When to Use Cold or Heat Therapy for Pain, Stiff Muscles and Joints (Evidence Based)

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When to Use Cold or Heat Therapy for Pain, Stiff Muscles and Joints

Heat and cold therapies are very common types of home treatments to relieve pain, but have you ever wondered whether you should use heat or cold therapy when suffering from sore muscle, injury or joint pain?

In this article I will explain the purpose of heat and cold therapies, and when to apply each one of them.

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What is Heat Therapy?

The aim of heat therapy (thermotherapy) is to increase blood circulation and supply oxygen and nutrients to the area where it is applied.

The heat also decreases joint pain, soothes sore muscles and muscle spasm, increases limited motion and flexibility of tendons and ligaments.

When our muscles are overworked and are put under stress, they are deprived of oxygen and can become sore due to accumulation of lactic acid.

Lactic acid build-up causes muscle ache, and in this case heat therapy can help to stimulate blood flow and help in removing the lactic acid from the muscles.

The Different Types of Heat Therapy

Heat therapy can be dry or moist, and can be applied locally to a specific area in the body.

Examples of dry heat therapy include a dry heating pad, a warm compress, hot water bottle or dry sauna.

Moist heat therapy include warm damp towel, hot bath or moist heating pad.

In this case the heat source should be warm, but not too hot, and should be maintained at a consistent temperature.

You also need to protect your skin from direct contact with the heat source to prevent burns and wrap the heat source with a towel.

It is also advised to apply heat therapy for no more than 20 minutes, unless your doctor or physiotherapist recommends otherwise.

Heat therapy can also be systematic, which means that it doesn’t applied locally to the affected area, but to the whole body. Systematic heat therapy increases the whole body temperature.

For example, you can use sauna or hot shower and bath as systematic heat therapy. Make sure to stay hydrated and avoid prolonged exposure when using systematic heat therapy.

When to Apply Heat Therapy

The basic rule is that heat is best for treating chronic muscle and joint pain and stiffness or an injury that is a day or more old.

As an example, you can use heat in chronic conditions such as back pain, neck pain and arthritis.

Heat therapy is not suitable for people with conditions such as diabetes (1), heart disease or high blood pressure, vascular disease and deep vein thrombosis (DVT)

Pregnant women should check with their doctor before using saunas or hot tubs.

What is Cold Therapy?

When the body is injured, the affected tissues become inflamed, and this can cause pain and swelling.

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The aim of cold therapy (cryotherapy) is to numb the affected area and slow down blood flow, thus relieving pain, reducing swelling, nerve activity, inflammation and bleeding.

Cold therapy should be applied locally to the affected area, ideally within 5-10 minutes of injury.

The Different Types of Cold Therapy

You can apply cold therapy to the affected area by using:

  • a cold gel pack
  • a bag of frozen vegetables
  • ice towel which you can make by damping a folded towel that has been sealed in plastic bag and placed in the freezer for about 15 minutes

Precautions When Applying Cold Therapy

When using an ice pack, avoid excessive use of cold which can cause tissue damage.

Never apply the ice pack or frozen object directly on your skin as it can damage your skin. Always wrap it in a towel before applying it to the affected area to protect the skin and don’t apply it for more than 10-20 minutes at a time. You can apply the ice pack later on after giving your body a break. (2)

When to Apply Cold Therapy?

  • Cold therapy is used immediately after injury for acute pain or a new and recent swollen and inflamed injury.
  • A cold treatment should be used for 24 to 48 hours after an injury and is good for sprains, strains, and bruises.
  • Do not use cold therapy on stiff muscles or joints.
  • Cold therapy is also used to relieve pain caused by a pinched nerve (for example pinched nerve in shoulder).

Always remember – you need to choose what works best for you and take into account the type of injury.

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If you are in doubt as to what therapy applies to a certain injury, call your doctor’s office.

If you suffer from diabetes, ask your doctor before using a heating pad or a cold pack. Many diabetics have peripheral neuropathy which causes feelings of numbness, usually in the hands and feet, but can also include arms and legs. In this case the person may not be able to feel if something is too hot, or too cold on his body, and the excess heat or cold can cause tissue damage.

Alternating Between Hot and Cold Therapy

Some conditions may require you to alternate between hot and cold therapy. This alternation is also called contrast bath therapy, or Contrast Water Therapy (CWT).

In this case the affected body part is immersed in hot water and then immediately in ice water. This procedure is repeated several times, alternating between hot and cold therapy.

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According to Dr. Michael W. Smith, there is some evidence that heat can help decrease low back pain, and although there is little proof that cold can help, some people do find that cold therapy helps them. (3) So if you suffer from back pain, you can try switching between heat and cold: use heat for 15-20 minutes, then use cold therapy for 10 to 15 minutes.

A study from 2013 reviewed the effect of Contrast Water Therapy (CWT) on recovery of muscle damage after exercise. The researchers reviewed previous studies and showed that CWT provided significantly greater improvements in muscle soreness and reduced muscle strength loss in comparison to passive recovery. The research says that these effects may be most relevant to an elite sporting population. (4)

The study also compared CWT to a large number of other recovery therapies, such as cold water immersion, warm water immersion, compression, active recovery and stretching. However, there was little difference in recovery outcome between CWT and the other recovery interventions.

The Cleveland Clinic and the Arthritis Foundation say that if you suffer from arthritis, you should use heat therapy for joint stiffness, and cold therapy for acute pain and swelling or acute gout flares. Also headaches can benefit from both heat and cold therapy: for throbbing headache use cold pack, whereas moist heat relieves painful neck spasms that contribute to headache. (5, 6)

What Research Says About Heat and Cold Therapy

A research published on 2015 mentions the confusion about which therapy (heat vs cold) is best used for. It says that most recommendations are based on observation or experience with limited evidence to support the efficacy of specific therapy. (7)

The use of cold therapy is helpful for reducing pain, blood flow, edema, inflammation and muscle spasm. Heat therapy is effective in relieving pain, increasing blood flow and improving elasticity of connective tissues.

The study has also shown that patients with acute low back pain benefited from heat therapy that provided short-term reductions in pain and disability. Heat therapy also provides significantly greater pain relief than cold therapy in cases of delayed onset muscle soreness (DOMS) which is the pain and stiffness felt in muscles several hours to days after strenuous exercise.

A study from 2013 compared the effect of dry heat vs moist heat in treating DOMS on 100 participants. The research showed that immediate application of moist heat had a greater pain reduction, although immediate application of dry heat had a similar effect but to a lesser extent.

Another advantage was that the moist heat was applied for a much shorter period of time than the dry heat (2 hours for the moist heat vs. 8 hours of the dry heat). (8)

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