How to Alternate Hot and Cold Therapy

Pain from acute injuries and chronic conditions is common. Hot and cold therapy is a natural remedy that may provide pain relief. It can be used as a standalone treatment or in conjunction with other types of pain relief.

Individually using hot and cold therapy has benefits. However, alternating ice and heat therapy may provide the most benefits. Understanding how hot and cold therapy help with pain and the steps for alternating between the two is also useful.

This article gives a guide on how to use hot and cold therapy. It covers the benefits and when to avoid each type.

What is Hot and Cold Therapy?

Hot and cold therapy involves applying heat or cold to an injured or painful area.

Hot therapy uses heat to increase blood flow to the area and promote healing. Cold therapy uses cold to decrease inflammation and pain and numb the area.

Studies on the Benefits of Hot and Cold Therapy

Studies also support the benefits of hot and cold therapy for pain. In 2021, a review and analysis of randomized controlled trials was published in the journal Physical Therapy and Sport. This review showed the benefits of hot and cold therapy.

The study looked at 32 clinical trials, including 1,098 patients. The patients received cold or hot therapy after exercise to reduce muscle soreness that comes later. 

Participants received hot or cold therapy within one hour after exercise. The results found that applying heat or cold therapy within one hour after exercise reduced pain from DOMS.

Why Alternate Hot and Cold Therapy: Benefits

Alternating hot and cold therapy may be more beneficial than just one method. To understand why alternating is best, it's helpful to learn more about what both hot and cold therapy do.

Sensory nerves in the body respond to applied heat by releasing certain chemicals. These chemicals help dilate the blood vessels, increasing blood flow to the area. Increased blood flow helps bring needed nutrients to the area and promotes healing.

Heat therapy improves circulation due to the increased temperature, which can relax a muscle, reducing pain and stiffness. However, heat can potentially make inflammation worse.

Cold therapy constricts the blood vessels, decreasing blood flow to the area. This constriction helps reduce inflammation and swelling and may reduce the risk of tissue damage. It also numbs the area and slows down pain messages to the brain. However, cold therapy can make muscle tension and spasms worse.

It's clear both hot and cold therapy help provide pain relief and promote healing. However, one method may not provide enough pain relief. Alternating between hot and cold therapy, referred to as contrast therapy, often provides the best of both worlds.

By alternating hot and cold therapy, you can decrease inflammation while simultaneously improving circulation and loosening tight muscles.

The benefits of alternating hot and cold therapy include: 

• Increased blood flow and circulation
•   Reduced pain and inflammation
•   Improved healing time
•   Enhanced muscle relaxation
•   Decreased muscle spasms
•   Reduced muscle stiffness

How to Do Hot and Cold Therapy: Step-by-Step Instructions 

The hot-cold method helps provide the maximum benefits for pain reduction. Usually, it's best to start by applying cold therapy and finish the treatment with cold therapy.

Heat is generally applied longer than cold to dilate the blood vessels and increase blood flow to the area.

Generally, the best hot or cold therapy position is resting and elevating the affected area comfortably. This helps to reduce swelling and maximize the benefits.

The general pattern for how to alternate heat and ice includes:

• Start by applying cold therapy for 1 minute
• Next, apply 3 minutes of heat
• Switch back to 1 minute of cold
• Apply 3 minutes of heat
• Return to 1 minute of cold
• Apply 3 minutes of heat
• Finish the treatment with 1 minute of cold therapy 

Tips to Maximize the Effectiveness of Hot and Cold Therapy 

Consider some tips below on how to do hot and cold therapy at home for maximum benefits.

• Use a towel between the heat source and your skin to prevent burns. 
• Do not fall asleep with either ice or heat applied to your skin to avoid irritation and burns.
• Do not apply ice directly to the skin. Instead, wrap an ice pack in a cloth to avoid skin irritation.
• Apply gentle pressure when using either a hot or cold pack to avoid injuring your skin.
• Be consistent with alternating hot and cold therapy a few times daily.
• Listen to your body; discontinue the treatment if you start to feel discomfort.

Comparison of Hot vs Cold Therapy and Their Effects

Below is a chart comparing hot versus cold therapy, when to use each, and their effects.

Types of Heat Therapy

There are different types of heat therapy available, including: 

Heating pads: Heating pads generally need an electrical source. You can set the temperature so you can get the amount of heat desired. Use a heating pad with a cover to protect your skin.

Hot water bottles:Hot water bottles are commercially sold with a removable cover. Fill the bottle about halfway up with warm water and seal it. The bottle is made of an insulated material to keep the bottle warm.

Warm baths: A warm bath provides an opportunity for moist heat therapy, which may be more effective than dry heat for some people.

Saunas: Dry sauna heat may be an effective form of heat therapy, especially for widespread pain throughout the body.

Microwavable packs: Microwavable heat packs can be reused and usually contain grains such as rice or wheat. Follow the manufacturer's instructions to avoid overheating the pack and burning your skin.

Types of Cold Therapy

Below are the following types of cold therapy available.

Ice pack: To make an ice pack, fill a plastic bag with several cups of ice, squeeze the air out, and seal the bag. 

Cold compress: Make a cold compress by running cold water on a wet towel and squeezing it until damp. Place the towel in a plastic bag and put it in the freezer for about 10 minutes. 

Gel pack: Gel packs are generally commercially sold and contain a gel material that, when activated, provides cooling.

Ice bath: To make a nice bath, mix your bathtub halfway with cold water and add some ice. Use caution when using an ice bath; the temperature can become too low, which may lead to complications such as frostbite.

When Not to Use Hot Therapy

Hot therapy is generally safe. However, there may be times when you should not use it. Do not use hot therapy in the following instances: 

• Open wounds
• Recent injuries
• Areas of numbness or poor circulation
• Pre-existing conditions that place an individual at higher risk for burns, such as vascular diseases, multiple sclerosis, and diabetes

When Not to Use Cold Therapy

There are also instances when an individual should not use cold therapy, such as the following: 

• Open wounds
• Numbness
• Decrease circulation
• Extreme muscle or joint stiffness
• Individuals with sensory disorders that may prevent them from feeling cold, such as nerve damage

Frequently Asked Questions (FAQs)

Commonly asked questions related to alternating hot and cold therapy include the following:

How long can I leave the hot/cold pack on?

The amount of time you leave a hot or cold pack on may vary depending on the cause of the pain. You can generally leave a hot or cold pack on for up to 20 minutes.

Can I use hot and cold therapy on the same day?

Yes, you can use hot and cold therapy on the same day. In fact, alternating ice and heat therapy may be more beneficial than using either alone.

What if hot/cold therapy doesn't seem to help?

If hot and cold therapy doesn't seem to reduce pain, there are several additional treatments you can try. The best treatment may depend on the type of pain and its cause. Other types of treatment include stretching exercises, pain relief creams, and over-the-counter non-steroidal anti-inflammatory medications.  

Conclusion 

Hot and cold therapy may provide a non-pharmaceutical way to decrease pain. Alternating hot and cold therapy may be even more beneficial than using one exclusively. Cold therapy is often effective at the onset of acute injuries to constrict the blood vessels and decrease inflammation and swelling. 

Hot therapy is also helpful, especially with chronic pain, as it dilates the blood vessels, increases blood flow to the area, and helps heal. 

If you are unsure of whether to use hot or cold therapy or you have underlying medical conditions that may affect use, it is best to contact your doctor. Your healthcare provider can provide more information on specific recommendations for your situation.