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Using Heat vs. Cold for pain.

Oct 06, 2020


Treating Pain:  Heat or Cold


We can treat things like arthritis, pulled muscles, & even inflammation with ice packs or heating pads.  Treating pain with hot and cold can be extremely effective for a number of different conditions and injuries.  The tricky part is knowing what situations call for hot, and which calls for cold.  Sometimes a single treatment will even include both.  As a general rule of thumb, use ice for acute injuries or pain, along with inflammation and swelling. Use heat for muscle pain or stiffness.


Heat & How it Helps-

Heat therapy works by improving circulation and blood flow to a particular area due to increased temperature. Increasing the temperature of the afflicted area even slightly can soothe discomfort and increase muscle flexibility. Heat therapy can relax and soothe muscles and heal damaged tissue.


There are two different types of heat therapy, dry heat and moist heat. Both types of heat therapy should use “warm” as the ideal temperature instead of “hot.”

  • Dry heat includes sources like heating pads, dry heating packs, and even saunas. This heat is easy to apply.
  • Moist heat includes sources like steamed towels, moist heating pads, or hot baths. Moist heat may be slightly more effective as well as require less application time for the same results.  


Professional heat therapy treatments can also be applied.  For example, heat from an ultrasound can be used to help pain in tendonitis.


When applying heat therapy, you can use different types of treatment. Local therapy is best for small areas of pain, like one stiff muscle. You could use small heated gel packs or a hot water bottle if you only want to treat one injured area.  Regional treatment is best for more widespread pain or stiffness, and could be achieved with a steamed towel, large heating pad, or heat wraps.  Full body treatment would include options like saunas or a hot bath.


Heat therapy is often most beneficial when used for a good amount of time, unlike cold therapy, which needs to be limited.  Minor stiffness or tension can often be relieved with only 15 to 20 minutes of heat therapy.  Moderate to severe pain can benefit from longer sessions of heat therapy like warm bath, lasting between 30 minutes to two hours.


When Heat is Not the Answer-

There are certain cases where heat therapy should not be used. If the area in question is either bruised or swollen, or both, it may be better to use cold therapy.  Heat therapy should not be applied to an area with an open wound.  Also, people with certain pre-existing conditions should not use heat therapy due to higher risk of burns or complications due to heat application. These conditions include diabetes, dermatitis, vascular diseases, deep vein thrombosis, and multiple sclerosis.  If you have either heart disease or hypertension, ask your doctor before using a heat therapy.


Cold & How it Helps-

Cold therapy is also known as cryotherapy.  It works by reducing blood flow to a particular area, which can significantly reduce inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain.


There are a number of different ways to apply cold therapy to an affected area. Treatment options include ice packs or frozen gel packs, coolant sprays, ice massage, or ice baths. 



For home treatment, apply an ice pack wrapped in a towel or ice bath to the affected area. You should never apply a frozen item directly to the skin, as it can cause damage to the skin and tissues. Apply cold treatment as soon as possible after an injury.  Use cold therapy for short periods of time, several times a day. Ten to 15 minutes is fine, and no more than 20 minutes of cold therapy should be used at a time to prevent nerve, tissue, and skin damage. You can elevate the affected area for best results.


When Cold is Not the Answer-

People with sensory disorders that prevent them from feeling certain sensations should not use cold therapy at home because they may not be able to feel if damage is being done. This includes diabetes, which can result in nerve damage and lessened sensitivity.  Also, you should not use cold therapy on stiff muscles or joints or if you have poor circulation.



For heat therapy, you need to be cautious of the temperature.  If you use heat that’s too hot, you can burn the skin. If you have an infection and use heat therapy, there is a chance that the heat therapy could increase the risk of the infection spreading. Heat applied directly to a local area, like with heating packs, should not be used for more than 20 minutes at a time.  If you experience increased swelling, stop the treatment immediately.


Also, if heat therapy hasn’t helped lessen any pain or discomfort after a week, or the pain increases within a few days, make an appointment to see your doctor.


For cold therapy, you need to be cautious of applied time.  Cold therapy for too long or too directly can result in skin, tissue, or nerve damage.  If you have cardiovascular or heart disease, consult your doctor before using cold therapy.


Also, similar to heat therapy, if cold therapy hasn’t helped an injury or swelling within 48 hours, call your doctor.


Knowing when to use cold therapy and when to use heat therapy will significantly increase the effectiveness of the treatment.  Some situations may even require both.  Arthritic patients, for example, may use heat for joint stiffness and cold for swelling and acute pain.


Always, if either treatment makes the pain or discomfort worse, stop it immediately.  If the treatment hasn’t helped much with regular use in a few days, you can make an appointment to see your doctor to discuss other treatment options.  It is also important to call your doctor if you develop any bruising or skin changes over the course of treatment.