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  • Writer's pictureRobin R Varghese, PT.

It's HOT, It's COLD!. Is it HOT or COLD? Are you confused whether to go for hot or cold therapy?

How do they differ in their effects?

Hot therapy

Cold therapy

​Heat boosts the flow of blood and nutrients to an area of the body. It often works best for morning stiffness or to warm up muscles before activity.

​Cold slows blood flow, reducing swelling and pain. It’s often best for short-term pain, like that from a sprain or a strain.

​Applying heat to an inflamed area will dilate the blood vessels, promote blood flow, and help sore and tightened muscles relax.

​Cold treatment reduces blood flow to an injured area. This slows the rate of inflammation and reduces the risk of swelling and tissue damage.

​Improved circulation can help eliminate the accumulation of lactic acid waste occurs after some types of exercise. Heat is also psychologically reassuring, which can enhance its analgesic properties.

​It also numbs sore tissues, acting as a local anesthetic, and slows down the pain messages being transmitted to the brain.

​Heat packs can be dry or moist. Dry heat can be applied for up to 8 hours, while moist heat can be applied for 2 hours. Moist heat is believed to act more quickly. Heat should normally be applied to the area for 20 minutes, up to three times a day, unless otherwise indicated.

Single-use wraps, dry wraps, and patches can sometimes be used continuously for up to 8 hours

​Ice can help treat a swollen and inflamed joint or muscle. It is most effective within 48 hours of an injury. Rest, ice, compression and elevation (RICE) are part of the standard treatment for sports injuries. Note that ice should not normally be applied directly to the skin.

When should we use them?

Hot therapy

Cold therapy


​Osteoarthritis (10 minutes on and 10 minutes off)

Strains and Sprains

A recent injury

Tendonitis or chronic irritation of tendons


To warm up stiff muscles before activity


To relieve spasm related to neck or back injury

Tendonitis or irritation of tendons following activity

Relieve spasm that may lead to headaches.

migraine (cold wrap around forehead)

DOMS (hot baths for more than 20 mins). Some researchers have suggested that moist chemical heat packs, which can be used for 2 hours, may be the best way to prevent DOMS through heat treatment.

DOMS A study published in The Cochrane Library in 2012 suggested that a cold bath after exercises may prevent DOMS, compared with resting or doing nothing. However, the researchers were not certain whether there may be negative side effects, or if another strategy might be more helpful.

When should we avoid them?

Hot Therapy Must be avoided if:

Cold Therapy must be avoided if:

  • ​the skin is hot, red or inflamed

  • the person has dermatitis or an open wound

  • the area is numb

  • the person may be insensitive to heat due to peripheral neuropathy or a similar condition

  • High blood pressure (Take expert’s advice)

  • Heart diseases (Take expert’s advice)

  • ​there is a risk of cramping, as cold can make this worse

  • the person is already cold or the area is already numb

  • there is an open wound or blistered skin

  • the person has some kind of vascular disease or injury, or sympathetic dysfunction, in which a nerve disorder affects blood flow

  • the person is hypersensitive to cold

Ice should not be used immediately before activity.

It should not be applied directly to the skin, as this can freeze and damage body tissues, possibly leading to frostbite

Alternating cold and heat

  • When cold is applied to the body, the blood vessels contract, vasoconstriction occurs. This means that circulation is reduced, and pain decreases.

  • Removing the cold causes vasodilation, as the veins expand to overcompensate.

  • As the blood vessels expand, circulation improves, and the incoming flow of blood brings nutrients to help the injured tissues heal.

Alternating heat and cold can be useful for:

  • Reducing exercise-induced muscle pain.

  • osteoarthritis

  • exercise-induced injury or DOMS

Contrast water therapy (CWT) uses both heat and cold to treat pain. Studies show that it is more effective at reducing EIMD and preventing DOMS than doing nothing.

A review of studies has suggested that, for elite athletes, CWT is better at reducing muscle pain after exercise compared with doing nothing or resting, but may not better than other strategies, such as heat treatment, cold treatment, stretching, or compression.

Please note:

  1. Never use extreme heat, and never put ice directly on the skin.

  2. Cryotherapy is primarily a pain-reliever. It will not repair tissues. It can prevent further damage of soft tissues if applied immediately after an injury.

  3. The effectiveness of heat treatment may depend on the depth of the tissue affected by the pain or injury.

  4. Heat and cold treatment may not be suitable for people with diabetic neuropathy or another condition that reduces sensations of hot or cold, such as Raynaud’s syndrome, or if they are very young or old, or have cognitive or communication difficulties.

Your Physical therapist will be the right person to guide you through the choice of treatment, the duration and the mode you must adopt. We do not recommend you to decide on these as you may benefit from an expert's advice far better than on your own.

At Valley Healing Hands, We provide the best physical therapy for conditions requiring Cryotherapy or Thermotherapy. Our highly qualified Physical Therapists will be happy to guide you through the choice of programme that will be best suited for you. Our patients are completely satisfied with us and you may learn about us here and get connected to us

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