Hot and cold therapy

[Immortal25]

Hello, would like to know if it's ok to use both hot and cold therapy on the same limb at the same time? Meaning, for example, the elbows are swelling and the shoulders are stiff so how about ice for the elb and hot pack for the sh; both at the same time? Will that somehow disrupt the circulation and causing any adverse effects?

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[Canuck Physio]

Interesting, I've never heard of a case of concomitant cryo/heat therapy, but there are cases (such as NFL players) who utilize hot/cold baths which alternate between hot for 15s, then cold for 15s for example, and if you look into some of the research into contrast bath therapy there appears to be some evidence showing its effectiveness.

[physio.smith]

Have used contrast bathing for same area...i.e. ankle etc for persistant chronic swelling (not hot) and has worked sucessfully. Don't know about 2 different areas on the same limb.

Is this for the same patient that you posted about regarding bilat. shoulder pain?
If so please consider rheumatological conditions, vascular status, neurological involvement etc...

[Canuck Physio]

The effect of contrast water therapy on symptoms of delayed onset muscle soreness.
Author: Vaile JM , Gill ND , Blazevich AJ
Source: J Strength Cond Res, 21(3): 697-702 2007

Abstract: This study examined the effect of contrast water therapy (CWT) on the physiological and functional symptoms of delayed onset muscle soreness (DOMS) following DOMS-inducing leg press exercise. Thirteen recreational athletes performed 2 experimental trials separated by 6 weeks in a randomized crossover design. On each occasion, subjects performed a DOMS-inducing leg press protocol consisting of 5 x 10 eccentric contractions (180 seconds recovery between sets) at 140% of 1 repetition maximum (1RM). This was followed by a 15-minute recovery period incorporating either CWT or no intervention, passive recovery (PAS). Creatine kinase concentration (CK), perceived pain, thigh volume, isometric squat strength, and weighted jump squat performance were measured prior to the eccentric exercise, immediately post recovery, and 24, 48, and 72 hours post recovery. Isometric force production was not reduced below baseline measures throughout the 72-hour data collection period following CWT ( approximately 4-10%). However, following PAS, isometric force production (mean +/- SD) was 14.8 +/- 11.4% below baseline immediately post recovery (p < 0.05), 20.8 +/- 15.6% 24 hours post recovery (p < 0.05), and 22.5 +/- 12.3% 48 hours post recovery (p < 0.05). Peak power produced during the jump squat was significantly reduced (p < 0.05) following both PAS (20.9 +/- 13.4%) and CWT (12.8 +/- 8.0%), with the mean reduction in power for PAS being marginally (not significantly) greater than for CWT (effect size = 0.76). Thigh volume measured immediately following CWT was significantly less than PAS. No significant differences in the changes in CK were found; in addition, there were no significant (p > 0.01) differences in perceived pain between treatments. Contrast water therapy was associated with a smaller reduction, and faster restoration, of strength and power measured by isometric force and jump squat production following DOMS-inducing leg press exercise when compared to PAS. Therefore, CWT seems to be effective in reducing and improving the recovery of functional deficiencies that result from DOMS, as opposed to passive recovery.

[Immortal25]

Have used contrast bathing for same area...i.e. ankle etc for persistant chronic swelling (not hot) and has worked sucessfully. Don't know about 2 different areas on the same limb.

Is this for the same patient that you posted about regarding bilat. shoulder pain?
If so please consider rheumatological conditions, vascular status, neurological involvement etc...

No, this is a different case. It's a fracture elbow actually. The shoulder is stiff now probably caused by the prolonged sling. So patient asked me if two things could be done at the same time to save time and I wondered...

Canuck, yeah same limb. I've heard of alternate but how about at the same time of the same limb?

Thanks for the read though!

[physio.smith]

Thanks. Not sure physiologically what the implications would be...I would tend to treat one at a time personnally.

If you come across any info on this let me know.

[Yarok]

hi

as far as i remember should be ok re limphatic flow hot on proximal part let easy flow of limph from the distal (cold). and i think in theory should help improving treatment.

thanks