“You’re hot and you’re cold
You’re yes then you’re no…”
– Katy Perry

Does anyone empathize with Katy Perry’s feelings when dealing with injuries?
While, they’re both useful for musculoskeletal injuries, when are heat and / or cold treatment appropriate?

To answer the above, here’s a quick lesson on the Pathophysiology of Pain.

In response to tissue injury, special nerve endings called nociceptors are activated. The nociceptors send a basic message to the brain, “HELP! SOS!” Once the brain receives the message, a pain sensation is recognized and the inflammatory response units begin to move to the pain location.

In the inflammatory response, there is an increase in blood flow, local temperature as well as cell metabolism in the area of the injury. This process is responsible for destroying harmful agents, toxins and damaged tissue ensuing new tissue generation.

At the same time, our neurotransmitters (nerve signal biochemicals found at the nerve endings) basically spilt everywhere and become “hyperactive” increasing muscle contractions in the injured area. This overkill in muscle activity can further damage the tissue.

So, in a nutshell, all this good (blood, oxygen and repair cells) and bad (toxins and harmful agents) stuff rushing to the injured area is what causes pain, swelling and spasms in your injury.

Hot or Cold?

In short, administering applicable treatment will depend on the ultimate outcome.
First off, what do you want the heat or cold treatment to achieve?

Heat therapy and cold therapy have opposing but effective uses for injury management and pain.

Heat (thermotherapy) is a muscle relaxant that increases blood flow, oxygen, metabolism and muscle extensibility and flexibility while cold therapy (cryotherapy) is a topical analgesic that decreases blood flow by constricting the blood vessels effectually reducing metabolism, oxygen and tissue extensibility and flexibility.

Back to this “What’s your ultimate outcome when treating an injury?” question.
As a general rule, if you’ve had a very recent injury and / or a joint or muscle is inflamed, your ultimate goal is to decrease swelling, stop the area from going into belligerent spasms and decrease the influx of the toxic agents. The immediate action to follow is to use an ice pack.

However, if you’re muscles are feeling stiff, immobile, lacking oxygen and need some good TLC, use a heat pack.

Hot and Cold
Hopefully that’s helped clarify the HEAT VS COLD debate and when someone asks you, you’ll know when to use heat and when you use cold.