Heat Or Ice – Thermotherapy For Everybody

IIYou’ve put in a good day chopping wood and carrying water. Now your shoulders are sore, your back wants to secede from the union, and your dogs are barking. You’ve done something to your left knee and it’s larger than it should be. Heat and ice both seem like a good idea – but which helps with which?

Thermotherapy – the application of different temperatures, either hot or cold – is as old as the first hominid sticking sore feet in a creek, or turning his aching back to the fire. Both are excellent remedies when used properly; both, when used improperly, can do more harm than good. Fortunately the rules for when to use which are simple and easy.


Heat brings several forms of relief to bear on fatigued, overused tissues. It opens up blood vessels under the skin, bringing a rush of nutrients to the area and whisking away the metabolic waste products of honest hard work. It sedates and relaxes the nervous system, allowing tight muscles to let go. Use heat on areas that are tired, exercise-sore, tight, or stressed.

Do not use heat on areas that are injured, torn, swollen, hot, or have open wounds. The additional blood, opening of capillaries, and increased activity caused by heat would be counter-productive and possibly painful.


Ice is Nature’s anti-inflammatory. The application of cold penetrates much deeper than heat. It physically freezes out pain signals along nerve pathways, decreases swelling, and stops the processes of inflammation that cause more swelling and nerve pain. Use cold on injuries, hot and swollen areas, strains, and sprains.

Do not use ice on fragile tissues, or on areas of poor circulation or decreased sensation. Do not use ice for longer than fifteen minutes every hour to avoid actually freezing anything. That would be bad.

Remember! If you need to use ice, then you also need to show your injury to a doctor.

The best ways to apply heat are: a hot water bottle, electric heating pad, a microwave beanbag, a sauna, and my personal favourite – a hot spring.bagby hot springs

The best ways to use cold are: ice cubes in a plastic bag, a basin of cold water with ice cubes in it, or a first-aid freezer pack. Frozen veggies, although popular and convenient, don’t work too well for serious thermotherapy.

Heat and cold are two of the most basic tools in the home health cornucopia. Used properly, according to simple rules, they are invaluable in helping us help ourselves – just like our ancestors have been doing since time began.


Massage Therapy Case Study – Adhesive Capsulitis vs. Arthritis

baking_breadEdie was a wonderful home-visit client, and not just because she was always baking. She was also a real therapeutic challenge.

Edie was 93 when I saw her. “I’m having trouble reaching the rolling pin, dear,” she said to me, “my doctor says you might be able to help.” The answer wasn’t long in coming: Edie’s arms were stuck to her sides.

Symphony Of Movement

Lift your arm out to the side. This simple movement – called abduction or elevation – is actually a complex symphony of movements at the glenohumeral joint (arm to shoulder blade), the scapulothoracic junction (shoulder blade to ribcage) and both ends of the clavicle (collarbone). Edie’s problem was a splendid case of adhesive capsulitis, where the glenohumeral joint gets sewn together by overzealous connective tissue. The limitation on her left was about 80%, and on the right was 100%; if she wanted to reach anything above her waist, she had to lean her whole body to the side.

We went to work. We did soft tissue and neuromuscular massage all around her shoulder girdle to the tolerance of a 93-year-old, we did fascial release around the clavicle and scapula, and we did gentle joint mobilizations to work the adhesions loose. Over the course of three sessions we gained ground, giving Edie some increased range.

Hidden Arthritis

Then we hit a wall. “That hurts, but different,” she reported. I assessed, and scratched my head, and then I got it. We had loosened up Edie’s adhesive capsulitis enough to hit her hidden case of arthritis. While the adhesions had kept her shoulder joints limited from within, the cartilage at the edges of her shoulder joints had been quietly withering from lack of use. In effect, her joints had rusted out.

We worked together for a few more sessions. I loosened up Edie’s shoulders to the point where she bumped up against her new pain, and that’s as good as it was going to get. She could reach her rolling pins; the rest of her baking gear she simply moved to the lower shelves. On our last visit she sent me home with cookies, and I left with a new appreciation for the fascinating challenges of age.