Hot or Cold Therapy – which to use?

We are often asked by patients whether to use hot or cold therapy for soft tissue injury.

Do you apply hot or cold packs to a soft tissue injury?

Both can be very beneficial, but knowing which to use, and when, is crucial to reducing pain and assisting the recovery process.

When used in conjunction with the correct physical therapies, the application of heat or cold  to an area of damaged tissue can reduce discomfort and promote faster recovery. The use of hot and cold therapy is something that you can and should do at home, and should be the first thing that you do following any form of soft-tissue injury.

To understand which treatment is right for you requires an understanding of the reason for the discomfort, and how the body repairs itself.

There are four generally recognised phases of healing for soft tissue injury. Whilst these phases are described here as individual events, there is considerable overlap between the stages.

1. The acute phase (bleeding, swelling,bruising)

The period immediately following any injury, whilst pain, bleeding and swelling is at it’s worst, is known as the ‘acute phase’. This phase commonly lasts for about 2 days. During this phase, the application of cold therapy is commonly advised. The  aim of this is to lower the temperature of the injured tissue, which reduces the tissue’s metabolic rate and  helps prevent edema formation (swelling). It should be noted that some swelling has been identified as an essential part of the healing process, so excessive cold therapy should be avoided. We recommend the use of an ice pack (or bag of frozen peas) wrapped in a tea towel, applied firmly to the affected area for 10 minutes every hour.

2. Sub-Acute – Proliferation or Repair Phase

The proliferation phase essentially involves the generation of the repair material, which for the majority of musculo-skeletal injuries, involves the production of scar (collagen) material. This phase phase has a rapid onset (24-48 hours) but can take considerably longer to reach its peak reactivity – usually 2-4 weeks post injury. The application of heat during this phase helps:

• Increase cellular metabolism and capillary permeability, aiding with the remove debris and waste product.
• Increase oxygen and nutrients into the area to promote healing
• Reduce muscle spasms – providing an analgesic (pain relieving) effect
• Increase extensibility of muscle and connective tissue to help facilitate stretching and elongation of the newly formed tissue

3. Late Stage – Remodelling Phase

Your body does not magically just stop healing after 4 – 6 weeks . Healing is a continuum. At this stage your healing tissue is reasonably mature, but as you stretch, stress and strengthen your new scar tissue your body often finds that it is not strong enough to cope with increased physical demand.

When your body detects that a repaired structure is still weaker that necessary, it will automatically stimulate additional new tissue to help strengthen and support the healing tissue until it meets the demands of your normal exercise or physical function.

4. Chronic Phase – Ongoing Repair and Remodelling

During the chronic stage of healing, the newly formed scar tissue is remodelled by the stresses placed on it. It is at this stage that the correct exercise and stretching routines are essential to ensure a full and complete recovery – this is where the services of a massage or sports therapist are beneficial.

In Conclusion

• Immediately after (and for about 48 hours following) an injury, the use of cold therapy in the form of ice packs can help reduce swelling, and thereby ease pain. Ice packs should be applied for about 10 minutes at a time, with at least an hour between each application. The skin and soft tissue surrounding the injury should be allowed to return to normal prior to re-application of the ice pack.
• Once the initial swelling following the injury has subsided, heat can be beneficial to promote the healing process.

Remember – these are general guidelines as every injury is different. If in any doubt, we recommend that you seek the advice of a medical professional who is qualified to diagnose the nature of your injury, and who will be best-placed to offer the correct guidance based upon their findings.

If you are suffering from a soft-tissue injury and  need to return to work or sport as soon as possible, Riviera Wellbeing – Chiropractic and Wellness Centre in Paignton can help reduce your recovery time.

We also stock a range of heat and cold therapy products at our clinic in Gerston Road, Paignton.