Thermal Applications: Heat & Cold
Several clinical practice guidelines recommend the use of heat to manage acute and chronic low back pain (Bleakley & Costello, 2013; Clijsen et al., 2021; Chou et al., 2018; Chou et al., 2020; Qaseem et al., 2017). Heat therapy in the form of deep moist heat or a heating pad is a mild analgesic that has several effects on the human body including increase in local blood flow, mitochondrial biogenesis, improved range of motion, and pain relief (Bleakley & Costello, 2013; Hyldahl & Peake, 2020; McGorm et al. 2018).
Cold therapy in the form of cold compress, ice pack or ice massage can act as a mild analgesic. The physiological effects of cold therapy include reduced blood flow, reduced metabolic demand, and pain relief. This form of therapy may be useful for patients with chronic pain (Garcia et al., 2021). There is limited evidence from randomized clinical trials (RCTs) supporting the use of cold therapy following acute musculoskeletal injury and delayed-onset muscle soreness (DOMS), also a mounting body of research has shown that ice can delay healing, increase swelling, and possibly cause additional damage to injured tissues (Duchesne et al., 2017; Fuchs et al., 2020; Malta et al., 2021; Peake et al., 2017).
PEACE & LOVE: New acronym for the treatment of traumatic injuries
One of the primary changes surrounding the management of acute injuries is that most guidelines recommend against the use of ice to control inflammation. It is now recognized that ice can delay healing, increase swelling, and possibly cause additional damage to injured tissues. Traditionally treatment of an acute sprain or strain consists of RICE (Rest, Ice, Compression, Elevation), the most recent recommendation has been to provide soft tissue injuries with the PEACE & LOVE protocol to encourage optimal loading of the joint and tissue around the affected injury can affect the amount swelling leading to a faster recovery (Dubois & Esculier, 2020).
- PEACE makes up the first steps you would take after an injury. Immediately after the injury you would want to protect (P) the injured structure, followed by elevating (E) the limb higher than the heart, avoid anti-inflammatory (A) both over-the-counter or prescriptions and ice, as they slow down tissue healing. Compress (C) the injured area to decrease swelling. Ensure patient education (E) on the risks of overtreatment.
- LOVE makes up the progressive return to activities a few days after the injury. Gradual load (L) will facilitate healing, optimistic (O) influences the perception of pain and recovery speed. Loading and progressive return to activity will facilitate vascularization (V) of the injured tissues. The last step involves activity exercises (E) can help recover range of motion, strength and proprioception.
Ice baths (also known as cold-water immersion or whole-body cryotherapy)
Even though ice baths may delay healing, that does not mean that there is no use for the techniques. Controlled stress is a way to promote adaptation in the body, this may include, but it is not limited to training, fasting, cold immersions, breathing exercises. One prominent figure in the world of body experimentation is Wim Hof a Dutch adventurer, known by the name “The Iceman” who has popularized the Wim Hof Method and cold-water immersion. Research on this method of cold exposure suggest that people can learn to modulate their immune responses — a finding that has raised hopes for patients who have chronic inflammatory disorders such as rheumatoid arthritis and inflammatory bowel disease (Kox et al., 2014).
|Technique||Application||Application notes (e.g., anatomical location, conditions)|
|Application of cold||Local application of cold/ice (e.g., compress, ice pack, ice massage) often for 15 minutes or less.||Used over areas of acute inflammation or pain. Generally, not used over areas of chronic inflammation. |
|Application of heat||Local application of heat (e.g., compress, magic bag) often for 10 – 5 minutes.||Used for acute and chronic pain. Not recommended over areas of acute inflammation. |
|Contrast application||Alternating application of cold (e.g., 3 minutes) with application of heat (e.g., 1 minute).||Used for subacute pain.|
For those who suffer from musculoskeletal pain, thermal applications have been shown to be a safe non-pharmacological therapeutic intervention that is simple to carry out, economical, and has relatively minor side effects.
References and Sources
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