Treating a sports injury – Hot

Treating a sports injury – Hot or cold?

As a sports massage therapist, a subject a lot of my clients get confused with is the old chestnut of when to use heat and when to use ice to treat a muscle problem or injury. To answer that question, it’s best to firstly understand what applying heat or cold does. We can then look at why you would use the technique and look at various methods and guidelines for application. You should also be aware of some of the dos and don’ts.

Let’s first look at using cold

Cold therapy (or Cryotherapy) is a popular treatment method for sports injuries. It is important first aid for acute sports injuries as well as being beneficial for long term, chronic injuries.

Cryotherapy works in a variety of ways to help speed the healing process after a sports injury by:

  • Reducing blood flow to the injured area, which helps to reduce swelling;
  • Acting as a pain-killer by numbing the affected area;
  • Reducing muscle spasms;
  • Decreasing tissue damage by reducing metabolism.

Let’s look at when we would use heat

Heat therapy is most commonly used for rehabilitation purposes, the therapeutic effects of heat include:

  • Increasing the elasticity of collagen tissues;
  • Decreasing joint stiffness; reducing pain; relieving muscle spasms; reducing inflammation, oedema…
  • Aiding in the post acute phase of healing by increasing blood flow to the affected area, provides proteins, nutrients, and oxygen for better healing;
  • The area will also feel more relaxed easing the pain.

Acute injuries

Acute injuries are those which result from traumatic incidents and are immediately painful, when an acute injury first occurs:

  • Bleeding, inflammation, swelling and pain must all be controlled.
  • Ice should be applied as soon as possible in order to cool the tissues, reduce their metabolic rate, nerve sensitivity and reduce blood supply.
  • Ice should remain in contact for up to 20 minutes at a time depending on the size of the area being treated and the depth of the injured tissues. It should be re-applied regularly, every 1-3 hours.

Following approximately the first 3-5 days of an acute injury, once bleeding has stopped and there are no signs of inflammation, you may wish to alternate cold and heat treatments.

  • Apply cold for 10 minutes, followed immediately by 10 minutes of heat.
  • Doing this causes massive increases in blood flow to the area, as the vasoconstriction caused by cooling reverses when heat is applied.
  • This results in an influx of blood to the damaged tissues. Remember to ensure all bleeding has stopped before applying this technique.
  • Blood is vitally important in providing all of the energy and nutrients that the body needs for repair.

The most common method of cryotherapy is the use of ice packs. There are different types of ice used in ice packs. The most common types are ice packs made with cubed, crushed and wetted ice. You can also use a frozen bag of peas wrapped in a damp cloth.

Methods of applying heat during soft tissue repair

Heat can be applied in the form of a wheat bag, heat pads, deep heat cream and hot water bottle or heat lamp. Expansion of the blood capillaries is the primary objective of heat therapy.

  • Heat therapy increases the effect on muscles, joints, and soft tissue.
  • Heat is typically applied by placing a warming device on the relevant body part.
  • In all cases, care must be taken in the application and length to ensure desensitisation of the skin is not present, which could result in a burn to the area,
  • Heat therapy is often most beneficial when used for a good amount of time, unlike cold therapy, which needs to be limited.
  • Minor stiffness or tension can often be relieved with only 15-20 minutes of heat therapy.
  • Moderate to severe pain can benefit from longer sessions of heat therapy, like a warm bath, lasting anywhere from 30 minutes to 2 hours.

When you should avoid using cold (Cryotherapy)

Cryotherapy should be avoided on areas of reduced sensitivity and a number of medical conditions:

  • Impaired sensation. People cannot report when they become anaesthetic from cold. Tissue damage occurs slightly below temperatures that produce numbness.
  • Open wounds after 48 hours.
  • Hypersensitivity to cold, such as Raynaud’s phenomenon, cold urticaria.
  • Angina pectoris or other severe cardiac disease.
  • Regenerating peripheral nerves.
  • In addition, those with joint conditions aggravated by the use of cold should avoid the use of this treatment.

Adverse reactions to using cold

Cryotherapy can reduce unwanted nerve pain and sometimes can leave the tissue affected with unusual sensations, such as numbness or tingling, or with redness and irritation of the skin. These effects are generally temporary. In addition, because of the effect of vasoconstriction, increase in blood pressure can also be a reaction. 

Actions to take in the event of an adverse reaction to Cryotherapy

Should you experience any adverse reactions during the application of cryotherapy, you should stop the process immediately and,

  • Assess the area treated for possible reactions i.e. skin irritation, freezer burn, and increased pain.
  • Should ice burn be present, look to bring the area back to normal temperature by soaking the affected area in warm water for 20 minutes.
  • If blisters or open wounds are evident, clean the area and bandage. If required GP intervention may be needed.

When you shouldn’t use heat treatments

There are certain cases where heat therapy should not be used, for example;

  • If the area in question is either bruised or swollen (or both), it may be better to use cold therapy.
  • Heat therapy also shouldn’t be applied to an area with an open wound.
  • People with certain pre-existing conditions should not use heat therapy due to higher risk of burns or complications due to heat application. These conditions include diabetes, dermatitis, vascular diseases, deep vein thrombosis and multiple sclerosis.
  • People with heart disease or hypertension should ask their doctor before using heat therapy.

Adverse reactions to heat treatments

Heat therapy should utilise “warm” temperatures instead of “hot” ones.

  • Using heat that is too hot, can burn the skin.
  • If the person has an infection and you use heat therapy, there is a chance that the heat therapy could increase the risk of the infection spreading.
  • Heat applied directly to a local area, like with heating packs, should not be used for more than 20 minutes at a time.

Additional adverse reactions can include localised swelling, dizziness, fainting, increased blood pressure and heart rate.

Actions to take in the event of adverse reactions to Thermotherapy

Should you experience any adverse reaction, stop the treatment immediately.

  • Remove the method of application and assess the situation.
  • Appropriate action should be taken depending on the situation, i.e. application of a cold compress to reduce localised temperature, first aid for treatment of fainting or dizziness.
  • Should you feel it appropriate, medical intervention should be sought.

Guest blog written by Derek Lowe ITEC Level 4 Sports Massage Therapist for Can Do Active. To find out more about Derek’s work, please visit