Heat vs. Cold…the Great Debate

Everyone has an opinion they swear by on this subject, usually with very specific time frames and methods.  In fact there are very few guidelines to take into consideration when choosing whether to use heat or cold and generally it comes down to a personal preference.

Let’s start with the physiology of the matter.  Heat and cold are both used to treat pain and swelling.  How can they both be used for the same issue when they are so opposite of one another?  Cold is a vasoconstrictor, it causes constriction or narrowing of the blood vessels of your body when applied locally.  Heat is a vasodilator; it causes dilation or opening of the blood vessels of your body when applied locally.  Each of these physiological responses has a benefit to you when experiencing pain and or swelling.

If your injury is acute, having occurred in the last 48-72 hours, then ice or cold is generally recommended.  It’s going to help to minimize the fluid flow or blood leakage into the injured area.  If you can minimize this you are going to also minimize the trauma to the surrounding soft tissues ie/ muscles, tendons and ligaments.
 
If your injury is greater than 72 hours old then heat is generally recommended to allow increased blood flow to the area with the philosophy that increased blood flow brings increased nutrition and healing and assists in removing the debris from the injury site so your body can eliminate it. 

There is actually another theory out there that the best thing you can do just after an injury is something called a contrast bath.  This is where you alternate putting the injuring into ice, constricting the blood flow for a minute or two and then switch to heat to allow increased blood flow to the area.  This works best for a distal injury like a hand/wrist or ankle/foot because you can actually submerge the entire area into a bucket of prepared fluid making the transitions between the two easiest. 

The idea is to use heat or ice 3x /day for 15 minutes at a time keeping close checks on your skin to make sure that you are not causing any burning from either the heat or the ice to your skin.  This is particularly important in the case of a contrast bath as you are actually submerging the body part into the substance vs. applying it.

Some General Rules of Thumb

1. Use a thin layer of material between your skin and either the ice or cold to lessen the chance of damaging your skin.
2. If you are dealing with arthritis heat is generally the better option, arthritis tends not to like cold.
3. If you are using heat and cold to treat an injury or even preventatively heat would be used as a warm up and cold after an activity.  You should not do any strenuous activity for 10-15 minutes after either modality as either could mask some pain and you could end up further injuring yourself. It is best to wait the 10-15 minutes after using them to proceed w/ strenuous activity.
4. As with any other form of exercise or treatment if you have a condition that could affect your sensation or your circulation you should always consult with your doctor before beginning something new. This is not meant as a specific program for anyone to follow just some suggested guidelines.

Maribeth Dever, PT

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