Pain is something that many people experience. It is an unpleasant experience which is caused by inflammation, injuries and certain conditions. Examples of conditions that cause pain include arthritis, lower back pain and muscle strains. Fortunately there are many ways to ease pain, such as heat and cold therapy.
It can be difficult deciding whether cold or heat therapy is appropriate for certain situations. Typically, ice is used for injuries where there is inflammation and swelling. On the other hand, heat helps ease muscle pain, stiffness and increase blood flow for recovery. However, this article will go into more detail about when heat or cold therapy can be used to help with pain.
Ice Therapy
Also known as cryotherapy, ice therapy helps ease inflammation, pain and swelling.The purpose of ice therapy is to lower the temperature of the body region. There are several ways that ice therapy works, including:[1]
-
Decreasing the sensitivity of nerves
-
Causes the blood vessels to vasoconstrict (shrink) to lower the blood flow and inflammation
-
Lower heart rate to decrease the blood flow and inflammation through the body
-
Reducing hormones, such as cortisol and adrenaline
-
Reducing the build of acid in the muscles.
Typically, 15-20 minutes of ice therapy is used to help reduce pain. The number of sessions across days and weeks will depend on the reason why the pain is occurring.
Types of Ice Therapy
Ice therapy can be used in a number of ways. As long as the treatment can lower the temperature of the tissue, it can efficiently help reduce pain. Always wrap these types of treatment in cloth to prevent damage to the skin. Common examples include:
-
Gel ice packs: Gel ice packs are filled with chemicals and water. These gel packs are stored in the fridge which helps it stay cold. They can be reused multiple times as it has a leak-proof coating which holds in the gel.
-
Ice packs: The simplest way of ice therapy is wrapping ice cubes in freezer bags or lunch packs.
-
Ice massage: Ice massages are performed by using ice cubes or blocks of ice to massage the skin.
-
Topical cooling gels: Gels which have chemicals, such as menthol, provide cold sensations and reduce pain.
-
Ice baths: Ice baths are generally taken in a tub or large container filled with water and ice cubes. They cool down the whole body instead of specific areas.
Other forms of ice therapy can be more expensive and less accessible. They are generally not needed for most people but used in specific environments, such as after surgery or sports rehabilitation.
-
Cryokinetics: Ice is applied around the injured area while performing exercise. Athletes who have recently been injured (e.g. sprains, strains) can start their rehabilitation with less pain.
-
Cryotherapy chambers: Similar to ice baths, cryotherapy chambers expose the whole body to cold temperatures. However, instead of getting the body wet, it exposes the user’s body to freezing dry air.
-
Cold therapy units: Cold therapy units are machines which attach onto specific areas to deliver cold. These machines are generally quite expensive but offer a consistent cooling effect.
When to Use Ice
Traditionally, ice has been used as part of the RICE principle (i.e. rest, ice, compression, elevate). This is widely recognised as the first aid method for the initial management of injuries, including:
-
Muscle strains
-
Ligament injuries
-
Contusions or corkies
-
Tendon injuries
-
Spasms
-
Joint pain
Recently research has suggested that this might not be the best way to manage these types of injuries. Some inflammation is needed to start the healing process.[2] Instead, ice might be used once or a few times after the injury has occurred to reduce pain. Long-term use may actually hinder recovery.
Ice therapy is also commonly used after surgeries, such as:
-
Joint replacements
-
Tendon repairs
-
Ligament reconstructions
-
Joint manipulations
-
Abdominal surgeries
Reducing the pain and swelling in these areas can help reduce pain to gain movement and function quicker.
When Not To Use Ice
Ice therapy may not be for everyone. Circumstances where it may not be appropriate, include:
-
People with poor circulation or conditions, such as Raynaud Disease’s
-
Those with reduced skin sensitivity, such as people with nerve damage or injury (e.g. diabetes, peripheral neuropathy)
-
People with previous injuries due to cold exposure
-
Application to bare skin and/or periods >20 minutes
Heat Therapy
Also known as thermotherapy, heat therapy is also used to help ease pain. Unlike ice therapy, its purpose is to lower the temperature of the affected body region. There are several ways that heat therapy works, including:[3]
-
Causes the blood vessels to vasodilate (open up) to help increase blood flow. This increases healing as blood contains nutrients, protein and oxygen to repair the injured area
-
Eases the way the brain processes pain through its soothing and calming effects
-
Relaxes muscle tone and tightness
-
Increases the metabolism of tissues which improves its ability to heal
When compared to ice therapy, it works very differently. While it also reduces spasms and pains, it can increase inflammation, swelling, the ability of the muscle(s) to stretch and blood flow.[3]
Typically, 15-20 minutes of heat therapy is used to help reduce pain. The number of sessions across days and weeks will depend on the reason why the pain is occurring.
Types of Heat Therapy
Heat therapy can be applied in 3 main ways, including:
-
Conduction (e.g. gel heat packs, wheat bags, hydrocollator packs): Conduction occurs when heat is transferred through a heated object, such as a gel pack or wheat bag. Typically, these treatments are applied around the injured area. Wrap these packs up in a towel and avoid using for more than 20 consecutive minutes to prevent potential burns.
-
Convection (e.g.hydrotherapy, fluidotherapy): Convection occurs when the surrounding fluid heats up the body. Being in warm water that is higher than the body’s temperature eases aches and pains. Hydrotherapy should be accessible at some swimming pools, where the water is warmer.
-
Conversion (e.g. ultrasounds, heat gels): Conversion heat therapy uses sources that do not emit heat but help warm the area up. For example, heat gel is applied onto the skin but relies on chemicals to warm the area up.
When to Use Heat Therapy
Typically, heat therapy is used during the later stages of injuries and long-term conditions, including:[3]
When Not To Use Heat
Heat therapy should only be used in certain situations. Circumstances where it may not be appropriate, include:
-
When there is swelling and inflammation
-
24-48 hours after a physical injury, such as a sprain or strain
-
Over a fresh wound
-
Those with reduced skin sensitivity, such as people with nerve damage or injury (e.g. diabetes, peripheral neuropathy)
-
Over the belly during pregnancy
-
Over sensitive areas, such as testes and the eyes
-
Over areas which are prone to burning, such as irritated or sensitive skin
-
People with poor circulation or conditions, such as Raynaud’s Disease.
Heat therapy may not be for everyone. Circumstances where it may not be appropriate, include:
-
People with poor circulation or conditions, such as Raynaud Disease
-
Those with reduced skin sensitivity, such as people with nerve damage or injury (e.g. diabetes, peripheral neuropathy, etc.)
-
People with previous injuries due to cold exposure
-
Application to bare skin and/or periods >20 minutes.
What To Do If You Are Not Sure?
It’s important to consider that ice or heat therapy alone will not ‘fix’ a condition or injury. Instead it can help ease pain for the short term and allow you to move more freely.
However, using the incorrect treatment can worsen pain and symptoms for a period of time. Those with pre-existing medical conditions should consider seeking professional help to determine whether heat and/or cold treatment is appropriate.
Consulting your physiotherapist about any physical injuries should be the first place to start if you are unsure. They will guide you to the best form of application, whether heat or cold is appropriate and other strategies to help improve your pain.
Key takeaways
Ice and heat therapies are commonly used to treat pain. Cold treatment is typically used to ease pain by reducing inflammation and the sensitivity of the nerves. Heat treatment is used to ease pain by improving recovery through increased blood flow.
Ice therapy is usually recommended during the early stages of injuries where there is inflammation and swelling present. It can even be used to numb areas on the body where the pain is persistent.
Heat therapy is usually recommended during the middle to later stages of an injury when the swelling and inflammation has settled. It helps improve recovery by delivering more nutrients, protein and oxygen to the affected tissue.
While effective, there are situations where heat and ice therapy is not appropriate. Examples include people with poor circulation and skin sensitivity.
