Hydrotherapy using cold and hot for injury recovery
Acute Injury
When you injure an area tissues will have either been stretched or an impact received causing blood vessels to be torn or damaged. The extent of bleeding will depend on the vascularity of the tissues involved, and may be increased if injured during exercise. Blood will flow out until the vessels are restricted (vasoconstriction), preventing further blood leaking into the surrounding tissues. It is important to stop bleeding into tissues as the blood will act as an irritant, increasing inflammation, and must be cleared from the tissues before the healing process can begin.
The following information will help you decide when to use cold, hot or contrasting hydrotherapy after an injury.
Cold Therapy
At the Back Pain Centre Sunderland we recommend the R.I.C.E. Method of Acute Injury Treatment:
Rest – the injured part as much as possible to allow the healing of tissues.
Ice – Apply ice for up to 10 minutes as soon after the injury as possible – do not wait for the swelling to start. This may be repeated every 2 hours during the first 72 hours after injury.
Compression – After ice, if possible apply a compression bandage to help minimise the swelling to the tissues.
Elevation – If possible elevate the injured part to help limit blood flow and prevent the use of muscles around the injury.
Cold therapy works by causing vasoconstriction of the injured area.
Cold therapy has three main benefits. Firstly it slows the inflammation that occurs after injury. Secondly it numbs the sore tissues (providing pain relief). Thirdly it slows the nerve impulses in the area, which interrupts the pain-spasm reaction between the nerves.
Store the gel pack in the freezer for two hours prior to use.
When applying ice, never do so directly onto the skin as this may result in ice burns to the skin. Wrap the gel pack in a damp cloth (a dry cloth will not transmit cold effectively).
You will feel various symptoms during a cold application; these are referred to as C.B.A.N – Cold, then Burning, followed by Aching and Numbness.
During the first 24 to 72 hours after an injury avoid any form of heat on the injury e.g. heat lamps, heat creams, spa’s, Jacuzzi’s and sauna’s and do not massage the injured area.
After the initial healing period of up to 72 hours, ice massage may be incorporated into treatments. By applying stroking movements with an ice pack, the blood vessels will dilate and constrict alternately bringing an increased supply of blood and nutrients to the area, increasing the rate of healing. This may be done for more than 10 minutes.
>Caution: Cold therapy is contraindicated for people suffering from Hypertension, Raynaud’s disease, Rheumatoid arthritis, Cold allergy and history of vascular impairment, such as frostbite or arteriosclerosis.
Deep Freeze is a topical analgesic which cools the area to help kill pain in a similar, but is not as effective as using an ice pack. We recommend them for patients who do not have access to an ice pack. Apply to the affected area no more than 4 times daily.
Contrasting Hot & Cold
Contrast hydrotherapy is the use of hot and cold in combination. The cold decreases blood flow and the heat increases it. The result is removal of unwanted inflammatory chemicals from the damaged tissue. This is referred to as a ‘vascular flush’. It is used during the sub-acute phase of healing (4 – 21 days).
To do contrasting hot and cold hydrotherapy effectively we recommend that you use two gel packs one cooled, one heated. Use the hot pack for 5 minutes before swapping immediately to the cold pack for 3 minutes and repeat three times.
The treatment should be done between 3 – 6 times a day.
It is also important to end the treatment with the cold application.
Heat Therapy
Heat therapy has three main benefits. Firstly it dilates the blood vessels of the muscles, increasing the flow of oxygen and nutrients to the muscles, helping to heal the damaged tissue. Secondly it stimulates the sensory receptors in the skin, decreasing transmissions of pain signals to the brain and partially relieving discomfort. Thirdly it facilitates stretching the soft tissues, including muscles, connective tissue, and adhesions. Consequently, with heat therapy, there will be an increase in flexibility.
Heat treatments should be used for chronic conditions (injuries over 21 days) to help relax and loosen tissues, and to stimulate blood flow to the area. Use heat treatments for chronic conditions, such as overuse injuries, before participating in activities.
Heat the gel pack in a microwave for 60 seconds on high(or as directed), wrap in a damp cloth and place firmly on the affected area for 15 – 30 minutes or until it reaches body temperature.
Heat treatment should be done no more than 6 times a day.
Do not use heat treatments after activity or an acute injury. Heating tissues can be accomplished using a heating pad, or even a hot, wet towel.
When using heat treatments, be very careful to use a moderate heat for a limited time to avoid burns. Never leave the hot pack on for extended periods of time, or while sleeping.
Caution: People have different tolerance levels to heat. Tolerance levels can vary between treatments, degree of injury or illness, and body temperature.
Arnica is a herbal remedy that reduces inflammation and therefore soothes the pain and improves mobility. It aids healing by improving the blood flow to the area, and soothes the nerve endings. It is very effective when used in conjunction with heat therapy. Apply to the affected area 3-4 times daily with gentle massage. Do not apply where the skin is broken.
We hope that you find this information useful. If you experience any adverse reaction to these treatments, stop, and report this to your practitioner.
The information provided is for general guidance only and must not be used for diagnosis or treatment of a health problem. This information is not intended to be a substitute for professional medical advice.
0191 565 8886
