FAQ: Heat or Cold?

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One of the most important and enjoyable parts of my job is educating someone on their injury and recovery. This FAQ series will answer some of the most common questions I get asked.

Do you have a question you want answered? Drop a comment below or email me at jesse@districtperformancephysio.com.


Question:  Should you use heat or cold when treating an injury?

The majority of the time, the answer is: whichever one feels better. In some cases, you will want to specifically use hot or cold or you shouldn’t use one or the other. In most cases, it’s really about whichever makes you feel better. Instead of stressing out about which is perfect, try alternating hot and cold for a few days and seeing which makes a bigger difference.

When to Specifically Use HEAT

The biggest benefit from heat is an increase in blood flow. The heat opens up your blood vessels, allowing more blood to circulate in that area. This is great for any injury that needs more circulation (most injuries), especially chronic tendon pain like hamstring, achilles, or rotator cuff in the shoulder. It’s also great for a joint or muscle that feels stiff like, a stiff knee, neck, or back. If your pain didn’t just start and has been around for a while, it’s usually a good idea to start with some heat before you try cold.

When NOT to use HEAT

There are times when increased circulation isn’t a good thing. If you have an inflamed area and there is redness, swelling, or a lot of pain, then heat probably isn’t a good idea. The heat can make the inflammation worse. If the area has a lot of pain, then heat also can make the intensity of the pain worse. If your injury is very acute (less than 2 days) then it’s usually a good rule of thumb to hold off on the heat.

When to Specifically use COLD

Using a cold pack has two main benefits: restricting blood flow and the numbing effect of the ice. Cold is great for calming pain down. Even if it’s only to numb the area, using a cold pack on a painful joint or muscle can go a long way to feeling better. What about for acute (less than two days)? The old rule of thumb was to put ice on an injury as soon as it happens to reduce inflammation. There’s some newer research out that shows that immediately icing a sprained ankle could actually delay healing instead of speeding it up. While it’s not perfectly clear either way, I probably wouldn’t recommend icing an acute injury right now. For now, my recommendation is to use a cold pack when you want to calm pain down and not for acute injuries.

When NOT to use COLD

Cold packs are usually not great to use when stiffness is the main problem. If you have tight muscles or a stiff knee or shoulder, the cold will probably make that stiffness worse before you get better. A better alternative would be to use heat, or even better, to use light stretching or exercise to naturally get an increase in blood flow to that area.

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