Hot or Cold for Pain Relief

Hot or cold?  What is best on an injury?  

After an injury, you might want to use an ice pack – or would heat be better?  We will look at the pros and cons of hot vs cold in treating various injuries.

Icing 

Icing involves placing something cold onto the skin to decrease the temperature of muscles, tendons and other tissues in  the area. It is best used for injuries that have just occurred or are new. It helps to reduce pain and muscle spasm.

Common methods of application

Ice packs	Place an ice pack in a towel on the injured area and hold in place for approximately 15 minutes
Cold compress	Soak a towel in ice water, squeeze the water out of the towel and apply to the area for 1-5 minutes. Repeat the process for a total of approx 15 minutes.
Ice slush bucket	Mixture of cold water and crushed ice in a bucket Immerse the foot and ankle into the bucket for approximately 15 minutes. Redness and numbness will develop. Remove foot from the bucket and begin slow gentle foot exercises

Cold treatments can feel unpleasant so might not be suitable for some people such as children. If there are any diseases of the blood vessels in the feet and toes, it is not appropriate to use ice therapy.

Heat packs 

Heat packs involve placing something warm on the skin to increase the temperature of muscles, tendons and other tissues in the area. Warmth makes the muscles more stretchy and pliable and also increases blood flow to the area. Increased circulation can bring more blood past an injury and help to clear older, stubborn issues.

Heat is best used in people with long term pain, conditions such as osteoarthritis, rheumatoid arthritis, chilblains and chronic inflammatory conditions. Heat is not ideal to use on injuries that have just occurred as heat will make the healing time longer by increasing blood flow to the area and as a result increasing swelling.

Common methods of application 

Heat packs	Microwavable heat packs (wheat, corn or gel) are the most common form of heat therapy as they are cheap and easy to use Once heated, the pack is placed on the area for approximately 20 minutes Cover with a towel before placing against the skin
Warm water foot baths	Water is heated to approximately 45°, additives such as salts or antiseptic may be used The entire foot is placed in the foot bath for approximately 20 minutes. You may need to top up the water to maintain the warm temperature
Wax foot baths	Not as easily accessible as the 2 types of heat application above Paraffin wax is heated to 45°-50° The foot is dipped into the wax and removed, this process is repeated until 3-8 layers of wax are on the foot The foot is covered with plastic and also wrapped in a towel for insulation. Rest for 20 minutes while the wax retains its warmth Remove the wax and begin gentle foot exercises

The use of heat therapy should not be used in people with sensory issues or loss and any diseases of the blood vessels.

Contrast therapy

Contrast therapy is the alternative application of heat and cold. It reduces inflammation and swelling via a pumping-like mechanism. Heat causes an increase in blood flow to the area and cold causes blood to leave the area. The overall effect of this pumping mechanism is to increase blood circulation. Contrast therapy should not be used on people with diseases of the blood vessels.

Method of application

• An ice slush bucket and a warm foot bath (45° water) are used
• The foot is immersed in the ice slush bucket for 1 minute and then removed and placed in the warm foot bath for approximately 3-4 minutes, this is repeated several times

If you are not sure if any of these therapies are right for you, consult your local podiatrist first.