Cold Therapy
When cold makes more sense than heat.

When it is appropriate to apply heat and when is it appropriate to apply cold to injuries?

Traditional Beliefs

Traditionally cold was only applied to acute injuries to reduce swelling and inflammation, and to reduce the chance of blood hemorrhage. Heat was applied to areas of chronic pain and spasm to increase blood supply, to increase the absorption of excess fluid and hopefully accelerate healing.

Some practitioners try to incorporate both of these processes by the use of contrast baths, which utilize vasoconstriction (constriction of blood vessels, slowing circulation) caused by cold, and vasodilation (dilation or expansion of blood vessels, increasing circulation) caused by heat. The result is a "pumping action" that helps remove waste products and excess fluid from the injured area and decrease swelling.

Recently, more and more physicians have been leaning toward prescribing the use of cold packs in the treatment of pain and spasm, even in chronic cases. Patients are often under the misconception that heat is best. However, when a patient can be persuaded to try cold therapy, they are often surprised by the degree of pain relief, as well as the duration of that relief.

Research on Cold Treatments

Physical therapist Michael Kowal gleaned through over 80 research studies and papers. He cites experiments that demonstrate a "hunting reaction". That is, when surface blood flow wavered between vasoconstriction and vasodilation when skin temperature was reduced to 50 0 F for any length of time. This again results in the "pumping action" referred to in the first paragraph.

Many studies backup the pain relieving effect of treatments involving cold application.

Other studies dealt with the subsequent range of movement that patients could achieve, after the application of ice. The researcher Doctor Mennell said that this was due to the decreased sensation, which enabled the patient to stretch out muscle spasm.

Other Researchers felt that stretching was best achieved in the "cooling stage" after "heating" by use of hot packs, massage, or ultrasound.

Current Best Practices

For best results, stretching of the part should be maintained while cooling the tendon. This was found to produce a longer-lasting increase the range of motion and the duration of the benefits of treatment than those treatments in which the stretch was stopped after heat was applied.

Heat, moist heat, is a valuable tool for temporary pain reduction. It provides a pleasing and comfortable means to improve superficial blood circulation, and also aids in your range of movement. The drawback to moist heat is that it may have the effect of increasing fluids in the region and create feelings of congestion, swelling, or stiffness. Some patients report that heat makes them feel worse. These patients, and those who have been trying moist heat application alone, with no real improvement, should consider trying cold therapy.