Hot or Cold ? A Common Question
I haven’t kept track but suspect that I resort to heat or cold first for almost any aliment that is bothering me – small pains or injuries. However, I remember from patients, family and friends that which one to choose (heat or cold) is not always intuitive for everyone. It’s a common question. When home treatments are part of your routine, it’s good to feel confident about your choices.
During recent times of COVID, Omicron and general pandemic, reports show that many have avoided the hospital or discretionary health care visits. These are times when self-help has to be a consideration. Good for us to at least conquer the low-hanging fruit.
How Heat & Cold Play a Role in the Mechanism of Injury
Injury isn’t the only time to decide about using hot or cold. But it’s a common conundrum that pops up at that urgent time. Soft tissue injury damages blood vessels, creating bleeding inside the tissue, leading to swelling noted around the injured site. Inflammatory features, which include redness, warmth, tenderness and swelling, are due to stimulated chemicals that cause blood vessels to enlarge and leak fluid. The pain is the result of specialized nerve endings, contained in the soft tissues and skin, which send signals of pain when the area is damaged.
Hot and Cold play a role in inflammation and healing. In the simplest of terms, it can be thought of like this:
You’ve heard about the man who put his money in the freezer
because he wanted cold hard cash?
Okay, so that is not the price of ice to which I speak. Somewhere in your experience, you have probably learned or read about the acronym P-R-I-C-E for first-aid applications. It stands for Protect – Rest – Ice – Compress – Elevate. I want to concentrate on the ice portion here.
A cold pack will relieve the swelling around the injury site by narrowing blood vessels that were dilated during damage. Heat can be helpful at times as it promotes blood flow, but it can also exacerbate an inflammatory process. Cold is less tricky, especially if you are making your own decision for home treatment.
Typical recommendations vary, but for the first 48 – 72 hours ice is generally helpful to reduce swelling and bruising. My general protocol is to apply the ice pack to the injured area for 20-30 minutes, repeating approximately every 3-4 hours (mostly depending on how busy I get). That method is fairly common.
You will usually notice some ‘deadening’ of pain while an ice pack is in place. This may create a tendency to leave it on longer than the recommended time — don’t. In simple terms, prolonged or continuous ice-use can mimic the effect of heat.
Cold Mitten Rubdowns
Here’s an old idea made new again. Friction rubs with cold mitts can stimulate blood flow, increase circulation and muscle tone and exfoliate the skin. It can be done with a cold washcloth, loofa sponge, or gloved mitts; most experts prefer Turkish-towel material.
Cold friction rubs are generally used as a broad tonic rather than for any specific condition, disease or fist-aid. There is little mystery about the implementation — simply rub as vigorously as you like (unless you have tendencies towards masochism) until the skin has a pink glow. Always start farthest from the heart and work toward it. Example, work from hand to forearm to shoulder, or from toes to legs to hips. Cold rubs are usually safe enough for daily use during or after a shower or bath. Admittedly, I question my interest in a cold rub after a nice warm shower, but hey, that’s me.
It’s doubtful that anyone reading this has never used heat for a painful area. Impossible? Heat is beneficial (promoting blood and nutrients to speed the healing process) and helps reduce pain by relaxing and loosening tense muscles. Definitely that ‘aaaaahhh’ feeling. Occasionally, I snuggle up to a heating pad simply because I’m cold.
Application options are a choice, like using a heating pad or a moist towel warmed in the microwave to apply to the painful area. If using a towel from the microwave be extremely careful of hot spots that may burn. I have a microwavable barley-stuffed heat pack that never has hot spots, and it holds the heat a long while. Further, you don’t have to worry about shutting it off. Additionally, you can simply take a warm bath or shower (not typically helpful for specific areas, other than perhaps low-back pain).
Timing is important to consider, especially because the heat can feel nice, and you might overdo. It’s best to apply heat for no more than 30 minutes at a time (20 preferred by some professionals), and with wait-times of at least 2-3 hours in between.
Heating pads often come with a ‘moisture’ cloth inside. These are simply rinsed in water, rung-out and placed back inside the cover. Moist heat is generally preferred over dry (except for a few situations, like surgical recovery).
In general, chronic pains (like certain back pain) seem to respond better to heat. If you tend toward muscle spasm that ice could exacerbate, stick to the heat. With acute injuries, if after 48 hours, the ice has reduced all swelling, then applying heat will likely augment continued healing.
A major caveat – if you use an electric heating pad, never sleep with it; never sleep on it.
The second big caveat about heat is this: without professional guidance (which may be hoping to achieve a specific reaction), never apply heat to an area that is continuing to swell or, after reducing, begins swelling once again. It will bring more blood back into the area.
What Kind of Pad to Use?
It matters little what kind of pad you use. You can even ring-out a washcloth with cold or hot water. However, here is a small note about accessibility if you don’t have an ice pack. Use a frozen bag of peas. Wonder if anyone is going to ask if frozen corn will work? [It will.] Quinoa may not work like peas, but I am including this just in case you are minding your “Ps and Qs.”
If you are really serious about having both hot and cold treatment available at home, consider purchasing a dual-use pad. Often cloth-covered, they can be kept frozen in the freezer (still somewhat flexible) or heated in the microwave. After having blown through many of these, I suggest that you don’t alternate them frequently. Best to have one for the freezer and one for the microwave; they seem to last longer that way.
Cheap and Preferred Tip. This is my personal favorite. I once received a package including foods needing cold storage. It arrived with several Trycold gel-packs (www.Trycold.com) for the perishables during shipping. I noticed they were flexible and touted their ability to “stay colder, longer.” I have had similar ones before, which I put in the freezer with variable success. This time, I placed the gel-packs in a jumbo plastic bag (despite we hate all this plastic) and put it in the deli drawer of the refrigerator. As with any pad, I still wrap them in a towel (leaving them in the bag) and they stay cold the entire 20-30 minutes I use for icing. A couple years later I can report they work great. I’m sold.
No matter what product you use, make sure it is covered (even if just with a small towel). This is to protect the skin. Color changes can indicate WARNING – the skin can turn bright red due to warm or cold temperatures (just an alert). However, the serious warning comes if the skin turns blue (as in frostbite) or a dark red color, indicating that your skin is being burned. Don’t think, “it can’t happen.” It can.
Happy Together – Contrast Therapy
Remember that old Turtle’s song, “Happy Together” (a rare ‘happy’ song that starts in a minor key). Well contrast therapy is a bit like that. We start out sad (minor) with our ache or pain and transition to a happy face.
That may be optimistic, but still, lots of at-home-treaters (and professionals) use hot and cold as contrast therapy. Alternating between the ice and heat can offer synergistic benefits above-and-beyond either alone.
While trying not to sound like a bad TV actor warning the audience “not to try this at home,” let me add this caution. Don’t attempt this, or any home-treatment, if you have an acute injury, medical condition, or any emergency physical situation in which common sense would steer you toward professional help. If that’s the case – go.
Still, for most of us, in most situations, contrast therapy can offer an easy and cheap way to aid ourselves – relax and loosen muscles, lower inflammation, and enjoy natural pain relief. Frankly, we are all different and you may need to experiment with your own reactions to determine if this is beneficial to you (and worth the slightly added effort).
I’ve experimented with different recommended schedules. While I have seen references to doing it only twice a day, when motivated, I’ve done it quite a few more and found it helpful. Basically, if you experience benefits, keep it up. However, if you are at all uncertain about an injury or pain continuing after three days, consult your PT, doctor, chiropractor, osteopath, or FNP for reassurance (or stronger treatment).
Two Contrasting Approaches to Contrast-Therapy
There are different schedules to follow if you decide to apply these two different mediums for the same problem. The goals are the same (as mentioned above) but the timing different.
- One from Mayo suggests applying heat for 15-20 minutes, wait a few hours and then use ice for 15-20 minutes. This is spaced throughout the day.
- Others suggest a different routine for applying the cold and heat, which I tend to prefer. Who knows why? Again, it’s just my own preference.
- 1 minute cold/or ice pack
- 3 minutes heat
- 1 minute cold/ice
- 3 minutes heat
- 1 minute cold/ice
- 3 minutes heat
- Finish with 1 minute of cold/ice (unless you feel compelled to return to heat)
Times to Avoid Contrast Therapy?
When sticking to a small area of pain or injury, applying hot and cold therapy is usually considered safe, and easy for the do-it-yourselfer. However, there are a couple times to avoid the alternating approach.
- An acute injury (within last 2-3 days). Stick to ice if not seeking professional help.
- Fever or infection. We don’t want additional heat for either.
- An open wound or skin issues. We want to avoid risk of infection from burns (even sunburn), cuts/scrapes or cysts and boils.
- Raynaud’s Syndrome or Cold Urticaria. Both of these conditions react poorly to cold – Raynaud’s constricting blood vessels and Urticaria producing hives.
- Circulatory and heart conditions. This is a time to check ahead with your doc (there can be bad reactions from alternative applications of extreme hot and cold).
- Peripheral neuropathy/diabetic neuropathy. This should be listed under Cold, Heat or Contrast Therapy. The condition reduces the sensation of pain; thus, you could burn your skin (with ice or heat) and not realize it.
A Quick Chart Reference
There are always new approaches and different ways to handle treatments, but the following chart offers you guidance for home use.
Time for Cold
Time for Heat
Note: Heat should never be applied to abdomen if symptoms of appendicitis are present, nor for any unknown, undiagnosed abdominal pain.
Heat or Cold is a hot item for discussion. Remember, that there’s a good reason to experiment with handy heat and thin ice; it’s the best way to achieve a major breakthrough. (Go ahead and say ‘ugh’ – it’s cold comfort.) Still, it’s smart to start with the easy, inexpensive, and at-hand possibilities first.
Picture credit: woman with question mark by Tumisu via Pixabay click here
Mayo Clinic on drug-free pain relief: Using heat and cold for pain | Mayo Clinic Connect
120 years and Holding – a Smorgasbord of Options for Everyday Wellness & Superior Longevity (2001) by Barbara Klein, (out of print)