localized vasodilation which is the expansion of the blood vessels.  This increases blood flow to the area which helps with repair.

Do not use heat therapy if;

  • You have deep vein thrombosis
  • You suffer from multiple sclerosis
  • If there is any skin condition in the area
  • On an open wound

(This is not a comprehensive list and if unsure seek professional medical advice first.)

Heat can also be used for muscle and joint stiffness as well as general muscle pain providing no inflammation or swelling is present.

I hope this has helped a few of you understand when you should use heat or cold to aid recovery from soft tissue injuries.

Written by Jackson Matar Myotherapist