Hot or cold?

Saturday, February 9th, 2019

I could be asking the same question of the bulbs we planted last year. With global warming apparently nudging us all closer to the Maldives climate, even the flowering plants are not sure where they are in the seasons!

But, back to the point.. A typical question for my patients is whether they have been using a hot water bottle on the area of pain? Of course, that’s a very natural thing to do and heat is very soothing – but only for certain tissues. A common situation is sitting in a warm bath to try and ease low back pain. Certainly this all feels better – until you get out. Why is that? A relaxing, warm bath is wonderful, but as a cure for pain?

Our body’s first response to most injuries is inflammation. When we are in pain, our next reaction, whether we like it or not, is to contract the muscles around a joint injury to restrict movement. So, the hot water bottle may ease the reaction of the muscles, but the heat will aggravate any inflammation.

I have seen many patients who come to the clinic with ever increasing pain around the pelvis and down the back of the thigh – often caused by problems in the sacroiliac joint. More often than not, they have been using a hot water bottle to try and ease the pain and are completely surprised when I recommend using  cold instead. Certainly, the hot water eases the contraction in the muscles and in that sense feels quite soothing, but the main problem here is not the muscles themselves but the joint inflammation and after an hour of heat, this simply gets worse resulting in a cycle of more heat and more pain.

What is a cold compress? I use a gel pack that can be left in the deep freeze but remains flexible. Frozen peas are also good in an emergency. In either case, only use for 3 minutes at a time and never directly onto your skin. Always wrap a tea towel around the pack.

So as a guide, pretty much any injury within 48 hours responds better to a cold compress. For anything else, I would recommend you come and see me before applying your trusty hot water bottle unless its on your feet!