Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury

Abstract

Nonpharmacological treatment strategies for acute musculoskeletal injury revolve around pain reduction and promotion of healing in order to facilitate a return to normal function and activity. Heat and cold therapy modalities are often used to facilitate this outcome despite prevalent confusion about which modality (heat vs cold) to use and when to use it. Most recommendations for the use of heat and cold therapy are based on empirical experience, with limited evidence to support the efficacy of specific modalities. This literature review provides information for practitioners on the use of heat and cold therapies based on the mechanisms of action, physiological effects, and the medical evidence to support their clinical use. The physiological effects of cold therapy include reductions in pain, blood flow, edema, inflammation, muscle spasm, and metabolic demand. There is limited evidence from randomized clinical trials (RCTs) supporting the use of cold therapy following acute musculoskeletal injury and delayed-onset muscle soreness (DOMS). The physiological effects of heat therapy include pain relief and increases in blood flow, metabolism, and elasticity of connective tissues. There is limited overall evidence to support the use of topical heat in general; however, RCTs have shown that heat-wrap therapy provides short-term reductions in pain and disability in patients with acute low back pain and provides significantly greater pain relief of DOMS than does cold therapy. There remains an ongoing need for more sufficiently powered high-quality RCTs on the effects of cold and heat therapy on recovery from acute musculoskeletal injury and DOMS.

Mechanisms for the control of local tissue blood flow during thermal interventions: influence of temperature‐dependent ATP release from human blood and endothelial cells

“…In support of the responsiveness of skeletal muscle macro-and microcirculations to thermal stimuli, local cooling and heating have been shown to change perfusion in the human thenar eminence muscle group in proportion to variations in intramuscular temperature (Binzoni et al 2012), an observation which is consistent with the local responses seen in porcine skeletal muscle with microwave heating (Akyürekli et al 1997), and the responses to different thermal interventions of the human lower leg muscles (Heinonen et al 2011) and the profunda femoral artery, which primarily supplies blood to the thigh muscles (Chiesa et al 2015(Chiesa et al , 2016. These haemodynamic responses and their impact on the supply of regulatory substances, oxygen and substrates form the basis for the widespread clinical and ergogenic application of heat and cold therapies and thermal interventions (Imamura et al 2001;Malanga et al 2015). However, the vascular signalling mechanisms involved in the regulation of limb tissue perfusion with changes in local temperature are as yet not fully characterized or understood.…”

“…2001; Malanga et al . 2015). However, the vascular signalling mechanisms involved in the regulation of limb tissue perfusion with changes in local temperature are as yet not fully characterized or understood.…”

International Olympic Committee consensus statement on pain management in elite athletes

“…Although cryotherapy is commonly used, there is little evidence from prospective studies assessing the benefit of this intervention 54–56. Ultrasound therapy may have a limited role in managing plantar fasciitis56 but has not demonstrated effectiveness in other studies 57. Electrical stimulation,49 58–60 massage therapy,48 61–63 myofascial trigger point treatments64–67 and acupuncture68–70 have not shown reliable and consistent efficacy for relief of pain resulting from musculoskeletal injury.…”

Diagnosis and management of intersection syndrome as a cause of overuse wrist pain

“…Similarly ice was not recommended in a chronic setting as it may exacerbate sensations of stiffness 28. Although there is limited evidence regarding its efficacy, these therapies are non-invasive, cheap, readily available and have relatively few side effects 29. Topical capsaicin and the weak opioid co-dydramol were also prescribed to optimise analgesia.…”