Thermal therapies work by affecting the superficial, intra-articular (joint structures) and core temperature of soft tissues. Appropriate use of cryotherapy (decreasing temperature) and thermotherapy (increasing temperature) is useful for treating numerous musculoskeletal conditions and injuries and providing natural pain relief. Ice or heat often decreases pain in muscles, tendons, and joints. These interventions have the opposite effects to each other on oedema, blood flow, inflammation, cellular metabolism, and tissue tension.

To apply thermotherapy you first need to decide on the method you will use

To apply heat choose from

heat packs or hot water bottles

baths, saunas,

infra-red lamps

moist heating pads or electric blankets

Usually after a remedial massage heat is the better option to reduce muscular tension returning.

To apply cold choose from

frozen gel packs,

ice baths, ice, and

coolant sprays

When applying heat make sure you have some kind of protective barrier and you test how hot the item is. Heat packs warmed in microwaves should have a cup of water with them to prevent burning or the pack catching on fire. You also don’t know how hot a heat pack or hot water bottle is, so don’t lie directly on top, use a barrier and if it feels too hot remove it or make the barrier thicker. Your remedial therapist may choose to apply a heat or cold pack during your massage.

The benefits of heat therapy

When the temperature of the skin/soft tissue increases – blood flow increases through an effect called vasodilatation. Vasodilation occurs in the capillaries – the smallest and most numerous blood vessels and means that the muscles in the walls of the vessels relax (like opening a tap to full) permitting more blood to travel through the vessel. As a result cellular metabolism increases.  In theory, this will increase the healing response by promoting inflammation – which may or may not be desirable for your injury.  Usually after a remedial massage heat is the better option to reduce muscular tension returning.

The benefits of cold therapy

When the temperature of the skin/soft tissue decreases the blood flow slows down through a process called vasoconstriction. Tissue metabolism will also slow – neuronal excitability (nerve conduction – pain bandwidth), inflammation also reduce, as does tissue extensibility (structures tighten up). When joints decrease below 30°C the activity of cartilage damaging enzymes such as protease, hyaluronidase and elastase is inhibited.  A slow metabolic rate reduces further damage.

You would use thermotherapy if you have muscle stiffness, menstrual pain, cramps, and the inflammatory response to an injury has passed.

Thermotherapy (heat therapy) is best for chronic muscle stiffness, pain, or spasms. It helps increase blood flow, relax tight muscles, ease cramps, and prepare muscles for activity. It’s often useful after the early inflammatory stage of an injury or following a remedial massage to keep muscles relaxed.

Cryotherapy (cold therapy)

Cold therapy is best for recent injuries, swelling, or sharp pain. Cooling the area slows blood flow, reduces inflammation, and numbs nerve activity to ease discomfort. It’s especially helpful in the first 48 hours after injury to limit swelling and protect tissues from further damage.

When the temperature of the skin/soft tissue increases – blood flow increases through an effect called vasodilatation. Vasodilation occurs in the capillaries – the smallest and most numerous blood vessels and means that the muscles in the walls of the vessels relax (like opening a tap to full) permitting more blood to travel through the vessel. As a result cellular metabolism increases. In theory, this will increase the healing response by promoting inflammation – which may or may not be desirable for your injury. Usually after a remedial massage heat is the better option to reduce muscular tension returning.

You can gain natural pain relief using thermotherapy for many different conditions, some include

• Low back pain
• Neck & shoulder pain
• Menstrual pain
• Sciatica pain
• Tendon and nerve pain

You can gain natural pain relief using thermotherapy for many different conditions, some include:

• Low back pain
• Neck & shoulder pain
• Menstrual pain
• Sciatica pain
• Tendon and nerve pain

People with decreased sensation, such as diabetic neuropathy in the feet – are not advised to use thermo-therapies in the area with reduced sensitivity.  Burns can easily occur.

Also be sure to do a skin test first if you are uses heating or cooling gels or creams

If you use a hot water bottle make sure there is a layer between the bottle and your skin. The same

applies to wheat bags heated in the microwave as you can easily overheat these and burn yourself.

Don’t leave the heat source on for too long.

You can gain natural pain relief using thermotherapy for many different conditions, some include:

1. Low back pain

2. Neck & shoulder pain

3. Menstrual pain

4. Sciatica pain

Heat will increase blood flow, relax muscles and improve movement but it is best to wait 48 hours

after an acute injury. At that point you would use cold therapy instead. Heat can also feel comforting leading your body to relax. It can also be helpful the day after a massage. Thermotherapy for low back pain should be a part of the solution especially if you have had ongoing back pain issues. If this is the case book a session with a Remedial therapist or Myotherapist to get your situation assessed and treated.

When should you use heat vs cold therapy?

Heat therapy (thermotherapy) is best for chronic stiffness, tight muscles, and ongoing pain. It boosts blood flow, relaxes muscles, eases cramps, and can be used after the initial inflammation stage of an injury or following a remedial massage to keep tension from returning.

Cold therapy is better for fresh injuries, swelling, or sharp pain. Applying ice slows blood flow, reduces inflammation, and numbs nerve activity—making it especially useful in the first 48 hours after an injury to control swelling and protect tissues.

👉 Rule of thumb: use heat for stiffness, use cold for swelling.