Should I use hot or cold? This is one of the most frequent questions I am asked when someone gets injured. It’s no wonder it’s so confusing when one professional tells you hot and the next is recommending cold. Choosing ice or heat is important and making the right choice depends on the stage of healing of your injury and on what you are trying to achieve.
How do I know whether to apply hot or cold for my injury?
Research shows these treatments  can be beneficial at any stage of healing. I generally recommend the application of hot, cold, or contrast therapy depending on where you are in your recovery.
Acute Stage – This stage typically lasts between 1 and 3 days.
This is the stage when you are feeling pain. The tissues are warm to touch, there is swelling, tissue discoloration and muscle spasm. During this stage the tissues are breaking down and preventing further injury is the main goal of treatment.
Preventing further injury is the main goal of treatment
Preventing further injury is the main reason to cool the tissues. Some literature supports the use of cold application to slow your tissue’s demands for nutrition and circulation. The benefit of cool is seen in near drownings. Cooler water means that delicate tissues, like the brain, are less injured. When tissues are cool you can go longer without providing new oxygen as the consumption of what’s in your body is slowed.
Slowing consumption can also be important in the acute stage of a soft tissue injury, particularly with more severe injuries as healing raises the demands on the metabolic process and swelling often slows the delivery. Cooling the tissues reduces the likelihood of running out of metabolic substance and not having the nutrition you need to repair the injury.
Sub-acute Stage – This stage follows right after the initial injury, from day 4 to 3 weeks.
During this phase the initial swelling is decreasing and bruising is changing from purple to yellow in color. Muscle spasm changes to tightness and discomfort replaces sharp pain. This is the repair phase when we can start to do more therapy. In addition to massage, stretching and exercises I often find heat is best to help you get moving but recommend cool if you over-do the activity.
Recovery Stage – This final stage can last from 3 weeks to 3 months.
Recovery follows the sub-acute stage. The bruising has resolved, there is no heat however you have muscle tightness. This is the remodeling phase when therapy is the most important. Deep tissue massage and more demanding exercises help the tissues to remodel stronger. I find heat is the best during this stage unless you over-do it
Why apply hot or cold?
The benefits of hydrotherapy treatments include:
- dramatically increasing the elimination of waste and assisting in detoxification
- loosening tense, tight muscles and encouraging circulation
- increasing the metabolic rate and digestion activity (heat)
- hydrating the cells, improving skin and muscle tone
- boosting the immune system, allowing it to function more efficiently
- improving the function of the internal organs by stimulating their blood supply
- reducing inflammation (cold)
- reducing lymphedema (contrast)
How to apply Cold
Cold hydrotherapy is used to reduce pain and decrease blood flow, minimize pain and swelling after an injury. At home, cold can be applied using ice or gel-filled ice packs, ice baths or cold, wet towels. Cold is applied for 10-15 minutes, depending on the part of the body being iced. You should wait a minimum of twenty minutes between applications. I recommend to my clients to use a warm wet towel around the ice. It’s not as threatening on first application.
How to apply Contrast treatments
Contrast hydrotherapy is an application of heat followed by an application of cold. This increases blood flow to and from the area, which can speed healing. Research shows both short and long-term benefits for distal blood flow and claudication in people with significant peripheral arterial disease. This research supports that contrast hydrotherapy may be a preventative treatment for lymphedema -which is a common type of swelling after traumatic injuries. I prefer contrast for lymphedema however it can be challenging to find access to facilities with tubs/pools for the legs. I find my clients like it for their forearms, hands and feet with arthritis and when minimal swelling is left and ice no longer feels good to apply.
Contrasts are usually started with very minimal differences in temperature. A general guideline for the timing of heat and cold applications is three minutes of heat followed by one minute of cold. This can be repeated for up to thirty minutes. A simple application is a rule of threes: three minutes heat, thirty seconds of cold, three times.
There are a number of ways to apply contrast hydrotherapy at home. You can alternate hot and cold packs depending on the body part being treated. For hands and forearms, I often recommend filling a two-sided kitchen sink with hot water on one side and cold on the other and alternating between the two.
How to apply heat
Heat can be used to make muscles softer and more flexible, increase circulation, reduce pain and provide relaxation. It often comes in handy for relief of tight, achy muscles which are often present inmore chronic conditions. At home, basic heat hydrotherapy can take the form of a hot bath, an electric heating pad or a microwaveable cloth bag. Heat is applied for up to 10-30 minutes at a time, and the temperature should never be uncomfortably hot.
Some precautions to consider when I use hot or cold for my injury treatment
Heat is not used when swelling or bleeding are present, as it can increase blood flow. Don’t use heat over an area with an infection, if you have a burn or a circulatory conditions, such as high blood pressure, then specific hydrotherapy applications may be required. If you use an electric heating pad – put a timer on to make sure you don’t fall asleep and get a burn. Cold is not advised if you have poor circulation or if you have extreme cold sensitivity. Be careful with both heat and ice if you skin sensitivity is diminished in the area you are applying the treatment.
If you are finding chronic tightness is limiting your ability to move well or if you have muscle soreness, book a massage therapy treatment with me to specifically address these areas and to learn application of hydrotherapy and self-release strategies you can use between treatments.
Juliette Woodruff is a registered massage therapist practicing in downtown Toronto at The Orthopaedic Therapy Clinic. Disclaimer-This information is not meant to replace medical/health advice. Contact your health professional to ensure the diagnosis and treatment are appropriate for your condition.