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Patient Resource Library
“If there is the slightest chance that a patient can be educated in the methods that enable him to reduce his own pain and disability using his own understanding and resources, he should receive that education. Every patient is entitled to the information, and every doctor should be obliged to provide it”.
Robin McKenzie, CNZM, O.B.E., FCSP (Hon), FNZSP (Hon), NZCP (HLM), Dip. MT, Dip.MDT
Education & Licensing
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Hot And Cold Therapy
Many people are not sure when to use heat and when to use ice in the self-treatment of pain and injuries. As a rule, any treatment should be individualized to the unique needs of the patient. That said, the advice that follows will serve as useful general guidelines on the proper use of heat & ice. This advice is given with the recommendation that you also seek out care from your chiropractic physician or other qualified health care provider.
Ice therapy or cryotherapy is often thought of as the therapy of choice for acute injuries. If you are having pain as the result of an identifiable injury (from a fall, or a blow, or a sprain, strain, sports injury, car accident, etc.) then it is usually best to use an ice pack for the first 24-48 hours. Apply the ice pack for 10-20 minutes (not longer), and repeat at least three times per day, or up to once every hour if pain is severe. Also, it is important that you do not apply the ice directly to the skin. Instead, wrap the ice pack (or bag of frozen peas) in a paper towel or thin damp cloth prior to applying to the injured area. The ice will reduce pain, muscle spasm, inflammation and decrease tissue damage.
If a small joint or area (ankle, knee, shoulder, elbow, etc.) is recently injured and/or swollen, then ice massage can be even more effective than the cold therapy described above. To do ice massage, first prepare by freezing water in several plastic cups. Once completely frozen, remove the chunk of ice from the cup by running it under warm water for a few seconds. Hold the chunk of ice with a towel or glove, and rub the ice in a slow motion directly on the skin of the affected area, for 3-6 minutes, until it becomes numb. The acronym to remember for this is C.B.A.N.:
- Cold. At first, the skin will feel very cold.
- Burning. Then you will feel an unpleasant burning sensation.
- Ache. Then you will feel an intense aching sensation.
- Numb. Finally, after 3-6 minutes, the area will feel relatively numb.
If the sensations become too intense or unbearable, then just pause the massage for a few seconds, and then resume again. You can interrupt the massage as many times as you need to in order to complete the process, ultimately reaching the numb phase. To avoid frostbite, it is very important that you stop the massage as soon as the area stops aching, and feels relatively numb. You’ve reached the numb stage when the ice no longer feels extremely cold anymore. If for some reason you fail to reach the numb stage, discontinue the massage after 5 minutes. Do not use this technique on broken skin.
Heat/Cold Contrast Therapy
If your pain is not the direct result of an actual injury, or if the pain has persisted for more than 48 hours, it is usually best to use moist heat followed by cold. This technique is also especially useful in treating various non-traumatic, inflammatory forms of joint and muscle pain, including arthritis, chronic tendonitis, and swelling. The best way to do this is to apply moist heat for 3-5 minutes, followed by an ice pack or very cold water (50-60 degrees) for 30-60 seconds. Just one single repetition of this therapy, performed 1-3 times per day (depending upon the severity of your symptoms) is usually all you need to do.
Important details to keep in mind:
The heat needs to be moist – not dry. Dry heat will dehydrate the soft tissues and interfere with the healing process, so you should never use a dry heating pad. Moist heat can be applied by letting the hot water from a hot shower directly heat the affected area for 3-5 full uninterrupted minutes, or by soaking in a bath, or by applying a specially designed hot moist pack that stays hot. Note that a hot wet towel will not retain the heat long enough to be effective. Do not apply heat for longer than 5 minutes. If you want to apply the heat longer because, for example, you’d like to take a long bath, then be sure to interrupt your bath every 3-5 minutes to apply cold to the painful area for 30-60 seconds. You should also never apply heat without following it with ice. Applying dry heat, or heat not followed by ice, or heat longer than 5 minutes will result in temporary pain relief, but at the expense of decreased circulation which will lead to increased pain and swelling minutes or hours later. However, when used correctly, the combination of heat & ice recommended above will increase circulation, thereby reducing pain & inflammation, relax tight muscles, as well as dramatically accelerate tissue repair and recovery.
To summarize, follow the rules below when using heat therapy:
- Always use moist (never dry) heat.
- Apply the moist heat for only 3-5 minutes.
- Apply cold immediately after the moist heat for 30-60 seconds.
- Perform the hot/cold treatment at least once per day, but ideally 2-3 times per day or more, depending on the severity of your pain and/or swelling.