“Do I ice or heat?” that is the question I have heard over and over throughout the years when discussing injuries and or pain in general. The answer is not as simple as you may think.

Although it can be confusing, hydrotherapy can be one of the most useful and inexpensive methods to help manage your pain. The use of water at various temperatures can help reduce inflammation, decrease pain, increase range of motion and function.

It’s curious to me why more people do not take advantage of this rehabilitation method and of those that do – how many use it incorrectly. To be very general – cold water/ice can decrease inflammation and pressure.  Hot water can increase blood flow, bring nutrient rich blood and relax muscles. Both hot and cold water can help to decrease pain if used at the appropriate time and for the appropriate duration.

Understanding the source of your pain is the first step.

• Acute Injury: something new or a flare-up of a chronic condition

• Chronic injury: something that has been around for a while

With Acute injuries, cold hydrotherapy is normally the first step. ICE 10 minutes/hour until swelling diminishes. This method can be used on bruises, on joints after repetitive movements or on damaged tissue – sprains and strains. The key is to rest and apply cold to reduce inflammation. The inflammation causes pressure around the injury, so reducing the pressure can help reduce the pain.

Chronic injuries normally respond better to warm or hot hydrotherapy. When there is less inflammation, heat can be used to bring nutrient rich blood to an injured area to help with the healing process. HEAT 10-20min/hour until pain diminishes. This method can also be helpful for painful or stiff muscles, by relaxing the tissue to provide relieve. If you are experiencing an acute flare-up with increased pain and or inflammation, then cold hydro will be your friend.

Hot and cold hydrotherapy can also be used together in various ways. One application is the flush: Fluctuating between hot and cold to help reduce discomfort from chronic pain. After inflammation has gone down, you can apply heat for 10 minutes followed by cold for 2 minutes, then heat again for 10 minutes.  This affects the blood flow to the area. Heat brings the nutrient rich blood but also may increase the pressure, follow with cold to decrease the pressure.  You can stop there or you can follow with another round of heat if it felt relaxing.  You can repeat this through out the day until the injury starts to feel better.

Fluctuating between hot and cold can also help you recover from injuries such as a sprain – damaged ligament.  Once you have passed the initial acute stage and the swelling has subsided, you can use heat and cold to help your joint regain it’s mobility. First apply heat to warm up the tissue, then do gentle full range of motion stretches, try to stay within a pain-free range. Once you have accomplished some gentle stretches then follow with ice or a cold wrap and rest the joint.

Hot and cold hydrotherapy can also be used at the same time for very specific outcomes. Consider stress or tension headaches for example. Applying a heating pad to the shoulders may help to reduce tension but also bring an increased blood flow. Applying a cool compress to the base of the scull at the same time will prevent the heat from travelling up the back of the neck into the head.

For those who suffer from inflamed wrists or ankles. The use of hot and cold can also help.  Applying a cool wrap to the inflamed area then a warm wrap at the end of the limb closest to the torso is an effective why to draw fluids away from an area. This can help to decrease the inflammation, pressure and discomfort.

When considering hydrotherapy in hot to cold form, there are a few important things to remember:

• Do NOT use HEAT on any new or acute stage injuries. The increased temperature and flow of blood will increase the inflammation/pressure and increase the pain by irritating damaged tissue.

• Do NOT STRETCH after ICE, the tissue will be short and immobile; you could damage the tissue further.

• After Acute phase as the injury is healing:  apply HEAT first – then STRETCH – then ICE – and REST

A very special hydro application, that is not for the faint-of-heart, is ice-cube massage. It can be used to reduce severe acute inflammation due to trauma i.e. sprained ankle, goose egg. Hold the ice cube with a paper towel and make circular motions over the affected area. Begin on the outer edges of the injury and work towards the center. The area will begin by feeling cold, then stinging, burning then turn numb. Use only one small ice-cube for application to avoid damaging the skin.

Now you have some suggestions on how to use hydrotherapy to help you with your aches, pains and injuries.  Please keep this very important point in mind regarding injuries..  If there is significant bruising, pain or malfunction then apply a first aid strategy – REST, IMMOBILIZE, apply COLD, ELEVATE and…CONSULT A DOCTOR.