WHAT TO USE AND WHEN TO USE IT

By Desiree Gagne, MA, OTR/L

It can be confusing when to use ice or heat, and for how long? Knowing the difference between an acute injury versus a chronic condition helps determine the use of ice or heat. Here are some tips that may help with making the right choice.

Heat can be used to treat arthritis, tendinosis, and pain. Heat eases chronically stiff joints and relaxes tight muscles.  Alternatively, ice can be used to calm gout flare-ups and tendinitis which numbs pain and eases inflammation. Alternating between heat and ice can be effective for many conditions and injuries such as headaches, sprains, and strains. When used for headaches, ice numbs throbbing head pain and moist heat relaxes painful neck spasms. For sprains and strains, ice eases inflammation and numbs pain while heat relieves stiffness after the inflammation resolves.

HEAT THERAPY

When heat is applied to an area of the body, the increased temperature works by improving circulation and blood flow to that area.  Heat can increase muscle flexibility by relaxing tight muscles, relieving achy joints, soothing discomfort or pain and healing damaged tissue. Chronic conditions such as muscle pain or soreness, stiff joints, arthritis and old/recurring injuries usually call for heat therapy.

TYPES OF HEAT

The two different types of heat include dry heat and moist heat. Both types of heat should be warm, not hot, which could cause burns to the skin. Heat can be applied to a localized area of the body, regional area, or an entire body treatment. A heating pad or gel pack could be used to treat a localized, or small area of the body, such as a stiff muscle. A heated towel, larger heating pad or heat wrap could be used to treat a regional or larger widespread area. A full body treatment would include a sauna, whirlpool, or warm bath.

Dry Heat includes heating pads or saunas. Heating pads are easy to apply; however, dry heat can draw moisture from the body and may leave skin dehydrated.

Moist Heat includes steamed towels, moist heat packs, whirlpool, and baths. The water temperature should be 92-100 degrees for whole body emersion. Moist heat may at times be more effective and require less application time.

Professional heat therapy, such as ultrasound, can also be applied to help pain from different injuries. Part of a physical or occupational therapy plan of care may include therapeutic ultrasound. It is used to provide a deep heating to soft tissues in the body such as muscles, tendons, joints, and ligaments.

WHEN NOT TO USE HEAT

There are certain instances when heat should not be applied, such as to an open wound.

Individuals with pre-existing conditions and impaired sensation should not use heat therapy due to a higher risk of burns or complications.

These conditions include:

• Diabetes
• Neuropathy
• Dermatitis
• Vascular Disease
• Deep Vein Thrombosis
• Multiple Sclerosis (MS)

If you are pregnant, check with your doctor before using hot tubs or saunas.

If you have heart disease or hypertension, check with your doctor before using heat.

Heat should not be used in the first 24 hours after an injury because it will cause an increase in swelling and inflammation.

HOW TO APPLY HEAT

Always use a thin protective cover between the skin and heat as a preventive measure against burns. A towel or pillowcase works well. For local areas such as for muscle stiffness or joint pain, the use of heat can help discomfort relief in about 15-20 minutes. For local area treatment, do not apply for longer than 20 minutes at a time.

COLD THERAPY

Cold therapy, or cryotherapy, works by constricting blood vessels and reducing blood flow to a particular area which can help to reduce inflammation and swelling, especially around a joint or tendon. Cold therapy temporarily reduces nerve activity, which numbs pain, relieves inflammation and limits bruising. It’s best to apply ice to an acute, or new injury. Acute injuries are short-term injuries and it’s best to respond quickly to the injury to help with healing and reduce inflammation.

TYPES OF COLD THERAPY

Treatment options for cold therapy include frozen bags of peas or corn, ice cubes in a baggie, ice packs, frozen gel packs, coolant sprays, ice baths, ice massage, and whole-body cold therapy chambers. Cryostretching uses cold to reduce muscle spasms during stretching and cryokinetics combines cold therapy and active exercise.

WHEN NOT TO USE COLD THERAPY

• Individuals with sensory limitations should not use cold therapy because they may not be able to feel if the damage is being done. This includes diabetics.
• If you have poor circulation, do not use cold therapy.
• If you have stiff muscles or joints, do not use cold therapy.

HOW TO APPLY COLD THERAPY

Wrap an ice pack or bag of ice in a towel and apply to the affected area for a home treatment. Never apply a frozen item directly to the skin as it could cause damage to the skin and underlying tissues. Use the ice for short periods, several times a day, as needed. Ice can be used for 10-15 minutes at a time but no more than 20 minutes to prevent tissue and skin damage. Continue to ice the injury 24- 48 hours until swelling, tenderness or inflammation are gone.

You can make an ice massage by freezing water in a Dixie cup, peel back the top of the cup and massage the tender area until it’s numb. This is best for targeted icing after an injury.  If the injury is acute, apply as soon as possible after the injury. For best results, also elevate the affected area that was injured which helps prevent swelling.

RISK FACTORS AND PRECAUTIONS FOR HEAT AND COLD TREATMENTS

• Heat should be used as “warm” and never “hot” temperatures. Hot temperatures could result in burns to the skin.
• If you have an infection, heat could potentially increase the risk of the infection spreading.
• Never sleep with heat treatment on your body.
• Do not use heat for acute injuries as it increases inflammation and can delay healing.
• If you experience swelling, immediately stop the treatment. If heat treatments do not help the pain or discomfort after a week, or if the pain increases with a few days, make an appointment to visit your doctor.
• Cold treatments that are applied for prolonged periods of time or directly to the skin, can result in damaged skin or tissues.
• If you have cardiovascular or heart disease, consult your doctor before using cold therapy.
• If cold treatments aren’t helping an injury or swelling within 48 hours, call your doctor.
• Allow the skin to return to normal temperature before reapplying ice or heat to avoid burns.

ICE OR HEAT SUMMARY

Knowing when to use ice or heat can significantly improve the effectiveness of treatment. As a rule, ice is used for acute injuries, pain, inflammation, and swelling. Heat can be used for stiffness and muscle/joint pain. Both modalities have minimal side effects and are easily accessible when dealing with pain.

Remember, if either treatment makes the pain or discomfort worse, stop immediately. It’s also important to contact your doctor should you develop bruising or skin changes over the course of treatment.  If the treatment is used for a few days and you have no relief, you can make an appointment to visit your doctor to discuss alternative treatment options.

A doctor can also help determine whether it would be wise to receive physical therapy. Physical Therapists can educate you through proper exercises that you can perform at home to regain mobility, flexibility, and strength. They can also guide you when it’s time to switch from ice to heat, or vice versa, to help your healing process and return you to tasks you may be having trouble performing.

For more advice on how to return to function following an injury or for help dealing with pain or arthritis management, call Rehability at 352-701-0494.

DISCLAIMER:

This article is intended to provide general health information and is not intended to provide individual specific medical advice, diagnosis, or treatment.