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2.7: Thermal Applications: Heat & Cold

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    Heat Therapy

    Several clinical practice guidelines recommend the use of heat to manage acute and chronic low back pain (Bleakley & Costello, 2013; Clijsen et al., 2021; Chou et al., 2018; Chou et al., 2020; Qaseem et al., 2017). Heat therapy in the form of deep moist heat or a heating pad is a mild analgesic that has several effects on the human body including increase in local blood flow, mitochondrial biogenesis, improved range of motion, and pain relief (Bleakley & Costello, 2013; Hyldahl & Peake, 2020; McGorm et al. 2018).

    Cold Therapy

    Cold therapy in the form of cold compress, ice pack or ice massage can act as a mild analgesic. The physiological effects of cold therapy include reduced blood flow, reduced metabolic demand, and pain relief. This form of therapy may be useful for patients with chronic pain (Garcia et al., 2021). There is limited evidence from randomized clinical trials (RCTs) supporting the use of cold therapy following acute musculoskeletal injury and delayed-onset muscle soreness (DOMS), also a mounting body of research has shown that ice can delay healing, increase swelling, and possibly cause additional damage to injured tissues (Duchesne et al., 2017; Fuchs et al., 2020; Malta et al., 2021; Peake et al., 2017).

    PEACE & LOVE: New acronym for the treatment of traumatic injuries

    One of the primary changes surrounding the management of acute injuries is that most guidelines recommend against the use of ice to control inflammation. It is now recognized that ice can delay healing, increase swelling, and possibly cause additional damage to injured tissues. Traditionally treatment of an acute sprain or strain consists of RICE (Rest, Ice, Compression, Elevation), the most recent recommendation has been to provide soft tissue injuries with the PEACE & LOVE protocol to encourage optimal loading of the joint and tissue around the affected injury can affect the amount swelling leading to a faster recovery (Dubois & Esculier, 2020).

    • PEACE makes up the first steps you would take after an injury. Immediately after the injury you would want to protect (P) the injured structure, followed by elevating (E) the limb higher than the heart, avoid anti-inflammatory (A) both over-the-counter or prescriptions and ice, as they slow down tissue healing. Compress (C) the injured area to decrease swelling. Ensure patient education (E) on the risks of overtreatment.
    • LOVE makes up the progressive return to activities a few days after the injury. Gradual load (L) will facilitate healing, optimistic (O) influences the perception of pain and recovery speed. Loading and progressive return to activity will facilitate vascularization (V) of the injured tissues. The last step involves activity exercises (E) can help recover range of motion, strength and proprioception.

    Ice baths (also known as cold-water immersion or whole-body cryotherapy)

    Even though ice baths may delay healing, that does not mean that there is no use for the techniques. Controlled stress is a way to promote adaptation in the body, this may include, but it is not limited to training, fasting, cold immersions, breathing exercises. One prominent figure in the world of body experimentation is Wim Hof a Dutch adventurer, known by the name “The Iceman” who has popularized the Wim Hof Method and cold-water immersion. Research on this method of cold exposure suggest that people can learn to modulate their immune responses — a finding that has raised hopes for patients who have chronic inflammatory disorders such as rheumatoid arthritis and inflammatory bowel disease (Kox et al., 2014).

    Table \(2.7.1\) Thermal Applications: Summary

    Technique Application Application notes (e.g., anatomical location, conditions)
    Application of Cold Local application of cold/ice (e.g., compress, ice pack, ice massage) often for 15 minutes or less. Used over areas of acute inflammation or pain. Generally, not used over areas of chronic inflammation.
    Application of Heat Local application of heat (e.g., compress, magic bag) often for 10 - 5 minutes. Used for acute and chronic pain. Not recommended over areas of acute inflammation.
    Contrast Application Alternating application of cold (e.g., 3 minutes) with application of heat (e.g., 1 minute) Used for subacute pain.
    Key Takeaways

    For those who suffer from musculoskeletal pain, thermal applications have been shown to be a safe non-pharmacological therapeutic intervention that is simple to carry out, economical, and has relatively minor side effects.

    References and Sources

    Bleakley, C. M., Glasgow, P., & Webb, M. J. (2012). Cooling an acute muscle injury: can basic scientific theory translate into the clinical setting?. British journal of sports medicine, 46(4), 296–298. https://doi.org/10.1136/bjsm.2011.086116

    Bleakley, C. M., & Costello, J. T. (2013). Do thermal agents affect range of movement and mechanical properties in soft tissues? A systematic review. Archives of physical medicine and rehabilitation, 94(1), 149–163. https://doi.org/10.1016/j.apmr.2012.07.023

    Bleakley, C. M., Bieuzen, F., Davison, G. W., & Costello, J. T. (2014). Whole-body cryotherapy: empirical evidence and theoretical perspectives. Open access journal of sports medicine, 5, 25–36. https://doi.org/10.2147/OAJSM.S41655

    Brasure, M., Nelson, V.A., Scheiner, S., Forte, M.L., Butler, M., Nagarkar, S., Saha, J., Wilt, T.J. (2019). Treatment for Acute Pain: An Evidence Map. Rockville (MD): Agency for Healthcare Research and Quality (US).

    Broatch, J. R., Petersen, A., & Bishop, D. J. (2018). The Influence of Post-Exercise Cold-Water Immersion on Adaptive Responses to Exercise: A Review of the Literature. Sports medicine (Auckland, N.Z.), 48(6), 1369–1387. doi:10.1007/s40279-018-0910-8

    Chou, R., Côté, P., Randhawa, K., Torres, P., Yu, H., Nordin, M., … Cedraschi, C. (2018). The Global Spine Care Initiative: applying evidence-based guidelines on the non-invasive management of back and neck pain to low- and middle-income communities. European spine journal: official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 27(Suppl 6), 851–860. doi:10.1007/s00586-017-5433-8

    Chou, R., Wagner, J., Ahmed, A. Y., Blazina, I., Brodt, E., Buckley, D. I., Cheney, T. P., Choo, E., Dana, T., Gordon, D., Khandelwal, S., Kantner, S., McDonagh, M. S., Sedgley, C., & Skelly, A. C. (2020). Treatments for Acute Pain: A Systematic Review. Agency for Healthcare Research and Quality (US). https://doi.org/10.23970/AHRQEPCCER240

    Clijsen, R., Stoop, R., Hohenauer, E., Aerenhouts, D., Clarys, P., Deflorin, C., & Taeymans, J. (2021). Local heat applications as a treatment of physical and functional parameters in acute and chronic musculoskeletal disorders or pain. Archives of physical medicine and rehabilitation, S0003-9993(21)00505-0. Advance online publication. https://doi.org/10.1016/j.apmr.2021.06.015

    Dantas, L. O., Breda, C. C., da Silva Serrao, P., Aburquerque-Sendín, F., Serafim Jorge, A. E., Cunha, J. E., Barbosa, G. M., Durigan, J., & Salvini, T. F. (2019). Short-term cryotherapy did not substantially reduce pain and had unclear effects on physical function and quality of life in people with knee osteoarthritis: a randomised trial. Journal of physiotherapy, 65(4), 215–221. https://doi.org/10.1016/j.jphys.2019.08.004

    Dubois, B., & Esculier, J. F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British journal of sports medicine, 54(2), 72–73. https://doi.org/10.1136/bjsports-2019-101253

    Duchesne, E., Dufresne, S. S., & Dumont, N. A. (2017). Impact of Inflammation and Anti-inflammatory Modalities on Skeletal Muscle Healing: From Fundamental Research to the Clinic. Physical therapy, 97(8), 807–817. doi:10.1093/ptj/pzx056

    Freiwald, J., Hoppe, M. W., Beermann, W., Krajewski, J., & Baumgart, C. (2018). Effects of supplemental heat therapy in multimodal treated chronic low back pain patients on strength and flexibility. Clinical biomechanics (Bristol, Avon), 57, 107–113. doi:10.1016/j.clinbiomech.2018.06.008

    Fuchs, C. J., Kouw, I., Churchward-Venne, T. A., Smeets, J., Senden, J. M., Lichtenbelt, W., Verdijk, L. B., & van Loon, L. (2020). Postexercise cooling impairs muscle protein synthesis rates in recreational athletes. The Journal of physiology, 598(4), 755–772. https://doi.org/10.1113/JP278996

    Garcia, C., Karri, J., Zacharias, N. A., & Abd-Elsayed, A. (2021). Use of Cryotherapy for Managing Chronic Pain: An Evidence-Based Narrative. Pain and therapy, 10(1), 81–100. https://doi.org/10.1007/s40122-020-00225-w

    Garra, G., Singer, A. J., Leno, R., Taira, B. R., Gupta, N., Mathaikutty, B., & Thode, H. J. (2010). Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Academic emergency medicine: official journal of the Society for Academic Emergency Medicine, 17(5), 484–489. https://doi.org/10.1111/j.1553-2712.2010.00735.x

    Hyldahl, R. D., & Peake, J. M. (2020). Combining cooling or heating applications with exercise training to enhance performance and muscle adaptations. Journal of applied physiology (Bethesda, Md. : 1985), 129(2), 353–365. https://doi.org/10.1152/japplphysiol.00322.2020

    Kox, M., van Eijk, L. T., Zwaag, J., van den Wildenberg, J., Sweep, F. C., van der Hoeven, J. G., & Pickkers, P. (2014). Voluntary activation of the sympathetic nervous system and attenuation of the innate immune response in humans. Proceedings of the National Academy of Sciences of the United States of America, 111(20), 7379–7384. doi:10.1073/pnas.1322174111

    Leemans, L., Elma, Ö., Nijs, J., Wideman, T. H., Siffain, C., den Bandt, H., Van Laere, S., & Beckwée, D. (2021). Transcutaneous electrical nerve stimulation and heat to reduce pain in a chronic low back pain population: a randomized controlled clinical trial. Brazilian journal of physical therapy, 25(1), 86–96. https://doi.org/10.1016/j.bjpt.2020.04.001

    Malanga, G. A., Yan, N., & Stark, J. (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate medicine, 127(1), 57–65. https://doi.org/10.1080/00325481.2015.992719

    Malta, E. S., Dutra, Y. M., Broatch, J. R., Bishop, D. J., & Zagatto, A. M. (2021). The Effects of Regular Cold-Water Immersion Use on Training-Induced Changes in Strength and Endurance Performance: A Systematic Review with Meta-Analysis. Sports medicine (Auckland, N.Z.), 51(1), 161–174. https://doi.org/10.1007/s40279-020-01362-0

    McGorm, H., Roberts, L. A., Coombes, J. S., & Peake, J. M. (2018). Turning Up the Heat: An Evaluation of the Evidence for Heating to Promote Exercise Recovery. Muscle Rehabilitation and Adaptation. Sports medicine (Auckland, N.Z.), 48(6), 1311–1328. doi:10.1007/s40279-018-0876-6

    Muzik, O., Reilly, K. T., & Diwadkar, V. A. (2018). “Brain over body”-A study on the willful regulation of autonomic function during cold exposure. NeuroImage, 172, 632–641. doi:10.1016/j.neuroimage.2018.01.067

    Nadler, S. F., Weingand, K., & Kruse, R. J. (2004). The physiologic basis and clinical applications of cryotherapy and thermotherapy for the pain practitioner. Pain physician, 7(3), 395–399

    Peake, J. M., Roberts, L. A., Figueiredo, V. C., Egner, I., Krog, S., Aas, S. N., … Raastad, T. (2017). The effects of cold water immersion and active recovery on inflammation and cell stress responses in human skeletal muscle after resistance exercise. The Journal of physiology, 595(3), 695–711. doi:10.1113/JP272881

    Peake, J. M. (2020). Independent, corroborating evidence continues to accumulate that post-exercise cooling diminishes muscle adaptations to strength training. The Journal of physiology, 598(4), 625–626. https://doi.org/10.1113/JP279343

    Petrofsky, J. S., Khowailed, I. A., Lee, H., Berk, L., Bains, G. S., Akerkar, S., … Laymon, M. S. (2015). Cold Vs. Heat After Exercise-Is There a Clear Winner for Muscle Soreness. Journal of strength and conditioning research, 29(11), 3245–3252. doi:10.1519/JSC.0000000000001127

    Petrofsky, J., Berk, L., Bains, G., Khowailed, I. A., Lee, H., & Laymon, M. (2017). The Efficacy of Sustained Heat Treatment on Delayed-Onset Muscle Soreness. Clinical journal of sport medicine: official journal of the Canadian Academy of Sport Medicine, 27(4), 329–337. doi:10.1097/JSM.0000000000000375

    Qaseem, A., Wilt, T. J., McLean, R. M., Forciea, M. A., & Clinical Guidelines Committee of the American College of Physicians (2017). Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Annals of internal medicine, 166(7), 514–530. doi:10.7326/M16-2367

    Singh, D. P., Barani Lonbani, Z., Woodruff, M. A., Parker, T. J., Steck, R., & Peake, J. M. (2017). Effects of Topical Icing on Inflammation, Angiogenesis, Revascularization, and Myofiber Regeneration in Skeletal Muscle Following Contusion Injury. Frontiers in physiology, 8, 93. https://doi.org/10.3389/fphys.2017.00093

    Skelly, A.C., Chou, R., Dettori, J.R., Turner, J.A., Friedly, J.L., Rundell, S.D., … Ferguson, A.J.R. (2018). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review. Rockville (MD): Agency for Healthcare Research and Quality (US). DOI: https://doi.org/10.23970/AHRQEPCCER209

    Skelly, A.C., Chou, R., Dettori, J.R., Turner, J.A., Friedly, J.L., Rundell, S.D., … Ferguson, A.J.R. (2020). Noninvasive Nonpharmacological Treatment for Chronic Pain: A Systematic Review Update. Agency for Healthcare Research and Quality (US). DOI: https://doi.org/10.23970/AHRQEPCCER227

    Van Hooren, B., & Peake, J. M. (2018). Do We Need a Cool-Down After Exercise? A Narrative Review of the Psychophysiological Effects and the Effects on Performance, Injuries and the Long-Term Adaptive Response. Sports medicine (Auckland, N.Z.), 48(7), 1575–1595. doi:10.1007/s40279-018-0916-2

    Wilson, L. J., Dimitriou, L., Hills, F. A., Gondek, M. B., & Cockburn, E. (2019). Whole body cryotherapy, cold water immersion, or a placebo following resistance exercise: a case of mind over matter?. European journal of applied physiology, 119(1), 135–147. https://doi.org/10.1007/s00421-018-4008-7

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