Warm versus Cold

Are you confused with the conficting information that you have read online or shared by your friends – why does one injury need ice while another needs a warm compress? Perhaps you are puzzled why a cold and/or warm compress were applied at certain times during physiotherapy sessions. For the fourth article in our series on sports injuries, a sports medicine physician explains when you should apply warm and cold therapy for sports-related injuries.

Warm therapy comprises warm compress, warm towels, heat-producing electrotherapeutic modalities and basically anything that provides heat or warmth.

In the same manner, cold therapy includes ice, cold compress and cold-producing electrotherapeutic modalities.

A cold pack is recommended if active inflammation is present especially in acute injuries such as:

1. acute (newly occurring) muscle strains or tears
2. acute ligamentous sprains or tears
3. acute fare of arthritic joints which includes knee osteoarthritis
4. new bruising due to contusions to soft tissue
5. delayed onset of muscle soreness (DOMS).

In a nutshell, if you have any injury that causes sudden pain and there is increased warmth in the painful area, you will not go too wrong by applying a cold pack.

WHY IS A COLD PACK USEFUL FOR THE ABOVE CONDITIONS?

There will be bleeding and hematoma (blood clot) in acute soft tissue injuries. Sometimes, the bleeding takes a while to stop which is why you will experience swelling. If the bleeding is superficial enough, there is bruising on the skin. With the new injury, there will be onslaught of inflammatory cells and chemicals that aid in the future process of regeneration of normal tissues.

However, swelling and inflammation causes severe pain and disability so much so the person suffering from the injury cannot proceed with early rehabilitation or even just daily activities of living. Therefore, a cold pack helps to constrict the blood vessels thus reducing the amount of cumulated swelling and controls the number of inflammatory cells entering the injured area.

With the reduction in swelling and number of inflammatory cells, so does the pain felt by the injured person.

A cold pack also to a certain degree, slows the nerve conduction of pain signals to and from the injured area to the brain thus it will be interpreted as reduction in pain.

When it comes to DOMS, the  pain felt is due to micro trauma to the muscles caused by physical activity thus it will react exactly like an acute injury but with a much lesser extend and pain subsides quickly. Depending on pain tolerance, sometimes cold therapy is not even necessary but if the discomfort is affecting daily activities, it is advisable to apply a cold pack to ease the symptoms.

“IN A NUTSHELL, IF YOU HAVE ANY INJURY THAT CAUSES SUDDEN PAIN AND THERE IS INCREASED WARMTH IN THE PAINFUL AREA, YOU WILL NOT GO TOO WRONG BY APPLYING A COLD PACK.”

LET’S LOOK AT WARM THERAPY

Indications for warm therapy:

1. Tight or spastic muscles
2. Stiff joints – chronic arthritis (not during fare-ups)
3. Any musculoskeletal discomfort or aches and pains that do not have any symptoms of acute infammation such as no increased warmth of the painful area, no swelling and defnitely not very painful.

Now let’s look into the reasons for the above indications. Muscles that are tight or affected by spasms should ideally be stretched out. However, stretching out tight muscles from the get-go can be tough therefore a warm compress is helpful in this situation. A warm compress increases blood flow to the area thus ‘warming up’ the muscle for stretching making the process much easier.

Sometimes, a warm compress can be applied before you stretch as it helps you stretch faster. This is also the basis of Hot Yoga and Bikram Yoga where the heated surrounding helps you get into the yoga pose.

A warm compress helps to increase blood circulation to stiff joints and the surrounding muscles especially in chronic osteoarthritis. It also eases the movement of the joints for easier and more conducive physical therapy. This is why patients with knee osteoarthritis almost always start with applying warm towels or compress to their knees prior to physiotherapy sessions.

However, sometimes arthritic joints tend to flare or become acutely inflamed due to walking too much so a cold compress is better. In a nutshell, the choice between warm or cold therapy depends on the symptoms.

As long as there are no symptoms of acute injuries or inflammation, a warm compress may help reduce musculoskeletal aches and pains. Many people prefer a warm compress over cold as it is more comfortable.

HOW WOULD YOU APPLY A COLD AND/OR WARM PACK?

For acute injuries or inflammations, apply a cold pack for 20 minutes and repeat every 2 hours. A note of caution when using a cold pack – it is advisable to protect your skin with a towel before applying the ice as direct cold contact to skin can cause a phenomenon known as ice burn, which is as painful as heat burn.

For those who are just returning to sports after an injury, it is better to use a cold pack over the previously injured region almost immediately after sports to prevent possible discomfort or swelling. The use of cold pack can be gradually reduced as participation in the sports become more regular and pain free.

Apply a warm pack over applicable areas for 15-20 minutes prior to stretching tight muscles or for physical therapy in arthritic joints. To prevent heat burn, protect your skin with a towel. HT

“A WARM COMPRESS INCREASES BLOOD FLOW TO THE AREA THUS ‘WARMING UP’ THE MUSCLE FOR STRETCHING MAKING THE PROCESS MUCH EASIER.”

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