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When to use Heat vs Cold treatment

If you have ever been to occupational or physical therapy?  Did your therapist put a hot pack or a cold pack on your injured body part?  I know I often use heat and cold modalities and many of my patients want to know why I am using it, should they also be using it at home as their home program, and what is better heat vs cold treatment.

Let me explain what I do.

paraffin treatment

paraffin treatment

Heat treatment modalities can include hot pack, paraffin, and some clinics had a fluidotherapy machine that is like a sand machine that blows hot air.  There are two types of heat treatments: MOIST HEAT and DRY HEAT.  About hmmm….99.999999% of everyone loves heat treatments!! Your injury and your pain is not a one treatment fits all deal though.  Different injuries tend to be appropriate for different types of heat treatment.  Moist heat is great for injuries or diagnosis where the joint is really stiff or chronic in nature.  For example arthritis, the hand and thumb really respond well to moist heat such as a heat pack or paraffin.  Many times, I may use paraffin when I have a stiff finger to wrap it down in to a stretches position, then paraffin it, and wrap it in moist heat.  The tissues become more elastic and the person also becomes more relaxed in that heat.  The moist heat loosens the tissues so I can stretch more in a shorter period of time.  I can’t paraffin an elbow or shoulder but I do but heat on it and use gravity to stretch an elbow depending on direction of the lack of motion, or for the shoulder I can place on a table and use the body to stretch it.  Heat alone won’t do the trick….if it was only that easy.  But using a stretch or exercise at the same allows the injured part to be less tight, and the person less guarded to allow that motion.   We also use a dry heat such as fluidotherapy.  It is a machine that has soft sand, blows warm/hot air around.  Your hand/arm goes in, the machine is turned on, and after a few minutes that your hand is warmed up, I then prescribe for you several exercises while in the machine.  The heat is dry, but with the combination of motion, so many of my patients love it as they come out of it with more motion and less stiffness then they came in.  It is also great for when the scar or injured body part is overly sensitive.  It only fits the hand, wrist, and forearm.  Like I said, it’s not a one program fits all, it depends on your need at the time, and our goal for your needs.  That can also change over time and that can change the type of heat you use or if you even need it at all.  Heat on a new injury with lots of swelling can be harmful though, there are contraindications.

gel cold pack

gel cold pack

Cold treatments include an ice pack or direct ice to the skin.  This is my favorite.  Does it feel good the 1st time? Not really.  Cold treatments is harder to tolerate at first, but so many of my patients love the cold packs or ice massage after an intense therapy session.  Ice is great when you have a new acute injury, muscle pain or when you have swelling.  I tend not to use it on the fingers too much unless they are really swollen, but for the bigger joints and diagnosis like tendinitis, ice is the best thing.  Ice should be very cold when you put it on, burns, pins and needles, and when you go numb, you know that you are done.  If you are going to use ice treatments to manage you pain and edema then you need to feel the cold, DO NOT put it around a towel.  You will never feel the cold therefore it is not as effective.  I like to use a gel cold pack, put it in a pillow case, and then place it on the injured body part.  The gel cold pack is wrapped around the injury for about 10 min more or more if you can tolerate.   My other favorite love of ice is a block of ice in a small paper cup or a frozen bottle of water.  This goes directly on to the painful area, massage and rub that area with the ice until it goes numb.  I like direct ice massage if there is one small area we need to target.  For bigger joints and muscle pain, I find ice to be very helpful to reduce the pain.

Now remember these are superficial treatments that are used in conjunction with other aspects of treatment in therapy.  There are other types of thermal treatment with machines such as ultrasound and laser therapy that penetrate deeper into the tissues but it is not cheap or easy to have at your disposal.  Hot packs and ice packs are easy ways that you can help yourself at home to combat stiffness or muscle pain.  Research does show that heat generally feels good but wears out after the heat is gone, but cold treatment can have a longer lasting effect especially when treating muscle pain and swelling.  Talk to you therapist to see how you can incorporate these easy treatments into your home exercise program to be as effective as you can be and also if you have any contraindications.

Have questions for about heat vs cold treatment me?  Give me a call or leave me a comment below.  Thank you for your interest!  Feel free to share if this has been helpful for you!

Hoang Tran OT/L, CHT

Hands on Therapy Services is a leading Miami certified hand therapist, specializing in rehabilitation of shoulder, elbow, wrist, and hand injuries resulting from injuries, surgery, or naturally occurring conditions. Our Miami hand therapy services are provided by our certified hand therapist in Miami. We also offer occupational therapy in Miami with our on site occupational therapist. Plus – coming soon – we will be offering physical therapy in Miami.

Disclaimer:  As with all our pages, this is NOT a substitute for formal medical treatment or occupational therapy.  It is intended to inform only.  Hands on Therapy Services disclaims any liability for the decisions you make based on this information.


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