Q: Is it better to apply hot or cold when you have pain?
A: This is a loaded question without an easy answer but, as a general rule, ice is best for acute injuries and inflammation and heat is best for sore muscles and stiffness. Here’s a look at a few common situations and the best approaches to each.
INJURIES – SPRAINED JOINT or STRAINED MUSCLE
It all depends on the type of injury, it’s severity and when it was sustained. Within the first 24-48 hours of being injured, there’s almost always inflammation so stick with cold but not for too long! Applications of 5-10 minutes is plenty. It’s fine to use the numbing properties of ice to take the edge off the discomfort but your body needs those inflammatory substances for healing and too much ice will get in the way of that and may ultimately prolong the healing process if overutilized.
After that, as inflammation eases, heat will loosen the injured tissue and help keep it pliable as it continues to heal and it’s essential to keep moving! A little discomfort is fine and to be expected but you should back off if there’s any spasm or the pain is intense. The last thing you want to do is be still for too long which can lead to stiffness and decreased range of motion.
Joints and connective tissues (ligaments and tendons) are a bit tricky since they don’t get a lot of blood flow so swelling can remain deep within the tissue for longer periods of time. After the initial injury or for structures that don’t seem to be recovering you can use a combination of heat and cold. Alternating between hot and cold applications will maximize circulation and clear any residual inflammation. Just make sure you always end with the cold application and either pat or air dry (no rubbing).
ARTHRITIS/GOUT FLARE UP
Although some types of arthritis are inflammatory (ie. rheumatoid arthritis and gout) there are many, like the more common osteoarthritis, that are not typically so.
Before choosing ice or heat, it’s important to understand the disease process of the particular form of arthritis you have. An osteoarthritic joint will respond better to heat because it eases stiffness and relaxes tight muscles.
As with injuries, it there is redness, heat and irritation ice is the best choice. As an example, rheumatoid arthritis and gout have periods of flare up. During a flare up affected joints will be red and inflamed so avoid heat. In periods of remission, however, heat can be helpful to ease pain and stiffness.
Again, there are different types of headaches and understanding your triggers can help determine if ice or heat can help. I suggest keeping a headache diary for a few weeks to help you determine the characteristics of your headaches and establish any patterns.
If your headaches are throbbing or pulsing then ice at the base of your skull to decrease blood flow may be helpful. If your pain worsens with increased tension in your neck and shoulders then heat to those areas with gentle range of motion is likely the better choice.
Tendons connect muscles to joints. Muscle overuse can lead to the irritation of tendons and microtears which exhibit inflammation. This can cause acute pain which responds well to ice. As a general rule, pain is considered acute if it has been present for 6 weeks or less.
When those tendons remain irritated for prolonged periods, collagen thickens in the area leading to tendinosis and an eventual thickening of tissue. If there is lingering inflammation then ice is best but for chronic conditions like this, heat can also be helpful to ease stiffness.
Sometimes a combination of both ice and heat can yield the best results. A good guideline for contrast applications is 2-3 minutes of heat followed by 30-60 seconds of cold. Repeat this 3 times and always end with cold. Then pat dry (do not rub).
TYPES OF HYDROTHERAPY
Health centres, spas and clinics usually have lots of hydrotherapy choices available but most of us don’t have regular access to very specialized equipment. Fortunately, one of the best things about hot and cold applications is the number of options that are inexpensive and easy to use at home which include:
- gel pack
- ice cube(s)
- ice bag
- cool compress
- bag of frozen peas (be sure to mark the bag so nobody eats it!)
- frozen water bottle (great for arches)
- cold running water (shower/sink/tub)
- ice bath (more for individual body parts than whole body bathing! Brr..)
- gel pack
- microwavable bean bag
- hot water bottle
- heating pad (try and find one with a variable temperature control and an automatic shut-off feature)
- steam (from the shower or a bowl)
- hot/warm towels
- hot shower/bath
- hot running water (shower/sink/tub)
SUMMARY & CAUTIONS
- constricts blood vessels, numbs pain, reduces inflammation and limits bruising
- best for acute injuries and irritation of chronic conditions
- prolonged cold may inhibit the healing process that naturally occurs after injury if overused so limit applications to no more than 5-10 minutes at a time
- take care, especially in the extremities, if you have a condition characterized by insufficient circulation (ie. Raynaud’s or Diabetes)
- increases blood flow, relaxes tight muscles and allows for greater ease of movement
- best for chronic pain/tension and after inflammation resolves following injury
- prolonged heat can cause protective mechanisms to overly relax and lead to increased pain when removed so limit applications to no more than 20 minutes
- avoid if you have swelling, bleeding, infection, fever, burns or cardiovascular concerns
ALTERNATING HEAT WITH COLD
- increases the exchange of nutrients and removal of waste within tissues
- best for chronic irritation, deeper inflammation and for structures that receive less than optimal blood flow
- the greater the temperature difference between the hot and cold applications the bigger the impact on the tissues so it’s best to start with warm and cool as opposed to hot and cold until you know how your body reacts.
WHAT IF I MAKE THE WRONG CHOICE?
As long as your hot or cold application is of short duration and uses mild to moderate temperatures, you likely won’t do any harm. There’s also the possibility that you’ll feel no change at all. You may just need to experiment and see what happens. If you find your situation worsens, back off and do less or try something else.
Other safety considerations include:
- it’s important to put a barrier between your skin and whatever hot or cold application you choose to use as burns can happen without your knowledge especially when distracted by the pain of injury. (YES, cold can cause burns too!)
- take care applying any hydrotherapy to areas that have diminished or altered sensation as you may not be aware that it’s causing harm if you can’t accurately feel it
- those with health conditions don’t need to avoid hydrotherapy so much as modify how they use it so don’t hesitate to ask for guidance
The most important thing is to pay attention to how you’re feeling and act accordingly. For example, most people prefer heat applications because they are soothing. However, it’s how you feel AFTER the application or the next day that will give you the most information about whether or not it was a good idea.
Lastly, remember that these are only guidelines and there are exceptions to every rule. If you’re still unsure, stop and consult a health care professional. For more information, just ask.