The Great Debate: Heat Therapy vs. Cold Therapy

In my clinical practice, I come across many who are confused about when to apply heat and when to apply cold.  Each of these therapies have their strengths in the healing process so I wanted to address them here.


Cold therapy, also known as cryotherapy, is the use of cold compresses to cool the skin and local tissues.  Thinking about the nature of cold, it tends to slow down circulation of all kinds, blood, lymph, even nerve impulses.  With this in mind, cold therapy is mostly used with acute injury where there is the potential for a significant amount of swelling, especially within the first 24 to 72 hours. It can also be helpful with active muscle cramping by slowing the impulse the muscle is receiving to contract.  

What the best protocol for cold therapy? 

One study suggests a 10-minute ice, 10-minute room temperature, 10-minute ice every 2 hours over the first 72 hours to be more effective, when compared to 20 minutes continuous icing.  Please keep in mind that cold therapy may not be appropriate for patients with high blood pressure, mental impairment, or decreased sensation and should be avoided by people hypersensitive to cold, cold intolerant, and those with Raynaud’ disease.  Please monitor the area you are treating closely to prevent frostbite. If you have any further questions about cold therapy and whether it is right for you and your condition, please consult your healthcare practitioner.

Heat therapy, as the name suggests, is the use of warm compresses or wraps to warm the skin and surrounding tissues.  Warming an area can provide pain relief, increase blood flow, increased metabolism in the local area, and elasticity of connective tissues. In my clinical practice,  see the most effective application for heat after the first 72 hours of an acute injury or for most chronic pain conditions. Increasing circulation to an area in need of healing ensures nutrients will reach the area in need and allow waste to be removed.  

Heat therapy is not beneficial for all chronic conditions and it depends on how the symptoms present.  For example, Rheumatoid Arthritis, a chronic inflammatory autoimmune disorder, commonly has swollen and painful joints in addition to other symptoms.  Heat therapy would most likely make this condition worse. Heat therapy, like cold therapy, should be used with caution in patients with decreased sensitivity, such as neuropathy and nerve damage.  Superficial burns are a significant concern here.

For some people, neither heat therapy nor cold therapy have an impact on their pain and in those cases consulting a healthcare practitioner for professional recommendations can be useful.

I know this is an article about cold and heat therapy but I would be doing you a disservice if I didn’t take the time to emphasize the importance of proper hydration, especially following treatments.  With acupuncture treatments, we work on improving circulation and it’s difficult to transport anything on a dry river bed. Now, don’t drown yourself in water! Instead, drink when you’re thirsty and if you’re never thirsty that’s a great indication that you need to come in for a treatment.  

Latest research suggest drinking half of your body weight in ounces (oz.).  For example, someone weighing 150lbs should aim for 75oz of water daily. This is just a guideline and adjust the amount to best support your lifestyle. Your body requires water to move nutrients in and waste products out and to detox your body.  A happy body is a hydrated one!