Hydrotherapy: When to HEAT/ICE

Hydrotherapy: When to HEAT/ICE


According to the Merriam-Webster Dictionary, hydrotherapy is defined as “the use of water in the treatment of disease or injury”. It is simple to do and also one of the most frequently recommended forms of homecare by massage therapists. They can suggest taking a warm Epsom salt bath or to ice a particularly damaged or inflamed area. However, the basics of where and when is often the subject of great debate.

As a simple rule of thumb, ice is for injuries and heat is for muscles/stress:

·  Acute injuries (less than 24 hours old) use ICE *do not place ice directly on skin, wrap in a towel/cloth*

·  Sub-acute injuries (2 days to 6 weeks or once swelling has gone down) use ice, heat or a combination of both (contrast hydrotherapy explained at the bottom)

·   Chronic (persistent for more than 3 months) use heat

The application of cold, generally ice packs, in acute stages of an injury plays a few roles on a physiological level. Cold acts to vasoconstrict the area it is applied to. By restricting the blood flow to the affected area, it helps to reduce swelling/inflammation, decreases the perception of pain and limits the formation of bruises.

The application of heat through hot water bottles, heating pads, hydroculators, warm water, heat packs etc. acts as a vasodilator. This opens up the blood capillaries allowing for more blood to reach the area being treated. This can help loosen up joints and muscles, taking the edge off of overused, tight or painful areas. Heat soothes the nervous system and helps decrease stress. Stress and fear often play a large role in chronic conditions, so finding any way to help alleviate them can be very helpful with pain management.

NOTE: it is important not to use heat/ice at the wrong times.

Using heat on an acute injury can increase inflammation resulting in a lot more pain. Alternatively, using ice on chronic issues such as painful trigger points (knots) in muscles can cause the muscle to spasm more, again resulting in more acute pain to the area.

Contrast Hydrotherapy

As a Massage Therapist with over 10 years of experience, I have found the greatest results in pain management and decreased recovery time from injury comes from the use of contrast hydrotherapy. It is the inverse application of both heat and ice to the affected area directly. To perform this, first apply heat to the affected area for 3-5 minutes immediately followed by the application of cold for the same 3-5 minutes; this is 1 cycle. Repeat for 3 cycles, always remembering to finish with cold. This prevents the area from being congested or inflamed at the end and also provides a slight analgesic effect, decreasing the perception of pain. I once had my father perform contrast hydrotherapy 3 times daily as he was laid up with a bulging disc in his low back and he was able to manage his pain levels without medication and was back up on his feet in much less time than it had taken him to recover in the past.

Ultimately, it’s personal preference that determines which is best to use for each individual throughout different stages of injury and discomfort. If you already feel flush, the addition of heat likely will be unpleasant and if you are chilled and hate the idea of being iced, the use of ice won’t be for you.

When applying heat or cold, always remember to exercise caution. Use temperatures within your tolerance to avoid burns and damage to the skin.

Mike McGinnes is an award winning massage therapist, whose practice is focussed on deep tissue massage therapy. You can read more about Mike on his profile page.