Hot Vs Cold Therapy

Massage therapists often see the after-effects of acute/chronic injuries, EIMD (exercise-induced muscle damage), DOMS (delayed onset muscle soreness) and many other painful conditions. The most common question is which is better to relieve the pain cold or heat.

The answer is not which is better, but which is most appropriate for the situation. Usually, you will start with either hot or cold, but in some cases alternating both is recommended.

Hot Therapy
Often heat therapy is what we want to reach for because it feels more comforting than cold therapy. A heating pad, hot bath, or warm compress may feel good, but it may not always be the best tool especially in acute injury cases. Hot therapy is most often used with chronic pain situations. Here are a few guidelines you should follow when using heat.

Use heat to
1. Recover from a hard work out session (DOMS)
2. Increase blood flow to inflamed muscles (EIMD)
3. Warm up or soften muscles before a massage, chiropractic treatment, or athletic event
4. Relieve pain from Osteoarthritis, tendinitis, chronic muscle pain or spasms

Avoid heat
1. On an acute injury for at least 48 hours.
2. When a fever is present
3. If the area is red, hot, and swollen
4. In cases of Peripheral neuropathy
5. Until doctor’s permission in cases of high blood pressure and heart disease

Cold Therapy
Cold therapy (ice) may not feel as good initially, but its effects are most notably perceived within 48 hours of an acute injury. It constricts vessels slowing blood flow in the area thus reducing swelling and pain.

Use cold to
1. Treat acute injury from contusion or strains
2. Relieve pain from migraine headaches
3. Treat pain associated with Osteoarthritis, gout, and tendinitis
4. Numb and area for pain relief
Caution: When using cold therapy be sure the area is warmed up and back to body temperature before any activity is resumed.

Avoid cold
1. If the area is already numb
2. In the presence of cramping
3. On blisters or an open wound
4. For extended periods of time on patients with nerve disorders that impede blood flow.

Alternating Cold and Heat Therapy
In some cases, using cold and heat alternatively can be very useful. Cold is a vasoconstrictor. Heat is a vasodilator. Alternating can effectively reduce pain and swelling while bringing nutrient-rich blood into the area for healing. As a Massage Therapist, I have seen this most effective in chronic pain situations or where EIMD or DOMS is present. One very effective method of using cold/hot treatment is to follow a session of ice with a warm bath. Also, I have recommended cold showers followed by wrapping in warm blankets to help relieve pain from Rheumatoid Arthritis or sore muscles.

Resources:
https://www.medicalnewstoday.com/articles/29108.php
https://www.mayoclinic.org/first-aid/first-aid-burns/basics/art-20056649
https://www.healthline.com/health/home-remedies-for-burns

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