​Choosing Heat vs. Cold Therapy in Rehabilitation

8th Dec 2016

Posted by Sara Zuboff on

​Choosing Heat vs. Cold Therapy in Rehabilitation

Should I use Hot or Cold TherapyMost patients, when given a choice, would always choose some sort of heat therapy over cold therapy mostly due to preference or comfortability. Both can be good choices for pain management, but using hot or cold therapy in rehabilitation is dependent on not only pain management, but increasing function and desired outcomes.

Truthfully, heat isn’t always the best option, because depending on the type of pain experienced, it can actually make pain worse due to its ability to increase circulation to the injured area, which can create a throbbing, pulsing sensation. On the other side though, heat can be effective in some cases for both reducing pain and increasing range of motion. This makes the rule of thumb for both heat and cold therapy to evaluate each patient’s issues individually and make decisions on a case-by-case basis. And, what we have found with some analysis, is that it isn’t always a case of heat versus cold therapy, since both are effective in the course of a treatment plan. We have discovered that what is most important about choosing whether to use heat or cold therapy is to consider the timing.

Let’s look at some hot and cold therapy options in regards to case studies in order to distinguish where hot or cold therapy would be appropriate and the timing of the treatments.

Hot & Cold Therapy Options for Diverse Rehabilitation Populations

A 45-year-old female patient complains of chronic sciatic nerve pain. She works in an office and can spend up to 10 hours at her desk every day during the week. The nature of her pain makes it difficult to exercise so she currently doesn’t follow any exercise regimen and has difficulty stretching.

Hot & Cold Therapy Options in Physical Therapy for Treating Sciatic Pain:

  • Cold Compression Therapy: With regards to our case study, it’s important to address the chronic pain in order to be able to treat the causes of her sciatica. In this case, cold compression therapy would be a great tool to consider because it uniquely combines cold therapy with compression effectively lowering pain and decreasing any swelling. Cold therapy is a great choice when treating acute sciatic pain, because it will effectively decrease the throbbing, sharp pain that the compression of the sciatic nerve can cause.
  • Heat Therapy: Conversely when treating sciatic pain and the intention is to stretch the sciatic nerve in order to release the pressure from the sciatic nerve, it would be more useful to use heat therapy. Whether using a heating pad or ultrasound therapy, research has found that using these modalities before stretching the piriformis are actually more effective in releasing the sciatic nerve.

A 55-year-old male patient complains of carpal tunnel pain. In addition to working at a desk on a computer for long stretches, he also plays guitar as a hobby for several hours a week. The nature of his pain makes it difficult to participate in daily activities, like cooking and interrupts his sleep.

Hot & Cold Therapy Options in Physical Therapy for Treating Carpal Tunnel:

  • Cold Compression Therapy: Cold compression therapy is beneficial when pain is most acute with carpal tunnel syndrome. The combination of ice and compression help control the excessive blood flow and swelling to the wrist and hand which can cause compression of the median nerve which results in pain. In addition, the cold delivers an almost immediate analgesic pain reducing effect, making it a great choice with both acute pain, but also after gentle stretches and therapeutic exercise.
  • Heat Therapy: Heat therapy in the form of ultrasound therapy is beneficial for the long term treatment of carpal tunnel pain. A study published in the BMC Musculoskeletal Disorders found that ultrasound therapy combined with wrist orthosis is beneficial in reducing the severity of pain but also improved the results for the palmar pinch test measuring pinch strength. One other significant thing to note about this study is that patients only received 5 minutes of ultrasound therapy twice a week and still had significant improvement, making ultrasound therapy not only effective, but time-efficient too. 

A 62-year-old female patient complains of osteoarthritis pain. The patient is a teacher and spends several hours a day on her feet. She has significant pain and swelling in her knees and ankles, most often at the end of a work day, making it difficult to participate in daily activities like driving, cooking and doing dishes.

Hot & Cold Therapy Options in Physical Therapy for Treating Osteoarthritis:

  • Cold Therapy: Cold therapy is beneficial for treating acute osteoarthritis pain and can help reduce inflammation, swelling, and pain. Oral pain medications are often prescribed for osteoarthritis pain, but have side-effects that can be detrimental in the long-term. Cold therapy gives patients a non-invasive pain-relieving alternative. Cold therapy for osteoarthritis is beneficial in the following modalities:
    • Cold packs
    • Cold Compression Therapy
    • Cold water whirlpool therapy

In addition, cold therapy is helpful when treating acute pain at the beginning of a physical therapy session in order to reduce pain enough to participate in more movement and/or strength based treatments. Conversely, cold therapy is also useful at the end of a session in order to reduce any triggered pain that may have arisen as a result of treatment and reduce the risk of inflammation to the joints.

  • Heat therapy: There are a few heat therapy modalities that can benefit osteoarthritis patients, including whirlpool therapy. The use of warm water whirlpool therapy is effective in both reducing pain and improving stiffness. A study published in the Journal of Physical Therapy Science found that warm water whirlpool significantly reduced both pain and swelling, but also helped improve range of motion and function in knee osteoarthritis. These findings indicate that warm water whirlpool therapy is a great modality to use at the end of a treatment session or immediately after therapeutic exercise.

When treating using hot or cold therapy it’s important to inform patients of the desired outcome from the chosen modality. Innovations have been made to make hot and cold therapy more comfortable for patients, however due to the extreme differences in temperature; there are differences in their rehabilitative applications. Evaluating each patient’s issues individually and choosing the correct time to use either heat or cold therapy increases the effectiveness of these powerful rehabilitative modalities.

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