Cold vs. Heat
Everybody seems to have an opinion
about the localized use of the physical agents heat and cold – how long, how
often, moist, dry... You name it. Here are my recommendations. I hope you will
find the rationale compelling. Bear in mind that this is not a discussion about
hot showers, baths, Jacuzzis, and saunas. They are all wonderful, but are
limited in that you can only use them once or twice a day. And they are used for
the whole body, not in a local manner.
Reason for use: Yours:
pain relief. Mine: increase local circulation to promote rapid healing while
optimizing safety, hopefully with pain relief as a side benefit.
How localized heat and cold work:
Your body has wonderful mechanisms it employs to maintain a reasonably constant
temperature of approximately 98.6 degrees. Perspiring and shivering are two
mechanisms it uses systemically. With local application of either cold or heat,
it can increase circulation in the area in an attempt to normalize the
temperature of the body area cooled or heated.
So, both heat and cold trick the
body’s temperature regulation systems to promote circulation. What difference
does it make which you use? In a controlled environment with a therapist
applying the agents in a systematic way, it wouldn’t make any difference.
However, I am asking you to do this for yourself at home, and I want you to use
procedures for yourself there that will maximize your potential for benefit and
minimize your risk of aggravating your condition or otherwise doing harm.
Heating pads:
The lovely sedative effect
that heating pads produce at skin level is a tender trap. After a short time,
depending on the heat, the pad with its continuing source of heat overwhelms the
body’s ability to cool the region with increased circulation. The heat then
penetrates to the muscles and joints. Remember one of the problems at muscle and
joint level (for which you may very well be taking anti-inflammatory
medications!) is that the area is inflamed. Adding more heat to an already
inflamed area just does not compute.
A key word in the last paragraph
is "sedative." Your sedated, or calmed, nervous system becomes less
aware of the intensity of the heat you have on – "Let’s turn this
rascal up higher!" And, no matter how many times people are warned that
more than ten minutes of a heating pad can make things much worse, it is only
human to feel so "calmed" that twenty minutes easily becomes twice as
good as ten. You do the math for leaving the darned things on all night!
Hot packs: Because
they do not have a continuing supply of heat the way heating pads do, hot packs
are not nearly so bad. They are still very tempting to use for too long periods
of time, though. If you do use them, always use a timer, and make ten minutes
the limit. Remember mild warmth is enough for the local skin effect –
penetrating deep down to muscles and joints doesn’t make sense.
Cold packs:
Cold packs are probably not as
good as a nice, hot shower. But, you can use them up to once an hour. The
electric or gas company and your dermatologist would love you to try
taking a shower every hour! It simply isn’t practicable.
Cold packs, when used in
conjunction with a timer (no more than 10 minutes) and some insulation to guard
against skin damage, are extremely safe. They are conveniently portable – many
people have a freezer or a cooler available at work where they can store one.
They can be applied easily without removing clothing, and they are incredibly
cheap.
Admittedly though, there are
people who do not feel comfortable with cold packs. If it makes a person feel
cold all over to use one, he or she will not be able to relax and will probably
not benefit from its use. If it causes the local pain to get worse, listen to
your body and discontinue using the cold pack.
Compromises: If
a cold pack seems too cold, even when applied through a linen towel or
sweatshirt, try keeping it in the refrigerator rather than in the freezer. If a
cold pack feels comfortable at first but causes discomfort after five minutes of
so, cut down the time of the application to within the comfort level.
If heat is the only way, use a
heat pack in preference to a heating pad. If the heating pad is the only way for
you, use it no longer than five minutes per hour on a maximum setting of low.
Make it your plan to do nothing that will risk making inflammation worse and
accept that heating pads on high for longer than five minutes can easily do
that.
Comments: It
really doesn’t matter what cold or hot packs have in them, whether its glycol,
Jell-O, frozen peas, or buckwheat. It’s the temperature differential from your
skin and body temperature and how comfortably the pack can be applied to the
body parts that count. I don’t feel the choice of moist vs. dry really matters
all that much. If moisture is important, moderate heat applied over the skin
stimulates sweat glands to provide moisture whether you want it or not.
People with impaired skin
sensitivity, such as is common with diabetics, should use heat and cold with
extreme caution. If the site of application cannot be seen directly or by
mirror, a family member or friend should inspect it for you frequently.
Convenience: Sullivan’s
postulate: "If it can’t be done conveniently, it probably ain't gonna get
done at all." I do not believe there is anything that can compare with the
use of cold packs in terms of both convenience and economy.
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Gerard
E. Sullivan, DC
4401 Bridgeport Way W
University Place, WA 98466
