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Hot and cold packs are commonly used to minimise pain from injuries. Standard management of a musculoskeletal injury is R.I.C.E. - Rest, Ice Compression, Elevation. The use of ice in this context is believed to minimise or delay the onset of inflammation as well as to minimise pain.

Clients ask which is better, to use a hot or a cold pack for management of pain. The answer is that it depends on the kind of pain: traumatic muscular injuries tend to respond better to cooling rather than heating; this is because traumatic injuries may present with inflammation or swelling that is aggravated by the application of heat, and which is eased by cooling.

Chronic pain is more tricky. There is evidence of effective short-term relief from muscular pain when using a hot pack compared to cold packs to treat back pain and ongoing injuries, but the same cannot be said of chronic shoulder inflammation, which responds better to cold than to heat.

The bottom line is that finding out which works best, hot or cold, is deduced through examination. First, the nature of the pain must be understood. Is it referred or primary pain? Is it muscular, structural, or nervous? Is the inciting injury a chronic or acute one? Then, the behaviour of the pain with respect to changing temperature needs to be established. Simply, what works best, and what is practical? Lastly, hot packs or cold packs need to be prescribed within the context of a larger management plan, and should work alongside other factors to help manage your pain.

With that in mind, here are a few points to be aware of.

Packs are more effective than gels or creams. The reason for this is that heat packs, wheat bags, ice packs, and frozen gel bags all provide a penetrating temperature change that works at the level of the skin and below to effect a physiological change. Bloodflow, inflammation, cellular processes and metabolism can all be affected by heat because all of those processes are at their most basic level chemical reactions that can be manipulated by changing temperature. Creams work at the level of the skin to produce a cool or warm sensation that stays at that level and has poor penetration into deeper tissues.

Hot or cold packs will not reduce pain entirely. They will take the edge off the worst of it but the pain will persist. This is because a hot pack or a cold pack manages the symptom, not the injury itself. Be mindful that if you keep applying a hot or cold pack and you're not feeling any different, the underlying cause of the injury needs further investigation. For this reason, hot or cold packs may not work in isolation.

Before you apply a hot or a cold pack, you should discuss the use of a hotpack with your Physio before you go ahead with it. This is because your physiotherapist can evaluate the use of this measure within the context of your injury and your state of health as a whole, and help you make the best decision for your care.

Lastly, you should know that the research consensus for use of hot or cold packs changes rapidly. The important thing to remember is that a lot of this research has to do with the management of high-level athletes and competitive sportspeople. For a regular Joe like you or me, a lot of this research won't be applicable because neither of us is going to compete at a National level; what we really want is to minimise our discomfort, and that depends more on the individual cause of pain and its behaviour within the context of our lives than getting us back to competitive sport.

Ultimately, what works best to effectively reduce your pain is going to be unique to you as a person. Some people love heat and cold, others like stretches, still others get the most benefit from exercises. Your physiotherapist will work with you to find the best solution for your problem, and to tailor that solution to best fit within the demands of your life and your work.

At Atlas Physio, we will provide you with education, structured management, and ongoing monitoring of your pain both in and out of the clinic. Contact us to arrange an assessment, and to take the first step on a course of corrective care today!


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