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Aug 25, 2023

Ice (Cryotherapy) and Heat (Thermotherapy): When & what to apply?

Updated: Oct 18, 2023



Ice (Cryotherapy) and Heat (Thermotherapy): When & what to apply?


Patients have always asked about ways to help them alleviate their pain. Should they use painkillers/anti-inflammatories? Does analgesic cream help? (Tiger Balm, Counterpain), should they use analgesic patches instead? (Salonpas).


While most of the above help control pain and swelling one way or another, one of the most efficient, effective, and economical pain management methods exists in a very simple form, temperature.


Cryotherapy (Ice) and Thermotherapy (Hot) protocols are a major part of any recovery and rehabilitation process in the sports and medicine field. However, their criterion of application still confuses many. If used incorrectly, it may worsen your current condition.


Cryotherapy (Ice) - Very useful form of analgesia (pain control), especially in the acute phase of injuries (24-72hours) where inflammation (pain, hot to touch, swelling, redness, bruise) exists. Ie sprains, strains, contusions, muscle and ligament tears etc. (1)

- Cold causes vasoconstriction (shrinking of blood capillaries), with the aim of minimising oedema and swelling and reducing secondary hypoxic injury by lowering the metabolic demand of injured tissues. (2,3) - Common types of application includes ice application (ice pack, ice bath), cold water immersion(CWI) and whole body cryotherapy (WBC). - More efficient protocol for ice application is two 10 minutes application with a 10 minutes break in between (10:10:10 protocol) as it prevents ice burns. Repeated every 2 hours for optimal effect (that’s what research says, and athletes do!) (4,5) - Typical CWI protocols involve the submersion of the limbs and/or torso for ∼5–20min in water cooled to temperatures of between ∼8–15◦C. (11) - Not recommended for open wounds (septic injuries), fractures (ouch!) as well chronic overuse injuries (no inflammation to control), unless there is an acute episode.


Thermotherapy (Heat) - Heat is usually only useful as an analgesic in the absence of an acute inflammatory process, as application of heat in that setting will worsen the swelling/bruising and hence pain. (6) - If in doubt, always err to the side of ice. - Good therapeutic value for chronic (weeks/months/years) muscle and connective tissue degenerative injuries. (plantar fasciitis, ITB syndrome, repetitive strain injuries (RSI), muscle spasms and trigger points) (7) - Works by increasing blood flow, soft tissue and joint elasticity and extensibility, increase neural transmission and muscle spasm reduction. May accelerate tissue healing. - Common types of application are moist heat applications (hot bath, heated gel packs, electrical heating pad) or deep tissue heating (ultrasound, infrared radiation). - 10-20 minute applications of 40-45°C thermotherapy is the most effective form of thermotherapy. Monitor for burns! (9)


Contrast Therapy (Alternate Heat & Ice) - Relatively new method used in the sports and performance setting, believed to improve recovery process. (10) - Commonly used with alternate cold and hot water immersion. - Optimal contrast therapy temperatures should range from 40-45°C (thermotherapy) and 12-18°C (cryotherapy) in 3:1/4:1 ratio i.e. 3 minutes heating alternate with 1 minute cooling. (10)



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