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Heat and Cold Therapy

See also:

Inversion Therapy

Massage Therapy

Muscle Release

Physical Therapy

Trigger Point Therapy


Personal Training

Genovive – Sample Nutrition & Fitness Report


Definitions and Terms Related to Pain


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Heat and Cold Therapy


When to Use Heat vs. Cold


To determine if applying heat or cold is best, it is important to understand what exactly applying heat or cold accomplishes. Applying heat increases blood flow, turning the tissues pink or red reflecting the dilation of the superficial blood vessels and their increased flow. Increasing blood flow provides injured or inflamed tissues with more of the nutrients necessary for rebuilding or repairing damages. Along with increased blood flow, lymphatic drainage is also increased allowing for removal of toxins and cellular debris associated with injury and inflammation.


Heat also relaxes muscles, providing relief of painful muscle spasm. It is particularly beneficial to apply heat, especially in the form of a hot soak, prior to obtaining a massage to allow for a synergistic benefit from the two therapies. Actually, the same argument applies to a hot soak after a massage as well.


Because heat dilates blood vessels, if heat is applied to acutely injured tissues such as a swollen, freshly sprained ankle, it will trigger greater fluids loss from injured vessels in the area resulting in more severe swelling and bruising. Therefore it is counter-productive to apply heat to new injuries where blood vessels are damaged and leaking. After the first 48-72 hours, when an acute injury has stabilized with no further development of bruising or swelling, applying heat may appropriate.



As one would predict, applying cold to tissues has much the opposite effect of applying heat. The application of cold causes blood vessels to constrict, reducing blood flow and also reducing fluid leakage from acutely damaged or inflamed vessels, thereby reducing the bruising and swelling associated with an acute injury.


Applying cold also slows and impairs nerve conduction, resulting in reduced pain signal transmission from an area of injury. Thus applying cold to an injury may reduce pain and, similarly, applying cold to an area of injury such as an injured muscle prior to stretching that muscle may allow for less pain and greater tolerability for stretching that muscle.


When to Use Heat and Cold

Well, not at the same time. But when recovering from an acute injury, there is often a good argument for using both heat and cold intermittently in the course of a day. In the morning, for example, an injury that has stabilized from a few days of rest and elevation and is no longer showing worsening swelling or bruising would likely benefit from either warm compresses or warm soaks to facilitate the healing process. However, towards the end of the day when daily activities have resulted in increased pain or soreness, especially if accompanied by some increased swelling, it would be appropriate to apply cold to reverse the transient worsening symptoms. Understanding the mechanisms by which heat or cold applications affect tissues allows for more appropriate application of therapy.

Heat Therapy

Your caregiver may advise heat therapy for your condition. Heat applications help reduce pain and muscle spasm around injuries or areas of inflammation. They also increase blood flow to the area and speed healing. Heat treatments should be used for about 30 – 40 minutes every 2 – 4 hours. Shorter treatments should be used if there is discomfort.
Different forms of heat therapy are:
Warm water – Use a basin or tub filled with heated water; change it often to keep the water hot. The water temperature should not be uncomfortable to the sk in.
Heat packs – For moist heat packs, use several bath towels soaked in hot water and lightly wrung out. These should be changed every 5 – 10 minutes. You can buy commercially – available dry heatpacks that provide more sustained heat. However, in general, moist heat packs or warm soaks are preferred because they transfer heat more efficiently than dry heat packs and are therefor more effective. Hot water bottles are not recommended because they give off only a small amount of heat.
Electric heating pads – These may be used for dry heat only. Do not use wet material around a regular heating pad because of the risk of electrical shock. Do not leave heating pads on for long periods as they can burn the skin or cause permanent discoloration. Do not lay on top of a heating pad because, again, this can cause a burn.
Infrared Devices & Heat lamps – Use an infrared light. Follow the instructions when using infrared devices. Keep heat lamp bulbs 15 – 25 inches from the skin. Watch for signs of excessive heat (blotchy areas will appear).
Be cautious with heat therapy to avoid burning the skin . You should not use heat therapy without careful medical supervision if you have: circulation problems, numbness or unusual swelling in the area to be treated.

Cold Therapy

g cold usually translates as applying ice but care should be taken not to apply ice directly to skin for a prolonged time as this can inadvertently cause frostbite and tissue damage. Wrap a cloth around ice or an ice pack prior to applying to the skin and limit the application to 10-15 minutes or so without a break. It can often be helpful to use frozen packs of peas that allow for molding to an area of injury and can be refrozen between applications.


Emphasis on Education


Accurate Clinic promotes patient education as the foundation of it’s medical care. In Dr. Ehlenberger’s integrative approach to patient care, including conventional and complementary and alternative medical (CAM) treatments, he may encourage or provide advice about the use of supplements. However, the specifics of choice of supplement, dosing and duration of treatment should be individualized through discussion with Dr. Ehlenberger. The following information and reference articles are presented to provide the reader with some of the latest research to facilitate evidence-based, informed decisions regarding the use of conventional as well as CAM treatments.


For medical-legal reasons, access to these links is limited to patients enrolled in an Accurate Clinic medical program.


Should you wish more information regarding any of the subjects listed – or not listed –  here, please contact Dr. Ehlenberger. He has literally thousands of published articles to share on hundreds of topics associated with pain management, weight loss, nutrition, addiction recovery and emergency medicine. It would take years for you to read them, as it did him.


For more information, please contact Accurate Clinic.


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