Hot and Cold Therapy

Some say that pain ends in heat, some say in cold. If you're dealing with muscle pain, you've probably heard praise for both heat and cold therapy, and you might not be sure which is right for you. We're publishing this guide to help you figure out what you need, whether it's for a sports injury or persistent aches and pain, so you won't get stuck sifting through conflicting information online the next time you pull a muscle at the gym. Everyone on an exercise regimen should know what to do for both acute injuries and soreness.

Cold Therapy

Also known as cryotherapy, cold therapy works by reducing the blood flow to an affected area, which can reduce inflammation and swelling. It may also reduce nerve activity in the area, which alleviates pain. Cold therapy is best used for acute injuries. You may have heard the classic mnemonic for soft tissue injuries, RICE: rest, ice, compression, and elevation. Although our current understanding of treating these injuries is more complex, as a safe and accessible form of pain control, ice still has its place.

Use cold therapy on:

• Acute injuries: sprains, bruises, muscle tears or pulls.
• Inflammation.
• Chronic overuse or tissue fatigue injuries: carpal tunnel syndrome, tennis elbow, tendinitis, iliotibial band syndrome, shin splints.

Remember: Ice is for injuries. It should generally be used for pain control in the first few days immediately after an injury, when you want to reduce pain and swelling. Inflammation is a helpful, natural process, but a stubborn one that you might need to control. Ice is for anything red, hot, swollen, or inflamed.

Don't use cold therapy on:

• Stiff muscles or joints.
• Muscle pain: be wary of trigger points, painful spots that may feel like an injury.
• Patients with poor circulation.
• Patients with sensory issues that prevent feeling cold sensations, like some cases of diabetes.

Cold Therapy Methods

• Ice packs or frozen gel packs.
• Cold wraps.
• Coolant sprays.
• Ice massage.
• Ice baths.
• Cyrostretching: the use of cold to prevent muscle spasms while stretching.
• Cyrokinetics: a combination of cold therapy and exercise, often used for ligament sprains.

Remember not to apply a frozen item like a cold pack directly to your skin unless it's designed to do that safely, and don't overdo it. Cold is best applied several times a day for short periods, usually 10-15 minutes at a time, and can be helpful when combined with elevating the affected area.

Heat Therapy

Chronic pain issues are best treated with therapeutic heating, or thermotherapy. If it's long-term aching or soreness without a clear cause, heat therapy is probably the best approach. It works by improving the circulation and blood flow to an affected area, which can relax muscles, reduce pain, and may even heal damaged tissue.

Use heat therapy on:

• Acute soreness: pain from over-exertion.
• Localized stiffness and pain: trigger points (muscle "knots"), most kinds of cramping or spasms.
• General pain and sensitivity: if you hurt all over, heat may help. Examples include rheumatic diseases, fibromyalgia, and sleep deprivation.

Don't use heat therapy on:

• Acute injuries: any tissue damage. If the skin is hot, red, inflamed, or swollen, heat will do more harm than good.
• Acute inflammation: such as arthritis flare-ups.

It can be tough to tell when to heat as opposed to when to ice. Heat is for pain that's not the result of tears, strains, or other tissue damage. But the difference between a muscle strain and a muscle knot can be difficult to determine. It may be best to consult a doctor or physical therapist if you're uncertain.

Heat Therapy Methods

There are multiple methods of heat therapy, organized by location of effect and type of heat used.

Dry Heat: conducted heat therapy.

• Heating pads.
• Dry heated packs.
• Saunas.

Moist Heat: convection heat.

• Steamed towels.
• Moist heating pads.
• Hot baths.

Local Heating: applying heat to specific areas in pain.

• Heating pads and heat wraps.
• Heated gel packs.
• Hot water bottles.

Systemic Heating: raising the entire body's temperature.

• Baths.
• Jacuzzis.
• Steam baths or saunas.

Contrasting Therapy

Therapeutic contrasting is the use of alternating hot and cold therapies to stimulate metabolic and circulatory response in tissues. This often involves contrasting hydrotherapy, or quickly alternating immersion in hot and cold water. Its greatest effectiveness seems to be on repetitive strain injuries. Stimulating the tissue without stressing it is valuable, because these injuries require a lot of rest. Examples include:

• Tennis elbow.
• Tendinitis.
• Shin splints.
• Carpal tunnel syndrome.