Hot and Cold Therapy

Whether used separately or in conjunction with each other, hot therapeutic interventions and cold therapeutic interventions work to reduce pain and promote the healing of injured tissues. Under certain conditions the body’s response to alternating hot and cold treatments often speeds up recovery in damaged muscle and other soft tissues.

COLD OR ICE (CRYOTHREAPY) THERAPY

 Cold therapy is often referred to as cryotherapy or the application of a cold source to treat damaged and healing tissues, especially in the acute phase of rehabilitation or healing. The acronym RICE is used as a guide for the therapeutic intervention of acute (new or immediate) musculoskeletal injuries where there is pain and swelling. The “R” stands for rest, the “C” stands for compression, and the “E” stands for elevation. The “I” refers to “ice” or cold therapy and is used to help lower the skin temperature, impede nerve pain signals, and control swelling by its ability to cause blood vessels to constrict and reduce blood flow to the site.

It is important to understand that the more swelling there is the more pain a person will experience as the swelling stretches tissues and activates the free nerve endings within the tissue. Also, the greater the swelling the longer the healing time because tissues cannot heal as fast when stretched due to swelling. 

Cold Therapy Application

The application of cold or cryotherapy following an acute injury (or post-surgery) is used to reduce the physiological responses to tissue damage – bleeding, an inflammatory response, and muscle cell activity. The local application of cold provides these effects that help reduce these physiological responses and protect tissues:

• Vasoconstriction to reduce blood flow and decreased microvascular permeability thereby limiting bleeding and tissue edema (swelling) at that site of injury as well as residual or nearby tissues
• Decreased local cellular and tissue metabolism, and therefore a reduced need for oxygen yielding a reduced inflammatory response, which is also associated with pain reduction and muscle guarding
• Decreased intra-articular temperature (with long-term application) reducing the metabolism of articular tissues and the deleterious effects of heightened cartilage-degrading enzymes
  
  

It is recommended that ice/cold be applied to an injury as soon as possible after the traumatic event with studies showing that the sooner cryotherapy is applied, the more beneficial the inhibitory effect on the physiological responses. The immersion of an extremity that has sustained a small burn in cool water or the application of a towel emersed in cold water and applied to the burned body part is also helpful in reducing the tissue degradation while providing a analgesic effect.

Cold therapy has also been used effectively on chronic painful conditions such as osteoarthritis, rheumatoid arthritis, adhesive capsulitis (Frozen Shoulder), and even tendinitis and epicondylitis.

Contraindications or Precautions to the Use of Cryotherapy

• A condition of Raynaud’s phenomenon: In some individuals this condition is triggered by exposure to cold and results in excessive vasoconstriction, increased pain, and a dramatic reduction in finger dexterity
• Cold urticaria: Can cause excessive release in histamine that could aggravate the condition resulting in hives
• Over superficial or regenerating peripheral nerves: Could possibly cause nerve injury and/or reduce nerve transmission
• Long-term application on at risk populations: Older adults and young children are at greater risk for excessive heat loss and possible drop in core temperature

 

General Use Guidelines for Cryotherapy

1. Intensity of Cryotherapy

• To reduce swelling and slow metabolism: A milder application for a tissue temperature drop not to exceed 15° C (59° F)
• To reduce pain: A colder application sufficient to depress nerve conduction by reducing tissue temperature to below 13.6° (56.5° F)
• To cool muscle or joints: A very cold source such a ice packs or ice massage

2. Duration of Cryotherapy Application

• To reduce swelling and slow metabolism: Up to 20 minutes
• To reduce pain: Skin anesthesia occurs with ice massage after 5 to 15 minutes
• To cool muscle or joints: muscle temperature drops to a sufficient level after 15 to 30 minutes depending on the use of ice massage or cold packs

3. Frequency of Cryotherapy: Can be repeated up to several times per day, but the use of cryotherapy after 24 to 48 hours may negatively impact healing due to vasoconstriction effects and reduced oxygen delivery to the injured site

Different Application Devices for Cryotherapy

• Ice packs
• Cold packs
• Ice massage
• Cold immersion baths
• Vapocoolant spray
• Controlled cold compression units 

HOT/HEAT (THERMOTHREAPY) Therapy

Hot therapy is often referred to as thermotherapy or the application of a heat source to damaged and healing tissues, especially in the chronic phase of rehabilitation or healing. Heat increases blood circulation to damaged tissue bringing oxygen-rich blood and important nutrients that promote healing to chronic injures and provide pain relief as well as facilitate the removal of lactic acid. 

Heat is also provided as a stretching adjunct to help muscles relax and other soft tissues to become less stiff and more pliable further enhancing stretching interventions toward increased joint range of motion. Relaxed muscles and other soft tissues like connective tissues alleviate pain.

Cold Therapy Application

Thermotherapy is the application of heat delivered through a variety of sources that produce electromagnetic waves within the infrared spectrum. Heat can be delivered via radiation (transferred through space such as a heat lamp), conduction (transferred via direct contact of the heat source with the skin (hot pack or heating pad), or convection (transferred by movement of warmed matter such as whirlpool therapy). The infrared waves produced by these thermotherapy agents are absorbed in the skin and deeper tissues have heat transferred to them via compression and conduction.

The effects of heat application depend on increasing the temperature of the targeted tissue to a level of 41°C to 45°C (106°F to 133°F) in order to produce physiological responses sufficient to achieve therapeutic results. In general, this degree of temperature is achieved in 8 to 10 minutes. The physiological effects in the heat-absorbed tissues include:

• Increased metabolism, oxygen tension, and vasodilation for enhanced delivery of oxygen and nutrients to healing tissues
• Muscle relaxation via inhibitory effects on muscle spindles and stimulatory effects on Golgi tendon organs
• Pain relief via the gate control theory of pain management and the inhibition of nociceptive signals in the spinal cord, and the sedation of sensory nerve endings
• Increased connective tissue extensibility when used in conjunction with stretching exercises

Indications for Use of Thermotherapy 

Indication for Use	Rationale
Chronic Conditions – low back pain, carpal tunnel syndrome, etc.	Pain is relieved at trigger points, reduced muscle stiffness, greater flexibility, enhanced grip strength, improved musculoskeletal functioning
Common Soft Tissue Pathologies – strain, sprain, dislocation/subluxation, contusion	Enhanced blood flow and oxygen and nutrient delivery and reduced pain sensation, greater range of motion
Chronic Inflammation Cumulative Trauma Syndromes – tendinitis, tenosynovitis, bursitis	Lower levels of pain and increased range of motion, greater flexibility and improved musculoskeletal functioning
Osteoarthritis and rheumatoid arthritis	Lower levels of pain, increased range of motion, more flexibility, reduced disability
Musculoskeletal contracture and scar formation	Increased soft tissue extensibility
In preparation for therapeutic exercise or manual therapy technique application	Warms the tissue for enhanced extensibility and ease of fluid movement while providing a pain reducing effect
Prior to electrical stimulation application	Stimulation of perspiration will decrease skin impedance and improve electrical conductivity of the skin

 

Contraindications or Precautions to the Use of Thermotherapy 

• Areas with acute inflammation: The heat induced increased blood flow may aggravate the inflammation and edema
• Malignancies: May lead to metastasis of the tumor due to increased blood flow
• Following denervation or surgical repair: May affect vessel dilation due to damaged neural control
• Thrombophlebitis: May increase blood flow sufficient to dislodge clot
• Areas of sensory loss: Sensory impairment dulls sensitivity making sensation of excessive heat less than normal
• Current Fever: May further increase body temperature if the application of additional heat triggers the central mechanisms to dissipate heat
• Superficial metal implant: If thermal transfer is excessive it may heat the metal and cause a burn

General Use Guidelines for Thermotherapy

1. Metal/jewelry should be removed from site of treatment
2. Check patient’s temperature sensation in the area to be heated
3. Check patient’s skin integrity before application
4. Periodically observe patient’s condition after heating is initiated

Different Application Devices for Thermotherapy

• Dry heat therapy
• Hot packs
• Air-activated heat wrap
• Whirlpool
• Paraffin bath 

Shop popular hot and cold therapy products used for physical therapy, occupational therapy, sports medicine and any rehabilitation form soft tissue injury. ProHealthcareProducts.com carries a variety of hot and cold therapy treatment products and systems as important treatment modalities in the treatment of pain and promotion of tissue healing.