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Heat and cold therapies are two nonmedicinal interventions that are commonly used to relieve pain and swelling, often in conjunction with other treatment modalities.
Each method has its own separate mechanism for providing relief. Thermotherapy involves the application of gentle heat to stimulate blood flow and circulation in the targeted area, which helps reduce muscle tension and the associated pain.
Cryotherapy or cold treatment involves exposing the injured site to cold temperatures, which shrink the underlying blood vessels and reduce the blood supply in the area.
Cold application to a specific spot limits nerve activity in a localized manner, rendering the area temporarily numb. Thus, cold therapy produces a short-term anesthetic effect, which makes you feel less pain.
Given that both these therapies work differently, deciding which one is better suited for you depends upon the genesis and type of your pain.
When dealing with muscle pain, which is better – warm compress or cold compress?
The short answer to this question is BOTH.
There are specific scenarios in which cold treatment (cryotherapy) is preferred over hot treatments and vice versa. To determine which option is appropriate, it is important to first understand the physiologic events that lead to muscle pain.
The pain that follows a strenuous activity is triggered by the release of inflammation mediators from the damaged muscle. Cytokines, tumor necrosis factor (TNF), interferon-gamma (INF-g), and prostaglandins are examples of the inflammatory chemicals that circulate the skeletal muscles, lowering the pH in the environment.
This change in the environment activates the pain receptors (proprioceptors), which are found near the muscle’s blood vessels, thus causing the sensation of pain.
Ibuprofen blocks the production of prostaglandin. This is the reason it is recommended to treat inflammatory conditions.
Keeping in mind how muscle pain occurs, it becomes clear why cold treatment would be recommended immediately following an injury.
Cold compress: The cold constricts blood vessels that carry the inflammation chemicals to their pain receptors. By limiting the blood flow to the muscle, inflammation is less, which means less pain.
Cold temperature also numbs the injured area and prevents bruising, which is blood that has leaked from tiny broken blood vessels (capillaries) near the skin’s surface.
Cold treatment is a safe, nonmedicinal way to treat minor, localized pain and to decrease inflammation and swelling after an acute injury. It works best if applied immediately after the injury and up to 48 hours following.
Warm compress: If the injury is subacute (>48 hours old) or chronic (>6 weeks), then heat is the better option for pain control.
Heat dilates the blood vessels, allowing more blood flow to the area. This increased circulation to the area improves the body’s ability to clear the inflammation mediators away from the area, improving pain.
Heat can also improve the muscle tightness, stiffness, and spasms that cause pain.
Because heat increases circulation to the area, it should not be used to treat a new injury. Otherwise, there will be more swelling, more pain, and delayed healing.
What is the best way to apply warm and cold compresses?
There are several ways to apply cold treatment to an injured area – ice directly onto the skin, ice packs, and topical cold sprays. Each method has its benefits.
Applying raw ice directly to the injured area is very effective. Keep the ice moving to avoid a cold burn. Raw ice therapy is often more effective than ice packs because as the ice melts, the cold water spreads into the wrinkles of the skin, conducting heat away.
Try freezing water into small Styrofoam cups. When ice therapy is needed, tear away a portion of the Styrofoam and apply it.
Topical cold sprays are a convenient way to apply cold therapy to an injury. These sprays contain a refrigerant that evaporates from the skin almost immediately after spraying.
Trained personnel should be the only ones applying cold sprays, as there is a risk for cold burn if incorrectly sprayed. Athletes are often treated at the sideline with a quick spray over the injured area to decrease the potential for inflammation and pain later.
Ice packs can provide prolonged and deeper tissue cooling effects, unlike raw ice or cold sprays. It is best used for muscle injury.
If a deep cooling effect is desired, do not place the cold pack directly onto the skin. Cover the skin with a towel, and then cover the pack to contain the cold. The cold pack may be left in place until numb, then removed.
When applying cold therapy, remember these rules:
- Start cold therapy as soon as possible after an injury or in the 48 hours following the injury for best effects.
- Keep the ice moving if applying to bare skin.
- Cover the skin if using an ice pack.
- Apply the cold treatment only until the area is numb.
- Reapply the cold treatment when the pain returns.
- Continue treatment cycles until the symptoms improve.
Heat therapy can be used for non-inflamed, non-acute body pain. As with cold therapy, there are several ways to apply heat to an injury.
Gel hot packs are convenient and can be activated when needed, but the temperature does not get very hot and does not last long. For its convenience, though, gel hot packs are still a good option.
Do not place gel hot packs directly onto the skin. Cover them with a towel to contain the heat more effectively.
Other methods in applying heat therapy are immersion into warm water, electrical heating pad, and heated body wraps. These methods allow the heat to penetrate the tissue deeper. However, they are not as convenient.
There is no standard temperature or duration for heat therapy. Most literature advises a level of heat that is “tolerable” and applying heat therapy until there is a relief. The main precaution is related to prolonged use of heat and the risk of burning. (Don’t fall asleep on a heating pad!)
For best results, how long should warm and cold compresses be applied?
There are no evidence-based guidelines for the duration of hot or cold therapy for muscle pain. A rule of thumb is to use ice therapy until the injured area is numb, then stop. Use heat therapy until the pain, tightness, or stiffness improve, then stop.
Always seek medical attention if the pain worsens or does not improves to any degree when using hot or cold therapy.
Remember that cryotherapy and heat therapy are meant to treat minor injuries and provide mild symptom improvement only. Severe injuries should be evaluated by the appropriate caregiver.
Would alternating cold and warm compresses be beneficial in relaxing muscles?
Alternating hot and cold treatment is called contrasting therapy. This technique stimulates the muscle and can improve blood flow and relieve tightness.
Pain related to injuries that are older than 48 hours or during the recovery phase of healing should benefit from alternating warm and cold compresses
Is it advised to use a cold compress to reduce a fever?
A cold compress may be used to reduce a fever temporarily in both children and adults but should not be used in infants or babies.
A fever is confirmed by measuring the body temperature >38 °C using a thermometer. Aside from fever-reducing medications such as acetaminophen and ibuprofen, cold compress treatment may be done to help reduce the temperature temporarily.
Use a towel soaked in an ice bath, ring out the excess water, and then dab the towel onto the skin. Dry the skin immediately with a separate towel.
Do not immerse the ill individual into an ice bath because the extreme cold temperature will cause shivering and elevate the body temperature even further.
Always seek medical attention for persistent fever!
What is best suited for back pain, a cold compress or warm compress?
Back pain is most commonly due to muscle spasms, tightness, and stiffness. Therefore, heat therapy is typically recommended.
Even if the back pain is acute, using ice therapy on the lower back may increase the pain. Cold triggers increased muscle tightness, whereas heat can help relax tense muscles.
Neither heat nor ice has been proven very effective in relieving back pain. The bottom line is whichever method improves the symptom, go ahead and do it!
Remember that if the pain is severe or associated with other symptoms such as numbness or weakness in the legs, a sudden difficulty with bladder control, or other neurologic symptoms, seek immediate medical attention.
Are there any side effects of cold and hot treatment?
Prolonged exposure of bare skin to extreme temperatures can be dangerous and can lead to tissue damage. So use caution, especially if there is a decreased sensation in the area being treated (such as in cases of diabetic neuropathy and Reynaud’s phenomenon and after application of topical muscle rubs).
Using either hot or cold treatments on areas that appear infected (painful, red, hot, swollen, oozing skin) should be avoided.
Finally, hot and cold therapy is reserved for minor pain or injury – not major trauma, abraded or open skin areas, or if symptoms are severe or prolonged. Seek medical attention for serious or concerning pain reasons.