Before starting an exercise program, consult a physician.

There has been controversy over the years as to when to apply cold and when to apply heat. Because heat stimulates blood flow, it promotes healing just as cold does. It can also relax muscles and ease pain.

But heat can make swelling worse. That's why cold is best right after an injury and heat is recommended for later, when swelling abates. As a rule of thumb, use ice for at least 48 hours after injury. Then, when the swelling is gone, you can apply heat.

Using cold therapy may not be a good idea for some people. Those who are very sensitive to cold will not be able to tolerate icing long enough to do any good. Conversely, those who have a high tolerance to cold-or who pride themselves on being "tough"-open themselves to injury by applying cold therapy too long.

People with problems in the blood vessels near the skin should avoid cold therapy, especially those with Raynaud's phenomenon (a condition in which the blood vessels in the fingers, toes, ears, and nose constrict dramatically when exposed to cold and other stimuli). If you suspect you may be at risk because of diabetes or another condition that can diminish blood flow, check with your doctor before applying cold to an injury.

This information was furnished by Dr. Bryant Stamford, PhD

Heat and cold therapies have been an integral part of health care for many years. Reference to their effective use dates back to ancient Greece. They have been widely used as both a home remedy and as a part of professional rehabilitation programs. Over the years, many new thermal delivery systems have been developed and made readily available to the public through retail outlets and/or healthcare providers. Many of these consist of a gel or clay covered with a protective material, some of which can easily be transferred from freezer to microwave, thereby providing a complete range of treatment. Whether providing temporary relief from discomfort, managing inflammation or relieving muscle cramps, heat and cold therapy are easy and safe to use as long as you follow some simple guidelines.

Heat therapy comes in two forms, dry heat (i.e., electric blankets and heat lamps) and moist heat (i.e., hot compresses, gel or clay packs, hot water bottles and whirlpool baths). Some leading experts consider moist heat to be more penetrating and therefore, more effective than dry heat. Uses for Heat Therapy:

Generally, heat therapy is most appropriately used when there is little or no risk of inflammation, as it tends to “warm-up” the afflicted area. Once inflammation has subsided, heat therapy can facilitate healing after an injury by increasing circulation, bringing much-needed oxygen and nutrients to the site, while helping to flush away waste products that accumulate during the healing process.

Heat therapy can also be used to warm up joints such as the knee or shoulder. Athletes often combine heat with stretching exercises before an activity. Subjective reports from patients who have used heat therapy suggest it is useful for providing relief from minor aches and pains, muscle cramps and symptoms of chronic arthritis when used correctly. Heat therapy is also effective in treating chronic problems like tendonitis, back pain and repetitive strain injuries.

However, the same properties that make heat therapy so effective for certain conditions make it a poor choice for other conditions.

To prevent burns, always use layers of insulation between the skin and the heating device. Never sit or lie on the heat source, as this too can result in skin burns.

Heat therapy should be applied with caution to children and the elderly. Pregnant women and patients with diabetes should first consult their physician or other appropriate healthcare provider.

• During the acute stage after an injury (the first 24-72 hours)
• Where blood clots or hemorrhage are present
• With topical analgesics, camphor or menthol products

Devices to deliver cold therapy come in a variety of forms, such as clay or gel-based packs that are kept in cold storage until needed, and disposable, one-time-use chemical bags that require no refrigeration, but become cold when the seal is broken. At home, an easy, inexpensive, yet effective cold therapy strategy is to use ice cubes sealed in a plastic bag.

Cold therapy, also called cryotherapy, is used to treat acute pain. It is most effective at the onset of an injury and can effectively reduce the pain and inflammation associated with strains, sprains and even some fractures. Lowering the temperature of the tissues reduces the blood flow and the rate of nerve impulses to the area, thus reducing swelling and providing pain relief.

Hospitals use cold therapy to manage postsurgical swelling common after joint repair or replacement. In such cases, the cold therapy is used in conjunction with rest, compression and elevation. This treatment protocol is often referred to as the “RICE” formula.

Cold therapy is also helpful in breaking what is commonly called the “pain-spasm-pain cycle.” Therefore, it is a good choice for the treatment of muscle spasms and cramps.

As with heat therapy, cold therapy also requires a layer of protection between the cold source and the skin. Areas of thin skin are especially susceptible to the risk of nerve damage.

Despite its accessibility and ease of delivery, cold therapy should be used with caution. The elderly, children and patients with vascular, circulatory or heart conditions must consult their physician before using cold therapy. Cold therapy is not the treatment of choice for all types of edema or swelling. Your healthcare professional can best advise you.

• On areas where nerves are regenerating
• Where vascular disease is present
• If you notice a rash-like breakout, as this may indicate a condition called Cold-Induced Allergy