We treat everything from arthritis to pulled muscles to inflammation with heat and/or cold therapy. Treating pain with hot and cold packs can be extremely effective for a number of different conditions and injuries. The tricky part is knowing which situation calls for hot, and which calls for cold. Sometimes a single treatment will even include both.

Heat therapy works by improving circulation and blood flow to a particular area. Increasing the temperature of the afflicted area even slightly can soothe discomfort and increase muscle flexibility. Heat therapy can relax and soothe muscles and heal damaged tissue via increased circulation of oxygen and nutrient rich blood properties. In Physical Therapy the most common heat source is moist heat (or “convection heat”). This is applied via hot packs covered in warm towels. Moist heat may be slightly more effective than dry heat as it allows the opening of pores for better penetration into the targeted tissue.

Another common application of heat is ultrasound. For hand specific injuries an application of paraffin wax baths can be very effective.
Cold therapy is also known as cryotherapy. It works by reducing blood flow to a particular area, which can significantly reduce inflammation and swelling that causes pain, especially around a joint or a tendon. It can temporarily reduce nerve activity, which can also relieve pain. Ice packs and ice massage are the most common cyrotherapy applications.

When to use heat

• Before active exercises for analgesic and sedative effects
• Before passive range of motion as it promotes relaxation and greater extensibility of soft tissues
• Before and/or during electrical stimulation to reduce skin impedance
• Before and/or during traction to promote general relaxation and decreased muscle tension in the muscles
• Before manual therapy interventions to increase the blood flow and relax the tissue
• When muscle spasms are present to help relax the muscles
• To increase circulation to tissue in need of the healing properties associated with increased blood flow

When to use ice

• Reduce acute pain by slowing nerve conduction velocity
• Reduce local swelling and inflammation post injury/ surgery
• Reduce muscle spasms
• Reduce post workout soreness caused by the inflammatory reaction process