Hot and Cold Therapy to Reduce Swelling

Alternating Ice and Heat Can Effectively Bring Down Swelling

Aug 15, 2009 Terry Zeigler

warm whirlpool - stock xchng Alternating hot and cold therapies can be used safely after the first 48 hours of an injury to reduce swelling. A variety of hot and cold therapies can be used. Ice is the appropriate and effective therapy immediately post-injury and for the first 48 hours. Ice is used during the first 48 hours to slow down the blood flowing into an injured area thereby reducing the amount of blood pooling into the area (swelling). The goal of the first stage of rehabilitation after an injury is physiological containment of the damaged area. Depending on the type and location of the injury, a number of types of cryotherapy can be used during the first stage including ice pack, ice immersion, cold whirlpool, chemical packs, and even frozen peas (good to keep in the freezer as they contour effectively to an area). When using cold therapy, care must be taken to ensure that there is no damage to the skin or allergic reaction to the ice. Ice should not be placed directly on the skin. A barrier should be used (paper towel, washcloth) to protect the underlying skin from getting too cold. Ads by Google Download Google Chrome Searching is fast and easy with Google's web browser. www.Google.com/Chrome Techni ice Australia Reusable Dry Ice Packs & Gel packs Stays frozen for days www.techniice.com

How Hot/Cold Therapy Works

Once the swelling has stopped increasing (usually at the 48 hour mark, but may vary depending on the severity of the injury), a combination of hold and cold therapies can then be applied to help reduce the swelling that has accumulated. The hot and cold therapies work together as a type of physiological pump to assist in moving the blood out of the area. The cold therapies reduce circulation to an area (vasoconstriction) while the hot therapies increase circulation to an area (vasodilation). The alternating cold and hot therapies act together to pump the extra fluid out of the injured area. The key is in the combination of the cold and hot therapies. Hot/cold therapies are safe for injuries of the extremities (foot, ankle, wrist, hand) and not designed for full body immersion.

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The general rule is to always begin and end the treatment session with a cold therapy. In between each cold therapy is a hot therapy. A typical hot/cold treatment would include three ice therapies and two hot therapies. The time for each cold or hot treatment is three to five minutes with a total treatment time of fifteen to twenty-five minutes.

Combinations of Hot/Cold Therapy

There are many variations in the types of cryotherapy and thermotherapy that can be used in hot/cold therapy. Possible combinations include: Ice pack/hydrocollator Cold whirlpool/warm whirlpool Ice immersion/warm bath Frozen peas/microwave heat pack Ice pack/jacuzzi

Care must be taken not to use temperatures that exceed 100 degrees for the heat portion of the treatments. The thermotherapy does not have to be too hot to be effective when used in combination with a cold therapy. Hot/cold therapy can be performed once or twice a day beginning on the third day post-injury or when the swelling has stabilized. This therapy can be continued as long as necessary until the swelling is gone.

Contraindications of Thermotherapy
It is important to note that heat therapy should never be used immediately post-injury. Heat increases circulation to an area. There may be multiple small and large torn blood vessels in and around an injured area. Applying heat will increase the blood flow to the area allowing the blood to flow freely from torn blood vessels into surrounding tissue. This can significantly increase the swelling in a new injury.

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Hot and Cold Therapies for Pain and Discomfort

Written by Dana L. Davis, MPT and Susan Spinasanta; Reviewed by Mary Rodts, DNP and Graeme Keys, PT, Dip MDT

Heat and ice are the two most common types of passive, non-invasive, and non-addictive therapies. Heat and cold can be used alternatively and are often used as a prelude to exercise therapy. Hot and cold agents should always be used with caution. It is a good idea to seek the advice of a healthcare professional prior to use. Hot Packs and Heat Therapy Heat therapy induces vasodilation: drawing blood into the target tissues. Increased blood flow delivers needed oxygen and nutrients, and removes cell wastes. The warmth decreases muscle spasm, relaxes tense muscles, relieves pain, and can increase range of motion. You may be interested in these related articles:

What is a Physical Therapist? Transcutaneous Electrical Nerve Stimulation (TENS) Physical Therapy: The McKenzie Method Ultrasound: A Common Treatment Used in Physical Therapy Superficial heat is available in many forms, including hot and moist compresses, dry or moist heating pads, hydrotherapy, and commercial chemical/gel packs. Hot packs in any form should always be wrapped in a towel to prevent burns. Punctured commercial hot packs should be immediately discarded, as the chemical agent/gel will burn skin. Cold Packs and Cold Therapy (Cryotherapy) Cold therapy produces vasoconstriction, which slows circulation reducing inflammation, muscle spasm, and pain. Superficial cold is available in many forms, including a variety of commercial cold packs, ice cubes, iced towels/compresses, and forms of hydrotherapy. The duration of cold therapy is less than heat therapy; usually less than 15 minutes. The effect of cold is known to last longer than heat. Cold or ice should never be applied directly to the skin. A barrier, such as a towel, should be placed between the cold agent and the skin's surface to prevent skin and nerve damage. Punctured commercial cold packs should be immediately discarded, as the chemical agent/gel will burn skin.

Hot, Cold, and Compression Therapy for Injuries Charles H. Booras, M.D. Co-Founder and Editor, Jacksonville Medical Park The modalities of hot, cold and compression have a very appropriate role in the treatment of most injuries. The immediate result of almost all injuries involving the soft tissues (muscles tendons and ligaments) includes pain, possible bleeding, and a leakage of fluid from damaged tissues into the area. Afterwards, there is a migration of white blood cells into the region of the injury. For this reason it is common to have inflammation, swelling and stiffness following an injury. The healing process requires increased blood flow into the area of an injury to support the process of cellular growth. As long as swelling persists and circulation is congested, the healing process is delayed or retarded. The swelling must be reduced before full recovery can occur. Cold and compression are medically recommended therapies for the first 72 hours after an injury to help reduce local pain and swelling. More importantly, by containing the severity of swelling, the application of cold and compression can have a significant impact on helping to promote healing and speed recovery from that injury. Many first-aid authorities recommend the simultaneous use of cold and compression therapy, often identified as R.I.C.E. therapy. R = Rest. Avoid over-exertion or weight bearing on the injured body part. I = Ice. Apply cold to the injury as described below. C = Compression. Apply compression with an elastic bandage. E = Elevation. Elevate the injured area above the level of the heart (about even with the lower portion of the breast) to help drain the area of excessive fluid accumulation. Once swelling has subsided (about 2-3 days or so), the application of heat will help reduce pain and promote healing. Heat can be used to provide effective relief from the aches and pain associated with sore muscles and stiff joints. What follows is further detail about each of these three therapies. 1. Cold therapy: It has been found that cold applications (ice packs, cold compresses, frozen gel packs, frozen bag of peas, etc.) to the surface of the body will cause a contraction of the small blood vessels in that area. This will have an immediate effect on reducing the flow of blood and other fluids through that area, and therefore help to reduce local swelling. An addition, a cold application will also help relieve any pain in the area by reducing the sensitivity of local nerve endings. The following specific problems respond especially well to cold therapy.

Bruises: apply cold to the bruised area to temporarily relieve pain, minimize swelling and reduce black-and-blue marks. If the skin has been broken, be sure to apply a sterile dressing to the area before applying cold. Toothaches: apply cold to the cheek or jaw to help temporarily relieve discomfort. Simple Headache: apply cold to the painful area to help relieve the discomfort. Insect Bites: apply cold to the bitten area to help relieve itching and reduce swelling.

Muscle Spasms: applying cold to the spastic area will help temporarily relieve discomfort.

Be careful not to apply an excessively cold product directly to the skin surface. At the very least, place a paper towel on the skin before applying cold and then wrap the cold product in place with an elastic bandage. Leave the cold product in place for approximately 15-25 minutes and elevate the involved joint or limb to about heart level if possible. Cold therapy can be applied every two hours during the initial 72 hours after an injury. If the injury is somewhat severe, the cold can be applied 2-3 times in a row for 15-20 minutes each with a 30-minute rest between applications. This type of treatment can be repeated several times a day. When used properly, cold therapy can help reduce the severity of symptoms and the time required for recovery. 2. Heat Therapy: Heat Therapy (hot compress, microwaved gel pack, heating pad, etc.) promotes blood flow and enhances healing. Moist heat will penetrate more deeply than dry heat. To aid recuperation from an injury, heat should only be used after swelling has subsided and after cold therapy has already been used. One should limit the application of heat to no more than 20 to 30 minutes at a time four times daily. Do not fall asleep on a heating pad! People with nerve or circulatory problems (such as advanced diabetes) should not use heat unless otherwise prescribed by a physician. Do not apply heat to broken and/or sensitive skin. One should not sit, lean or bear weight on the hot compress. Proper use of heat can Relieve muscle aches and pain. Temporarily relieve discomfort from arthritis. Relieve sore and stiff joints. Relieve the discomfort of muscle tension and cramping.