Injured? Here’s how to know when to use heat, cold, or compression therapy

Hot, cold, and compression therapies are common treatments for managing pain and easing both acute injuries and chronic aches. But just because one method feels soothing, how do you know if it’s the correct option for healing?

The general rule has always been to use ice for inflammation and numbing pain, heat for stiffness or muscle soreness, and compression as complementary to both, says Jamie Cunha, a California-based clinic director and physical therapist at EXOS.

But a growing field of research shows that icing an acute injury delays recovery by prohibiting the body’s natural inflammatory reaction. “Now, the science says you have to go through the inflammatory process or you won’t heal properly,” says Cunha.

Even so, physical therapists see the benefits of icing, particularly for chronic pain like arthritis and tendinitis. Pairing it with compression can be even more impactful. We’ve broken down what temperature therapy is best for what types of injuries, and how compression fits into the mix.

Heat therapy

Heat is typically applied as a pre-treatment before exercising or before a physical therapy session to warm up the muscles, stimulate blood flow, and increase circulation. Even taking a warm shower first thing in the morning can ease chronic pains and increase range of motion before starting the day.

Heat can also be applied pre- or post-treatment to reduce muscle guarding, or tightness, that’s often associated with pain.

“It’s used for someone who is very stiff but not inflamed,” says Cunha. Using heat on an acute injury, Cunha explains, will invite fluid to an already swollen and inflamed area, causing more swelling and discomfort.

For the most effective outcome, use a moist heat pack, versus a dry pack, for at least 10 minutes. There are also options that combine heat with vibration, like the Hyperice Venom.

Ice therapy

For centuries, icing has been widely accepted as the go-to method for acute injuries and pain. Athletes take ice baths after competing and post-surgical patients are encouraged to ice frequently. But over the past decade, scientists have been analyzing whether icing lives up to its reputation.

“The research is calling for people to do movement to get rid of swelling and let the inflammatory process happen,” says Cunha, who has cut back on icing for injuries in her clinic.

Moving the injured body part uses the body’s muscles to pump fluid up through the lymphatic system to process and get rid of excess fluid, which reduces swelling without interfering with inflammation.

Because the research refers to acute injuries, and not chronic pain such as arthritis or tendonitis, physical therapists still widely use ice to assuage pain. For injuries like tennis elbow, where the pain is contained to one location, an ice massage — which involves direct, aggressive cooling — can be focused on the area for five minutes.

“Clinically, what I’ve seen is that people do like ice when they’re really sore,” says Robb Blackaby, an athletic trainer and physical therapist at EXOS. “It takes away some of the pain and allows some of the muscles to relax.”

Ice is typically used at the end of an exercise or psychical therapy session, or even at the end of a full day of activity. Some options like the Hyperice ICT Utility use compression and cold therapy for an upgraded healing experience.

Compression therapy 

Compression therapy is often paired with icing to bring down swelling. Compression machines tighten and release around a person’s arm or leg, depending on the injury. It pushes fluid away from the swollen area and up through the lymphatic system to be processed.

“It’s three-fold,” Blackaby says. “The cold reduces the pain, the compression reduces swelling, and that restores range of motion.”

Even compression alone has its benefits. “It’s good for recovery after a workout,” says Blackaby, who explains that it mimics the effect of the body’s muscles pumping and brings fresh blood back to the affected areas. 

For acute injuries, Blackaby recommends a lighter compression level than for chronic pain. High-tech solutions like NormaTech products allow you to choose your compression levels and target the areas where you need the most recovery help.

EXOS believes in the use of high-quality products. That’s why we recommend Hyperice.

About the Author

Lauren Katims

Lauren Katims is a Northern California-based writer and editor.

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Why at-home physical therapy is just as important as clinical time
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