When injury strikes, athletes and trainers seek effective ways to alleviate pain, reduce inflammation, and accelerate recovery. Two timeless and evidence-backed treatment options remain at the forefront: heat therapy and cold therapy. But which one is best for your specific injury? And when should you use each?
Cryotherapy, often known as ice therapy, is a therapeutic approach to relieve pain, manage swelling, and lessen inflammation. It entails applying cold temperatures to a body part that has been hurt or compromised. The mechanism applied here is Vasoconstriction: Ice therapy’s cold causes blood vessels to narrow, reducing blood flow to the injured area. This reduces inflammation and swelling. The cold also numbs the surrounding tissue, lowering discomfort and nerve activity.
Applying heat to the body to promote healing and ease suffering is known as heat therapy, and it is frequently used as a rehabilitation technique. Heat encourages more blood flow, which can aid in supplying tissues with nutrients and oxygen for healing. Moreover, heat helps ease pain, stiffness, and muscle relaxation.
There are advantages and downsides to both heat and cold therapy in sports injuries, which will be covered in the sections that follow.
Cold therapy
Cryotherapy is used in the management of acute sports injury/trauma, chronic pain, muscle spasms, DOMS, inflammation, and oedema. Acute ankle sprains are a prototypic injury for which cold therapy is used, generally within the context of rest, ice, compression, and elevation (RICE) therapy.
Cold therapy has multiple physiological effects on injured tissue. Decreasing skin and muscle temperatures reduces blood flow to the cooled tissues by activating a sympathetic vasoconstrictive reflex. Cold-induced decreases in blood flow reduce oedema and slow the delivery of inflammatory mediators (e.g., leukocytes) thereby reducing inflammation of the affected area. Decreasing tissue temperature also reduces the metabolic demand of hypoxic tissues, potentially preventing secondary hypoxic damage in injured tissue.
Cold therapy, if used inappropriately, can put patients at risk for local cold-induced injuries, such as frostbite. Commonly reported complications of cold therapy include allergic reactions, burns, and intolerance/pain.
Heat therapy
This is the application of heat to the body resulting in increased tissue temperature. Superficial modes of heat therapy include hot water bottles, heat pads, electric heat pads, heat wraps, heated stones, soft heated packs filled with grain, poultices, hot towels, hot baths, sauna, paraffin, steam, and infrared heat lamps.
An alternative mode of heat therapy is deep-heat therapy, which involves the conversion of another form of energy to heat (e.g., shortwave diathermy, microwave diathermy, ultrasound). Physiological effects of heat therapy include pain relief, increases in blood flow and metabolism, and increased elasticity of connective tissue. Increasing tissue temperature stimulates vasodilation and increases tissue blood flow. This is thought to promote healing by increasing the supply of nutrients and oxygen to the site of injury.
The rate of local tissue metabolism is also increased by warming, which may further promote healing. Heat-induced changes in the viscoelastic properties of collagenous tissues may underlie the demonstrated efficacy of heat therapy for improving range of movement.
A handful of trials have directly compared the effects of cold therapy versus heat therapy. The pain relief score was 138% greater with the heat wrap versus the cold pack at hour 24 post-exercise. Heat therapy has demonstrated therapeutic benefits for both analgesia and promoting healing in certain injuries. Patients can be counselled to apply ice during the initial 48 to 72 hours after an acute injury of the musculoskeletal system (eg, sprains, strains), whereas, after the first 72 hours, there is little evidence for continued benefit. Heat is the modality of choice for acute low back pain and muscle soreness.
REFERENCES:
- Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for
musculoskeletal injury. Postgraduate medicine. 2015 Jan 2;127(1):57-65. - Nadler SF, Weingand K, Kruse RJ. The physiologic basis and clinical applications of
cryotherapy and thermotherapy for the pain practitioner. Pain Physician 2004;7:395–9.
Author – Jesvin Bose, Physiotherapy Intern
