Should you use heat or cold?

Remember the last time you stretched your lower back in heavy curls? Or that throbbing elbow pain that comes back every time you train the biceps? Or even that muscle pain you felt a few days after that monster leg workout?

Weightlifters, like many other athletes, often suffer from injuries to muscles, tendons, ligaments, or other soft tissue. Some injuries come and go in relatively short order. Other injuries hang around – they never quite heal and are easily made worse by further activity. But whether an injury is acute or chronic, it requires prompt and proper care if you want to minimize your downtime.

Some of the more commonly prescribed treatments are the application of cold and ice (cryotherapy) or heat (thermotherapy). Since these treatment methods do not require a medical prescription and are readily available with minimal risk, athletes use them frequently.

The question is, which one is better for a given injury: heat or cold?


How pain signals work

When tissue is damaged, nerves send messages to the brain that are perceived as pain. Simultaneously, chemical messengers known as neurotransmitters trigger a reflex that can lead to muscle spasms in the surrounding area. These spasms can potentially cause further tissue damage due to decreased blood flow to the area, which can create more pain.[1] The pain-spasm-pain cycle continues and may increase the level of pain. It can also decrease mobility, sometimes markedly.

To avoid further injury and pain, you will need to take action. Hot and cold treatments are effective in reducing pain and muscle spasms.[1] They both stimulate temperature-sensitive nerve endings, inhibiting the transmission of pain signals to the brain. While heat and ice can help block the pain-spasm-pain cycle, each provides a opposite effect on tissue metabolism, blood circulation, inflammation, edema (swelling caused by excess fluid), the speed of nerve impulses (speed of nerve conduction) and the ability of your muscles to stretch.

When and how to use the cold

Effective cryotherapy should reduce the temperature of the tissues 2 to 4 centimeters (about an inch or more) under the skin to 18 to 27 degrees F.[2] This causes narrowing of the blood vessels and the resulting decrease in blood flow reduces tissue metabolism, oxygen use, edema, and inflammation.[3] Nerve conduction slows down, while pain tolerance increases.[4]

Despite its effects on blood circulation and inflammation, there is little research supporting its use in the management of acute injuries or delayed onset muscle pain (DOMS).[3] Additionally, there is a lack of evidence to suggest that it can be a useful tool in speeding up recovery time.[5]


How to use

Ice packs, cold packs, frozen vegetables, and direct contact ice massage are commonly used. Finely crushed ice in a large bag or frozen vegetables are easy to use and follow the contours of your body. Ice packs also work well and can get moldy as well. Direct contact ice massage penetrates quickly and deeply, but it is not suitable for all individuals or circumstances.

The frosting is usually uncomfortable for the first 3-5 minutes, but it should never be unbearable. The processing time should be 15-20 minutes; However, direct contact ice massage should only be applied for 5-10 minutes. Cold therapy can be reapplied every two hours. A thin layer of fabric, such as a pillowcase, should be used between the skin and the cold compress.

When to use

Apply cold within 48 to 72 hours of acute trauma to any part of the body except the lower back. It can also be used for the management of chronic pain after activity (such as a baseball pitcher after the game) and inflammation such as swelling. Do do not use cold if you have overly sensitive skin (eczema, dermatitis) or areas of poor circulation. Be especially careful when treating areas with poor blood circulation, if you have known cold allergies, or if you have advanced diabetes. A lack of sensation resulting from diabetes-related nerve damage could lead to excessive application of cold.

When and how to use heat

Heat therapy increases the temperature of the tissues, causing vasodilation or widening of the blood vessels, which can increase blood flow to the injured area.[3] Research suggests that increased blood flow improves tissue healing by delivering oxygen, protein, and nutrients to the injury site.[1]

As with cryotherapy, there is little evidence to support claims that heat therapy is effective in improving an athlete’s return to participation. But research has shown positive results on the effectiveness of heat therapy for pain relief in patients with acute low back pain.[6]


How to use

Dry compresses, warm wet compresses or hot baths can be used. Localized moist heat tends to penetrate better and can prevent drying out your skin. The heat should be warm but tolerable, not too hot. It is best to maintain a constant temperature during the treatment. It is recommended that the tissue temperature reach 104-113 degrees F (40-45 degrees C). The treatment time should last 15-30 minutes, depending on the thickness of the tissue and the type of injury.

Areas with thicker tissue, more spasticity, or both may take up to 30 minutes. Heat can be reapplied every two hours. Diapers should be used to avoid burning your skin. The alternation between hot and cold has not been demonstrated to be conclusive.[7]

When to use

Apply heat for acute lower back pain (short-term injuries), injuries persisting for more than 72 hours, relief of muscle spasms in case of inflammation do not present and menstrual pain. Do not use immediately after exercise, except for lower back pain and injuries where inflammation is present. Take special care when treating people with diabetes, spinal cord injury and multiple sclerosis. Nerve damage caused by these diseases can result in excessive heat application.

Remember that injuries that continue to preclude the performance of normal activities should be followed by a visit to a qualified health care professional such as a physician, certified athletic trainer, or physiotherapist. These injuries must be properly assessed and treated so that they do not get worse. Self-treatment through the use of heat therapy, cryotherapy or both is effective in the short term but not in the long term.

The references
  1. Nadler, SF, Weingand, K., & Kruse, RJ (2004). The physiological bases and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain doctor, 7(3), 395-400.
  2. Galiuto, L. (2016). The use of cryotherapy in acute sports injuries. Annals of Sports Medicine and Research, 3(2), 1060.
  3. Malanga, GA, Yan, N., & Stark, J. (2015). Mechanisms and effectiveness of heat and cold therapy for musculoskeletal injuries. Postgraduate Medicine, 127(1), 57-65.
  4. Algafly, AA and George, KP (2007). The effect of cryotherapy on nerve conduction speed, pain threshold, and pain tolerance. British Journal of Sports Medicine, 41(6), 365-369.
  5. Hubbard, TJ, Aronson, SL and Denegar, CR (2004). Does cryotherapy accelerate the return to participation? A systematic review. Athletic Training Journal, 39(1), 88.
  6. Dehghan, M., & FarahbOD, F. (2014). The effectiveness of heat therapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. Journal of Clinical and Diagnostic Research, 8(9), 1-4.
  7. Stanton, DEB, Lazaro, R., & MacDermid, JC (2009). A systematic review of the effectiveness of contrast baths. Hand Therapy Journal, 22(1), 57-70.


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