Should I use Hot or Cold?

Osteopathic advice in LymingtonUsing hot and cold treatment is easy, cheap and effective for pain relief and I often advise patients to use it as part of their osteopathic treatment. There is a lot of conflicting information out there and advice tends to be generic without considering individual factors. Still, I hope this blog will help you to feel better informed as I aim to explain how and why this simple therapy can work to relieve your symptoms.

When referring to heat and cold I am referring to things like a hot water bottle, wheat bag, warm bath or shower, cold packs and good old frozen peas- all of which must have a protective layer to protect your skin from burns.

It’s also worth noting that in particularly fleshy or bony areas, the tissues’ penetration time can take more and less time, and so 20 minutes is a long enough application for both.

What do heat and cold applications do?

Simply put, application of heat or cold on the skin work by affecting the superficial tissues’ blood supply of the area you place it, to increase or decrease local circulation. Heat brings an increased blood flow to the area and cold reduces local blood flow temporarily.

  • Using heat on the body is well known to comfort and help to relax sore muscles and aches and even abdominal pains. Heat works really well on muscle spasms and ‘knots’ as it relaxes local tissues. Though, if your symptoms are resultant of a new injury causing local swelling (tear, sprain, obvious swelling with heat), the act of encouraging extra blood flow increases the swelling and makes it feel a lot worse so heat is not advised in those cases
  • Applying cold to areas of local heat and swelling provides temporary relief of these symptoms by reducing the pain causing inflammation. Soft tissue injuries where there is lots of swelling can put strain on surrounding ligaments causing further pain such as with an ankle sprain, so this is ideal for cold application as it also literally ‘numbs’ the pain by effecting nerve transmission.
  • HOWEVER- Not all inflammation benefits from cold application as there are different types of inflammation- such as chronic low level inflammation in arthritis and following and injury which we will discuss in ‘contrast bathing’. Cold leads to tightening of local muscles and tissues and so generally people find it unpleasant, and so it is only really useful for the above situations.

Some important tips and examples of hot and cold application

  • If the weather or environment you’re in is already hot, or you are a ‘hot’ person, you are not going to want to add more heat to the situation if you are already feeling very warm, this can actually aggravate your body and even make you feel worse.
  • Likewise, if you know you dislike the feel of cold, it probably won’t help and just add to your tension, though if a lot of swelling exists and it feels hot, get yourself nice and warm and comfortable before applying your cold pack for 20 minutes at a time and first of all ask yourself whether it feels right to be putting cold on the area- your body normally knows what it wants.
  • If you have had a sudden recent tear, sprain or strain caused by a trauma and the area feels hot and swollen– obviously get it checked for underlying damage such as fracture and ligament tear particularly if it is affecting your ability to move and weight bear, but this sort of injury will normally respond well to cold treatment. Bringing down the swelling help prevent damage to nearby structure and reduced the pain.
  • Don’t overdo the hot and cold applications, stick to 20 minutes and do not use extreme temperature, as prolonged use can affect the blood vessels in the area becoming over dilated or constricted too regularly affecting circulation negatively and causing long term skin mottling.
  • Neck pain and back pain usually respond well to heat, rarely does cold application help these areas and usually it actually makes you feel worse! Heat helps the muscles relax even if it is not purely a muscle complaint- the muscles react to any local structure pain or irritation and so getting them to relax is beneficial also aiding movement.
  • When using heat on a muscle spasm or very painful muscles, be careful to move slowly afterward to get the body used movement after being so relaxed, as a quick movement can sometimes cause the muscle to guard up and spasm again.
  • Stiff joints respond very well to heat as it increases the blood flow and therefore joint fluid to make movement easier.
  • Listen to your body, if it feels wrong, it’s wrong!

What about contrast bathing?

Contrast bathing is useful for chronic inflammation such with a prior injury that still looks a little ‘fluidy’ for example knee and ankle injuries, long term low back problems where the circulation could be improved. Circulation is also boosted greatly by movement of the joint itself by you actively or a trained professional passively to reduce inflammation and encourage circulation.

How to contrast bathe; you can use a cold pack and either just open air (just take the cold off!) or heat – always start and end with cold, apply the cold for 2 minutes, then the hot for 2 minutes (or leave cold off 2 min) and repeat this pattern until there have been 5 applications and so a total of 10 minutes for the whole procedure. This creates a ‘pump’ like system allowing the blood flow to increase and decrease to the local area.

Please let me know if you have any further questions!