Do I use heat or cold?

 Do Osteopaths recommend hot or cold for a particular injury? Well, the jury is still out. Recent literature does not provide us with a concrete answer. 

This blog aims to give you some information of what heat and cold will do for you.

Heat Therapy

Heat therapy is also known as thermotherapy.  It aims to improve circulation and blood flow. As a result, the application of heat may:

Ease discomfort, relax muscles and increase muscle flexibility.

Heat therapy may also reduce muscle spasms and cramping. The thought is that as blood vessels relax blood flow improves.  This result is more relaxed muscle tone.

There are two main types of heat therapy:
•    Dry Heat: this includes heating pads, dry heating packs, and sauna
•    Most Heat: Steamed towels, hot bath, moist heating packs

Thermotherapy is commonly used in chronic pain injuries. 

Don't use heat when there is bruising or swelling of a body part.

Please be aware some people should take extra care when using heat. Some medical conditions affect or reduce your ability to feel the heat.  For example, if you have diabetes, vascular disease or multiple sclerosis.
Use heat therapy for:
•    Chronic pain
•    Relaxation of muscles
•    Recurrent injuries


Cold Therapy

Cold/Ice therapy is also known as cryotherapy.  It aims to reduce blood flow to a particular area and thus may reduce inflammation.  The reduction in blood flow may lead to a decrease in pain, swelling.

Cryotherapy may be used in acute injuries such as ankle sprains.    
It may also help overuse injuries such as tennis elbow or tendinitis. 
Sports Medicine Australia recommend the R.I.C.E.R protocol for soft tissue injuries.  This means to continue using ice for 48-72 hours after the injury.  Apply a cold pack to an area for 20 minutes and then follow up with 20 minutes of removal for 2 hours. You can do this while sitting watching TV at night.  R.I.C.E.R stands for rest, ice, compress and elevate. 

Take care as a cold pack should never be directly placed on the skin as it may cause burns.  Cover your ice with a wet tea towel. 

Again, remember to be careful using heat in those with altered skin sensation.  If unsure, consult your doctor.

Ice therapy may be useful for
•    Acute injuries

•    Overuse injuries

•    Tendinitis/Tendinopathy


The Verdict

I tend to agree with Sports Medicine Australia's guidelines.  The R.I.C.E.R protocol.  With little conclusive research, out there as an osteopath we recommend to apply what feels better for the individual. The above information aims to better inform everyone as to what each therapy may assist with.
By Dr Andrew Charalambous, Osteopath