The Use of Heat Versus Cold for Treatment

By July 11, 2014Healthy Aging

PT Sue LogoThe use of heat and cold for treatment of injuries has been around for years. Heat and cold come in many different forms and they are relatively inexpensive, easily accessible, portable, and easily administered.

Regardless of the form of ice for treatment, the principle of cold is to: promote vasoconstriction of the blood vessels to decrease the peripheral blood flow within the first 15 to 20 minutes of application; decrease metabolic rate; and provide topical relief from muscle spasms. Cold is very effective in reducing inflammation after an injury. Compression with the cold at the injury site helps to increase the relief of the vascular congestion. The treatment rule is: RICE—rest, ice, compression, elevation. The resulting vasoconstriction of the blood flow in the injured area puts a demand on the deeper blood flow to dilate and carry away the excess fluid from the involved area.

In using cold, it is best to place a cold damp cloth over the ice pack against the affected area in order to maximize the effect of the cold to reduce the skin temperature. An ice pack, or ice cubes, is better than chemical cold since it is more effective in absorbing the heat generated by the injured tissue. Chemical cooling agents may numb the tissue but they are not as effective in reducing tissue and skin temperature.

Heat, in any form, is used to promote vasodilation of the peripheral blood vessels, thereby increasing blood flow; increasing the metabolic rate; and triggering relaxation of the muscle spasms, pain relief, and increased elasticity of the connective tissue. Moist heat appears to be more effective in raising skin and tissue temperature by increasing circulation. The effectiveness of the hot pack is influenced by the amount of subcutaneous fat below the skin of the area being treated. The fat can block, or slow down, the transmission of the heat into the deep muscular tissue, requiring a longer use time.

One needs to use caution, or actually avoid, combining topical agents with traditional hot and cold packs, which when combined, may cause extreme pain and/or burning of the skin. The standard amount of time for the application of heat or cold pack to an affected area is 20 minutes. The use of heat and cold, alternately, called contrast baths, is very effective to act as a pump to flush out the excess fluid and is best accomplished with two pans of water, one hot and one cold. Start and end the entire session with the hot water. The “hot” water should be comfortably warm; the “cold” water should be anywhere from cold tap water to cold tap water with ice cubes. The “hot” or “cold” should not produce pain. Consider: 5 to 8 minutes in the “hot” water pan, and 3 to 5 minutes in the “cold” pan of water and repeat at least 3 complete cycle (one “hot” and one “cold” treatment constitutes one cycle).

Use ice after an acute injury, especially while there is swelling in the tissue. Continue the ice treatment three to four times a day for 24 to 72 hours and longer if you are responding well to the cold. Heat is used more for chronic pain where there is no swelling and the purpose is to increase circulation to the tissue. Both heat and cold are helpful in abating symptoms. It is important for you to know which works best for your body.

Please feel free to contact me if you have any questions at my web site,; my office (951)369-6507; or my email, My goal is to help seniors keep healthy and moving. I welcome all questions and/or comments.

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