How to Use Hot and Cold in Physical Therapy?

From rheumatic joint pains to muscle strains and herniated discs, hot or cold applications are used in the treatment of almost every disease affecting the musculoskeletal system. Hot and cold applications can be done in physical therapy units, as well as treatments that people can often do on their own at home. The main advantage of hot and cold applications is pain relief, muscle relaxant, edema reducing effect without the use of drugs and inexpensively. So when is hot and when cold treatment is preferred and what are the issues to be considered while doing these treatments?

Two types of self-made hot treatments can be mentioned: Dry and wet hot treatment. 

As a general rule, cold application is used for the treatment of sudden (acute) injuries and pain. Inflammation (immune system activation) and edema are high in acute injuries. Cold application reduces this. Hot application is generally preferred for long-standing (chronic) problems. Warm treatments reduce muscle pain and spasm. Sometimes, both hot and cold applications can be used alternately or simultaneously for different body parts in the same person.

Why Is Hot Pain Good?

In both treatments, a moderate temperature increase is aimed, not overheating the tissues. Dry hot packs are an example for dry heat treatment; are more practical to use. Wet hot treatment is done with moist towels, wet hot packs or hot baths.

In addition to the superficial heating treatments performed in a dry or humid environment, physical therapy also includes treatments for heating deep tissues with special tools. Ultrasound, short wave diathermy, microwave diathermy are some of the methods used for deep heating.

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Expansion (vasodilation) occurs in the veins with hot therapy. Blood flow increases. Thus, more oxygen and nutrients reach the tissue. Waste materials are removed faster with increased circulation. The transmission of the signals of the sense of heat with the nerve fibers reduces the signals of the sense of pain reaching the brain. Hot therapy is beneficial in reducing connective tissue stiffness and dissolving tissue adhesions. With warming up, muscle spasm is resolved, pain is relieved and range of motion increases.

Heat therapy can be applied to a small area, locally or in a way that affects the whole body. In local complaints such as muscle stiffness, it is sufficient to apply hot application only to the affected area. Regional treatments can be performed for pain and stiffness affecting a wider area. A hot damp towel or a large hotpack can be used for this. Treatments such as hot springs and saunas that warm the whole body can be preferred for common joint calcification.

If there is no obstacle to exercise, stretching and warm-up exercises are also a good method to warm up the body and muscles.

When Is Hot Treatment Harmful?

If there is bruising or swelling in the problem area, hot treatment may be inconvenient. In this case, cold is more useful. Hot treatment is not applied on open wounds.

Hot therapy may be harmful in the case of diabetes, dermatitis, vascular disease, patients with intravascular clots (deep vein thrombosis), multiple sclerosis. In diabetes, the sense of sensation may be decreased in the person; therefore the risk of burns increases. In multiple sclerosis, the application of heat worsens the complaints. Severe heart failure and uncontrolled high blood pressure prevent treatments such as spa and sauna.

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How is Hot Therapy Applied?

Cold therapy should be applied for a limited time, while hot treatments can be done for longer periods. Mild muscle tensions can be relieved with 15-20 minutes of hot therapy. More severe pain and stiffness may require prolonged application, which can last from 30 minutes to 2 hours. Hot packs should always be used wrapped in a towel to prevent skin burns.

Cold Treatment

Cooling treatments are also called cryotherapy. With cold application, narrowing of the vessels (vasoconstriction) is provided. Thus, the blood flow in a certain area can be reduced. As a result, immune system activity (inflammation) and edema are reduced. Since edema in joints and tendons causes pain, reducing edema relieves pain. In addition, the temporary decrease in the activity of nerve fibers with cold application also contributes to the reduction of pain.

Cold Application Types

Ice packs, cold gel packs, cooling sprays, ice massage, ice bath are various methods of cold application. Cold can be applied to reduce muscle spasms during stretching exercises. Cold therapy and active exercises can be combined in ligament injuries.

When Should Cold Therapy Not Be Used?

People whose sensory sense is impaired by diabetes or nerve injury may not feel pain that indicates tissue damage; Therefore, it is inconvenient to apply cold therapy at home. Cold application is not preferred for affected muscles and joints. If there is circulation disorder, cold application should not be done because cold reduces circulation even more.

How is Cold Therapy Applied?

Cold packs should be used wrapped in a towel. Never let a frozen object come into direct contact with the skin. If the cold comes into direct contact with the skin, it can damage the skin and subcutaneous tissues.

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Cold application should be started as soon as possible after acute injuries. The duration of cold therapy is shorter than hot therapy. It is applied for 10-15 minutes several times a day; should not exceed 20 minutes at a time. You can set an alarm to remind you of the time. In order to reduce edema, keeping the cold treatment area above the heart level provides better results.

Risks of Hot and Cold Therapy

In hot treatment, extreme temperatures should not be exceeded, otherwise skin burns may occur. If there is an infection, warm application may cause the infection to spread. Local hot applications such as Hotpack should not exceed 20-30 minutes at a time. If edema develops in the relevant area during hot therapy, the treatment should be stopped. If the complaints of pain and discomfort increase despite the warm treatment at home, or if they do not decrease after a week, you should consult a doctor.

Cold application can also cause skin, soft tissue or nerve damage if care is not taken. Caution should be exercised in people with cardiovascular disease. If edema and pain do not regress within 48 hours despite cold application, consult your doctor.

If hot or cold application causes pain or increases your complaints, you should not insist on treatment. If you wish to reapply the hot or cold treatment during the day, make sure the skin temperature has returned to normal before the treatment to prevent tissue damage.

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