“Knowing others is intelligence;
knowing yourself is true wisdom.
Mastering others is strength;
mastering yourself is true power.”
― Lao Tzu, Tao Te Ching
Heat and Cold Applications – Hydrotherapy
You can learn how to listen to your body and use simple methods to manage pain and soreness. During your treatments, based on my findings at the time, I will recommend cold, contrast or heat. You can also learn how to interpret your body’s symptoms, as outlined below. This allows you to better manage your symptoms and manage and improve your recovery post-treatment.
Invest in a soft blue plastic “gel” pack, available at most pharmacies for cold [or heat] application. For heat, you can use a heated gel pack (note that a pack kept for heat use only will last longer than one you use for both heat and cold), a heating pad or immersion in a bath or hot tub.
Everyone is different and each injury and your body’s condition at the time may be different; try to learn your body’s typical and non-typical reactions and treat with cold, heat or contrast therapy as indicated. The signs of inflammation can be pain, heat, redness or swelling, which indicate that cold may be most helpful.
Contrast heat and cold therapy is used for conditions of sub-acute care, when you may want the properties of both heat and cold working for you. When a muscle is “tight” or hyper-toned, heat will offer more relief because the tissue becomes ischemic (a lack of blood into the area on a cellular level) and the heat increases blood circulation into the area. Use caution with heat applications if you have inflammation as well as tightness — too much heat will aggravate the problem, although it may feel good at the time of application. Pay attention to how it feels an hour later. When you are unsure, contrast is the best solution as it simply drives more circulation to the area, speeding recovery. Keep in mind – inflammation is the body’s healing response and it does serve a purpose in recovery – we just need to limit or manage it sometimes – to give comfort from pain and limit excessive inflammation.
Cold is used to treat inflammation and for acute care to speed recovery by managing our bodies’ correct but sometimes over-done inflammatory response. Apply cold typically for about ten minutes. Longer may have a detrimental effect. Store your gel pack in the freezer to have it handy for emergent cold care. Wrap the pack in a thin cloth to prevent frostbite to the skin but allow the cold to penetrate. Repeat every 45-60 minutes or as needed. This is often recommended to use after a treatment if the treatment was uncomfortable or you experience discomfort after your treatment.
Local effects of cold are vasoconstriction (contraction of the blood vessels) resulting in a slowing of local circulation, less leukocytic (white blood cells) migration through capillary walls, and a decrease in tissue metabolism. The result most people will notice is the anesthetic effect, or the numbing feeling.
Cold applied to back of neck, top of shoulders and/or upper back may help some headaches. Use of cold over acutely inflamed joints, bursae, contusions and sprains causes vasoconstriction and relief from pain and swelling.
Contrast is used for conditions of subacute care, when you may want the properties of both heat and cold working for you. Always apply heat first and always finish with cold! Typically a contrast application may consist of 15 mins of heat, followed immediately by 5 to 8 mins of cold, then a return to heat and repeat of this same cycle for three times as a set, with the set repeated every hour or as desired. Shorter or longer sets may be used, with the rough rule of heat first followed by cold at one third to one half the length of time as the heat and always finishing with cold.
Heat can be applied (or immersed in) for ten to fifteen and up to twenty minutes each hour as often as needed. Local effects of heat include vasodilation (opening up of blood vessels) thereby increasing blood flow into the application area. A moist towel over your application or a moist heat pad increases the “depth” of the effect.
Injury management is best done with consultation with a health care practitioner to be sure of accurate assessment and diagnosis. Until you can see someone, pain is a good guide – stay as active as you can without aggravating the pain. Your practitioner, after having assessed you, will likely recommend treatment as well as exercises to maintain and build your active range of motion. You may need to change your preferred activities for a time, diversify into new or different exercise and activity regimes to allow for recovery (eg a runner may need to switch to swimming or biking temporarily) or diversify your workouts for longer term management. You will get more specific guidance from your health team.
An Important note about ‘Tight Muscles’
Many people confuse ‘tightness’ of soft tissue with shortening. Hypertonicity best describes what a RMT may find that you might consider ‘tight’ tissue. There are many varieties of ‘tightness’. Soft-tissue can be hypertoned or ‘tight’ but still of normal functional length. Sometimes, the hypertoned tissue may be functionally either shortened or lengthened. Depending on which case that is (or if other issues like neural facilitation are involved), the management of it may be quite different. This is where the assessment and management skills of your therapist become important and is why it is important to follow their instructions and provide feedback on the results, so that over time, your therapist can give you not only a manual treatment, but guidance to best management of your specific condition, often including prevention of further problems.
Also, it is important to note that contrary to common belief, performing strength exercises with appropriate resistance and good form, does not necessarily lead to “tight” muscles. Hypertonicity, or excessive “tightness”, may occur as a result of over-use (pushing past tolerance and rest needs), compensatory use (ie use when muscle may be compromised while it is working out of balance with synergistic and antagonistic muscles) or under-use. Your therapeutic team will assess for these issues and guide your recovery exercises with this in mind.