Hot or Cold?

Hot or Cold?

Pain is a part of life. Whether it comes from a nasty fall, a basketball play gone wrong, or simply from daily chores, pain is something that everyone feels. Pain is described by the International Association for the Study of Pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage…” Even though pain is unavoidable that doesn’t mean that it should be unmanageable. One of the easiest ways to deal with simple pain from injuries is to change the temperature. The practices commonly referred to as icing and heating are formally called Cryotherapy and Thermotherapy. “Although cold and hot treatment modalities both decrease pain and muscle spasm, they have opposite effects on tissue metabolism, blood flow, inflammation, edema, and connective tissue extensibility” (Nadler). As we see from studies, heat therapy as well as cold therapy are effective in decreasing pain, but they do it in different ways.

Before you try either of these approaches it’s important to know the contraindications for treatment. In other words, there are times when it is unsafe to drastically change the temperature of your body or when you should be extra cautious when doing so. We’ve provided a list of some contraindications at the end of the article.

Everything you do and feel is brought about by your Nervous System. Your nervous system is, simply put, your brain and all of your nerves. Your nervous system acts by sending chemical and electrical messages from your body to your brain and vice-versa. It’s your nervous system that is responsible for telling you when you’re in pain.

Cryotherapy can be used to slow down the pain signal and as a result, the sensation of pain is lessened. Studies have shown that lowering the temperature of skin can decrease Nerve Conduction Velocity (NCV) which is simply the speed that nerves relay information through your body. If you’ve ever tried to move quickly when you’re cold, you know how much lower temperatures can make a difference in your speed. This is is a good way to intuitively understand what cold does to signals of pain. Imagine that your nerves were a series of pipes filled with water and the messages are sent through these tubes. We can imagine that these messages are sent like a letter in a bottle. In normal conditions the bottles flow just fine through the rivers of our nerves, but if the water were to begin to freeze it would be much slower!

One of the major ways that thermotherapy decreases pain is by increasing blood flow. Blood is responsible for transporting nutrients essential for healing. This is one of the reasons you see swelling in an injury. All your little blood cells rush like little paramedics to the site of the injury to help heal it up. When you use heat to treat an injury, it warms up your blood and the surrounding area. It increases the speed that the blood cells can bring nutrients to the injured site. It’s similar to our example about nerves, but in the opposite.

Now that we’ve briefly touched on one example of pain management for each cryotherapy and thermotherapy, the only question left for you might be which one is right for you. Before ever considering treating yourself you should consult your doctor with any questions. When treating pain you should always remember - it’s objective. That means that nobody else can feel what you’re feeling. The goal of pain management is that it makes you feel better, so if you like heat more than cold then use it. If you love the feel of an ice bath, then give yourself an ice bath. The goal of pain relief is ultimately to encourage your body to relax. Regardless of whether you prefer thermotherapy or cryotherapy the most important thing is to be consistent. A one time treatment isn’t going to fix your problems, but heating your lower back several times a week can aid tremendously in healing. A good rule of thumb if you’re unsure of what to do is this: heat before activities and ice after. If you’re going to be moving around it’s important to help your muscles stretch out and by heating you encourage blood flow. Once you’re done with your activity you can ice the area to bring down the inflammation and slow your systems down. It is also generally a good idea to use heat on chronic issues because it encourages the healing process of the body.

Nobody wants pain to get in the way of the things they love, and you don’t have to. Heat and cold therapy are cheap and easy ways to manage your own pesky pains so you can get back to the activities you enjoy!

The list below is not a complete list and you should always speak to your health care provider if you have concerns or questions.

Contraindications for Thermotherapy:

  • Acute inflammatory disease
  • Skin lesions (cuts, scrapes, etc)
  • Peripheral neuropathy (issues with your peripheral nervous system)
  • Circulatory issues
  • Rheumatoid Arthritis (deep heating should be used with caution)
  • Multiple Sclerosis
  • Diabetes Mellitus
  • Spinal Cord injuries

Contraindications for Cryotherapy:

  • Nerve damage
  • Diabetes Mellitus
  • Raynaud's phenomenon (a circulation problem dealing with constricting blood vessels)
  • Open wounds


Nadler, S. F., Weingand, K., & Kruse, R. J. (2004). The Physiologic Basis and Clinical

Applications of Cryotherapy and Thermotherapy for the Pain Practitioner. Cryotherapy

and Thermotherapy for the Pain Practitioner 395 Pain Physician, 7(3), 395–399.

Retrieved from

Algafly, A. A., & George, K. P. (2007). The effect of cryotherapy on nerve conduction velocity,

pain threshold and pain tolerance. British Journal of Sports Medicine, 41(6), 365–369.

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