Fire v Ice - Part 2 Thermotherapy

I am frequently asked about the use of hot and cold in the self treatment of injury.  Is hot better than cold? Are ice baths effective? Should I treat pre or post exercise? How long should I treat for? As this is quite a large topic I've split this article into three parts.  This is Part 2 of a series of 3. If you missed Part 1 on cold treatments you can read it here.

Temperature treatments are a free and easy form of self treatment and can be an effective part of rehabilitation and recovery from injury.  Although there is little scientific evidence as to the effectiveness of temperature treatments for injury recovery, they are frequently prescribed by sports doctors and therapists and many patients and athletes report having beneficial effects.  

Generally speaking ice is used for acute injuries and heat is used for muscles.  It is important to use temperature treatments correctly otherwise they can make injuries worse! I explain why below... 



Heat treatments can be used 48-72 hours post acute injury as long as cold treatments have been applied as above.  Up to 72 hours after injury only cold should be used for an acute injury - never use heat on acute inflammation!  For more information on this see Part 1.  A sports doctor or Physio will advise each patient individually on whether heat is appropriate and when Thermotherapy can begin.  


The theory

Once tissues have stopped bleeding heat treatments can aid with healing by increasing circulation, improving exchange of toxic waste and nutrients for tissue recovery, decrease muscle spasm, analgesic affect on surrounding tissues.


It's good for... 

Heat is particularly effective for tendons*.  Tendons are made up of 90% collagen which become more pliable and elastic when heated. This can have a positive affect on rehabilitation exercises as a greater range can be worked through when the tendon is more pliable. 

Heat is also used for injury prevention and in the rehabilitation of overuse injuries as it helps to warm up tissues and decrease joint stiffness in preparation for use. It can be particularly useful to apply before warmup before training and competition in cold weather conditions. 

**Heat is affective in the treatment of muscle spasms and trigger points (often referred to as knots in the muscles). For chronic pain conditions heat can be soothing to the nervous system and off-set fear and anxiety associated with it.  


Modalities of heat therapy

Common methods of heat therapy are water immersion, hydrotherapy, heat packs, hot water bottles, cherry stone heat packs and hydrocollator packs.  Ultrasound is a form of deep heat treatment used by Physios which can heat tissues up to 10cm in depth from the skins surface*. 


How to apply

Heat can be applied for 10-20 minutes or longer for chronic pain conditions and be applied every day or as needed.  Just be aware not to put a high heat directly on the skin as it may result in superficial skin damage. 


Do not use heat on... 

Never use heat on an acute injury as it will increase blood flow, swelling and pain to the area when you want to encourage clotting, decrease swelling and decrease pain. For acute injuries always ice. For more information on ice read Part 1 of this triple bill! 


Always seek the advice of a qualified Physio or sports doctor to make sure you use the right type of treatment for your injury.  

For any further questions on heat and injury recovery please do email me at Part 3 on contrast treatment comes out in 2 weeks! Sign up to our mailing list to get our articles sent directly to your inbox. 

* Sports Injuries Their Prevention and Treatment 3rd Edition. Lars Peterson & Per Renström