Thermotherapy is the application of hot or cold interventions (heat packs link to heatpack and ice packs most common).
Thermal therapies work by affecting the superficial, intra-articular (joint structures) and core temperature of soft tissues. Appropriate use of cryotherapy and thermotherapy is useful for treating numerous musculoskeletal conditions and injuries. Ice or heat often decreases pain in muscles, tendons and joints. These interventions have the opposite effects to each other on edema, blood flow, inflammation, cellular metabolism, and tissue tension.
Why would I use thermotherapy?
- 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.
- 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.
How do I use Thermotherapy?
The most common methods of applying heat to soft tissues are heat packs. baths, saunas, and infra-red lamps.
The most common methods of applying cold to the tissues are frozen gel packs, ice baths, ice and coolant sprays.
What are the Effects?
THe effects of heat and cold are well documented.
- heat improves blood circulation and encourages relaxation in the muscles while decreasing stiffness in the joints(blood flow).
- Cold usually decreases pain, swelling and slows down the metabolism.
What Precautions should I take?
People with decreased sensation, such as diabetic neuropathy in the feet – are not advised to use thermotherapies in the area with reduced sensitivity. Burns can easily occur.
- V. Hurley et al., Non-exercise physical therapies for musculoskeletal conditions, Best Practice & Research, Clinical Rheumatology, 2008. 1C
- Brosseau L., Yonge K.A., Welch V. et al., Thermotherapy for treatment of osteoarthritis, the Cochrane library, 2003. 1A
- Petrofsky J., Berk L., Lee H., Moist heat or dry heat delayed onset muscle soreness, Journal of clinical medicine research, 2013. 2B
- Scott F. Nadler, DO, FACSM, Kurt Weingand, PhD, DVM, and Roger J. Kruse, MD; The Physiologic Basis and Clinical Applications of Cryotherapy and Thermotherapy for the Pain Practitioner, pain physician, 2004. 1A
- L. Kellogg Jr., In vivo mechanisms of cutaneous vasodilation and vasoconstriction in humans during thermoregulatory challenges, the American Physiological Society, 2006. 3A
- Hendee W.R., Physics of Thermal Therapy, Fundamentals and Clinical applications, By Taylor and Francis group, 2013.
- Heinrichs K., Textbook of medical physiology, Philadelphia, 1986. (chapter 16: superficial thermal modalities).
- Bleakley C.,McDonough S.,MacAuley D., The Use of Ice in the Treatment of Acute Soft-Tissue Injury: A Systematic Review of Randomized Controlled Trials, The American Journal of Sports Medicine; 2004. 1A
- Tricia J. Hubbard et al., Does Cryotherapy Improve Outcomes With Soft Tissue Injury? Journal of Athletic Training, 2004. 1A
- Ernst E., Fialka V., Ice freezes pain? A review of the clinical effectiveness of analgesic cold therapy, J pain symptoms manage, 1994. 5
- Amin A. Algafly, Keith P. George, The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance, Br J Sports Med, 2007. 3B
- Choi YJ et al. Therapeutic effects and immunomodulation of suanbo mineral water therapy in a murine model atopic dermatitis. 1B
- Hiroharu K., Kiichiro T., Effectiveness of Aquatic Exercise and Balneotherapy: A Summary of Systematic Reviews Based on Randomized Controlled Trials of Water Immersion Therapies, Journal of epidemiology, 2010. 1A
- Eversden L, Maggs F, Nightingale P, Jobanputra P., A pragmatic randomized controlled trial of hydrotherapy and land exercises on overall well-being and quality of life in rheumatoid arthritis, BMC Musculoskeletal Disorders, 2007. 2A
- Lacy A. Holowatz et al., Mechanisms of acetylcholine-mediated vasodilatation in young and aged human skin, The Physiological Society, 2005. 3B
- Swenson C et al. Cryotherapy in sports medicine. Scand J Med Sci Sports. 1996 Aug6(4) 1B
- Kathleen A. Sluka, PhD, PT, Michelle R. Christy, MPT, Wendy L. Peterson, MPT, Staci L. Rudd, MPT, Stacie M. Troy, MPT, Reduction of pain-related behaviors with either cold or heat treatment in an animal model of acute arthritis, Archives of Physical Medicine and Rehabilitation, March 1999. 3B
- Fahey T.D., Athletic training: principles and practice, Mayfield.
- Oosterveld F.G.J., Rasker J.J., Effects of local heat and cold treatment on surface and articular temperature of arthritic knees, American college of rheumatology, 1994. 1B
- William E. Prentice, An Electromyographic Analysis of the Effectiveness of Heat or Cold and Stretching for Inducing Relaxation in Injured Muscle, The journal of orthopaedic and sports physical therapy, 1982. 1B
- Steven E. Peres, David O. Draper, Kenneth L. Knight, Mark D. Ricard, Pulsed shortwave diathermy and prolonged long-duration stretching increase dorsiflexion range of motion more than identical stretching without diathermy, Journal of Athletic Training, 2003. 2B
- Oosterveld F.G., Rasker J.J., Treating arthritis with locally applied heat or cold, semin Arthritis Rheum., 1994. 5