Therapeutic Applications of Heat vs Cold

If you've ever had an injury—whether it's a sprained ankle from running or joint stiffness after a long day—you've probably wondered: Should I grab an ice pack or reach for a heating pad? The truth is, both cold and heat therapies have their place in both recovery and injury rehabilitation. But knowing when to use each can make all the difference in your healing process.

Cold Therapy

Cold therapy, also known as cryotherapy, is the go-to for acute injuries. Think sudden sprains, strains, or any type of trauma where swelling is your body's immediate response. Ice helps to reduce swelling, numb the pain, and limit damage to the tissues.

How It Works:
When you apply cold, it causes blood vessels to constrict (Knight & Draper, 2013). This reduces blood flow, which means less swelling. It also numbs the area, providing almost instant pain relief—especially useful during the first 48 hours after injury. Research indicates that cryotherapy is particularly effective at reducing swelling and pain during the initial phase after an injury or surgery (Hubbard & Denegar, 2004). Some common methods include:

• Ice packs or gel packs: Quick and easy for small areas like a sprained wrist or ankle.

• Ice baths: Athletes swear by these for post-exercise recovery, especially after intense training.

• Cryotherapy chambers: More intense, these are becoming popular for whole-body cold therapy.

When to Use It:
Cold therapy is most effective within 48 hours of injury and should be applied for no more than 20 minutes at a time. It’s is perfect for:

• Acute injuries (sprains, strains, or fractures)

• Reducing post-workout soreness

• Controlling post-surgical swelling

What to Watch Out For:

• Do not apply ice directly to your skin—it can cause frostbite. Always wrap it in a towel or cloth to protect yourself.

• Cold therapy should also be avoided if you have poor circulation or conditions like Raynaud’s disease. 

Additionally, it's important to note that while ice can reduce pain and swelling in the short term, the long-term benefits of cryotherapy, particularly on tissue repair and recovery, remain unclear (Hubbard & Denegar, 2004).

Heat Therapy

Where cold therapy excels at calming inflammation, heat therapy is ideal for those days when your muscles are tight and your joints feel stiff. Heat is a great way to increase blood flow and relax the muscles. It’s perfect for anyone dealing with chronic pain or conditions like arthritis.

How It Works:
Applying heat causes blood vessels to dilate, allowing more oxygen and nutrients to reach sore areas. This helps relax tight muscles, soothe joint pain, and improve flexibility (Knight & Draper, 2013). There are two main types of heat therapy:

• Dry heat: Heating pads or an infrared sauna.

• Moist heat: Warm baths or steamed towels, which penetrate deeper into the muscles.

When to Use It:
Heat therapy can be beneficial before activities that require significant flexibility or range of motion. It’s recommended to apply heat for 20-30 minutes, and works best for:

• Chronic neck or back pain

• Joint stiffness from arthritis

• Muscle tightness or spasms

What to Watch Out For:

• Be careful not to use heat on new injuries or swollen areas. It can actually make swelling worse. 

• Make sure the heat is comfortable, not too hot, to avoid burns.

Can You Combine Cold and Heat?

If you’re wondering whether you can use both, the answer is yes. This is known as contrast therapy, where you alternate between cold and heat. Cold reduces the swelling, and heat increases blood flow and mobility.

Contrast therapy is especially useful for:

• Soft tissue injuries

• Post-surgical recovery

• Reducing muscle tension after exercise

Listen to Your Body

At the end of the day, both cold and heat therapies are powerful tools, but they aren’t one-size-fits-all. The right treatment depends on your specific condition and how your body responds. Always consult with a healthcare professional if you are unsure, especially if your symptoms persist or worsen.

Cold and heat therapies are simple but effective ways to manage pain, reduce inflammation, and promote recovery. Whether you’re dealing with a new injury or chronic stiffness, using these therapies correctly can help you get back to doing what you love—without unnecessary setbacks. 

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To learn more, check out these resources:

Hubbard, T. J., & Denegar, C. R. (2004). Does cryotherapy improve outcomes with soft tissue injury? Journal of Athletic Training, 39(3), 278-279.

Knight, K. L., & Draper, D. O. (2013). Therapeutic modalities: The art and science. Lippincott Williams & Wilkins.

How intense does massage really need to be?

When it comes to massage therapy, many people wonder how intense the pressure needs to be to achieve the best results. There is a common misconception that the deeper and harder the pressure, the more effective the massage. However, the relationship between pressure and therapeutic outcome is more nuanced. Let’s explore the difference between deep pressure and deep tissue massage, why excessive pressure can be counterproductive, and how to find the optimal level of pressure for your needs.

Too Much Pressure?

One key aspect of effective massage therapy is understanding that getting muscles to release isn't about forcing them into submission. When a massage therapist applies pressure, sensory receptors in the skin and muscles send signals to the brain. These signals can help the brain to recognize tension, slowly convincing it to relax the muscles.

While other physiological effects also contribute to reduced tension in the body, putting the brain into a parasympathetic state is key to maximizing the benefits of massage. This means that excessive pressure is actually counterproductive, causing the body to go into a protective mode and tightening up the muscles even more in response to pain or perceived threat. Even worse, too much pressure can cause bruising, inflammation, or further injury.

Finding the Optimal Pressure

The goal of massage therapy is to promote relaxation and facilitate muscle release, not to cause pain. While a certain level of discomfort might be expected, particularly when working on tight or knotted areas, the sensation should be more of a "hurts so good" feeling rather than outright pain.

The optimal pressure during a massage varies from person to person and even from one area of the body to another. What feels good for one person might be too intense or too light for another. The "hurts so good" sensation is often an indicator that the right amount of pressure is being applied. This feeling suggests that the pressure is sufficient to address the muscle tension without causing excessive pain.

Take Control of Your Experience

To get the most out of your massage therapy session, there are several things you can do to help facilitate muscle release:

1. Stay in Communication

Always communicate with your massage therapist about the pressure being applied. No massage therapist, no matter how experienced, can know exactly what you are feeling. Your feedback is essential to ensure the pressure is just right.

2. Avoid Tensing Up

Try to keep your own muscles from tensing during the massage. Tension in the muscles can counteract the effects of the massage and make it harder for the therapist to work effectively.

3. Breathe Deeply

Make sure not to hold your breath. Deep, steady breathing can help to relax your muscles and enhance the therapeutic effects of the massage. When an especially tender or tight area is being worked on, focus on taking deep breaths to help the muscles release.

4. Relax Your Mind

Mental relaxation is just as important as physical relaxation. Try to let go of any stress or anxiety you may be holding onto. A calm mind can help facilitate muscle relaxation.

Effective muscle release involves communicating with the brain through slow and deliberate touch. The right amount of pressure to accomplish this is different from person to person and won’t even be consistent throughout your entire massage. Let go of any preconceived notions about how light or deep a massage needs to be. By finding a balance that promotes relaxation and healing without causing unnecessary pain, and by communicating with your massage therapist, you’ll be surprised at how much more benefit you can get out of each massage!

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To learn more, check out these articles:

Journal of Bodywork and Movement Therapies

Deep tissue massage: What are we talking about?

National Library of Medicine

Brain Activity Underlying Muscle Relaxation

The mechanisms of massage and effects on performance, muscle recovery and injury prevention

Reactive vs Proactive Athletic Wellness

Depending on where you are in the country, preseason is underway for fall sports. No matter what level, most teams require some form of pre-participation exam. These annual appointments are designed “to screen for injuries or medical conditions that may place an athlete at risk for safe participation."¹ Regrettably, there is not a standardized exam in the US, resulting in a wide range of effectiveness. The National Athletic Trainers' Association Position Statement includes the following guidelines for designing an exam:

• Medical and Family Health History

• General Health Screening

• Cardiovascular Screening

• Neurological Screening

• Orthopedic Screening

• General Medical Screening

• Review of Medication Use

• Nutrition Assessment

• Heat- and Hydration-Related Illness Risk Factors

Considering all the areas assessed, it is important a medical physician (MDs or DOs) supervise these exams. Missing from that list however, is a Functional Movement Assessment. Both ATCs and PTs can be instrumental in helping you establish an athletic baseline.²

By evaluating basic movement patterns, any strength imbalances or compensatory strategies can quickly be identified. Check out our instagram post on the functional assessment I used with the Warriors Dance Team for the 2021-2022 preseason screens!

Your provider can review any significant findings with you, helping you understand how they may be impacting your performance. But if the findings from your assessment don’t correspond with pain, should you still address them?

Short answer: It depends. 

As clinicians, it is important to take the whole athlete and their goals into account. Understanding the demands of the sport and the anticipated load throughout the season is one piece of the puzzle. A rising high school freshman basketball player with lower extremity strength imbalance may have been fine playing at the middle school level 3-4 times per week. However, once introduced to the demands of a varsity squad- weight lifting, practices 5 times a week, and a heavier competition schedule- may no longer thrive. It is reasonable to anticipate that they will begin to experience lower extremity joint pain at some point during the season. By providing them a short home exercise protocol that addresses the imbalance, they may be able to avoid the scenario altogether.

A semi-professional golfer will expectedly present with a strength imbalance dominant to non-dominant side rotation due to the demands of their sport. Assuming their regular strength and conditioning includes bilateral rotational power and deceleration work, minimal changes may need to be made.

Ultimately, we believe that sports medicine should be proactive not reactive. While it is impossible to avoid injury in sports entirely, athletes can train more effectively based on their individual strengths and demands.

To learn more, check out these articles:

1. Wingfield K, Matheson GO, Meeuwisse WH. Preparticipation Evaluation: An Evidence-Based Review. Clin J Sport Med 2004; 14(3):109-122.

2. Conley KM, Bolin DJ, Carek PJ, Konin JG, Neal TL, Violette D. National Athletic Trainers’ Association Position Statement: Preparticipation Physical Examinations and Disqualifying Conditions. Journal of Athletic Training 2014;49(1):102–120.

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Daily Foam Rolling

Myofascial release is a hands-on technique using sustained pressure to the connective tissue restrictions to relieve pain and restore motion. But does it work? Dr. Betsy Webb certainly thinks so, stating “this is one of the most common modifications I suggest to patients. Maintaining soft tissue and joint mobility is so important in preserving joint health and building strength.”

According to a systematic review conducted by Beardsley and Škarabot, myofascial release can help to increase flexibility and reduce soreness. Regular maintenance helps with joint and soft tissue extensibility and mobility, will improve tissue length and pliability and its ability to accept force and load. This allows the body to do more work with less strain overall. Methods like foam rolling, gua sha and massage can improve arterial and vascular endothelial function, or the flow of blood and lymph through the tissues. Self-myofascial release allows for consistent and cost-effective management. Athletes of all levels most commonly use a foam roller or ball of varying density.

Despite being versed on the benefits, Betsy has trouble incorporating soft tissue work. “I love working on strength and cardio work,” she laughs, “but often under prioritize mobility in my own physical fitness. I know how valuable mobility work is, yet I struggle to incorporate it into my routine.” As part of our Athlete Within Challenge, Betsy agreed to spend 10 minutes foam rolling everyday for two weeks. Here’s how it went:

As with any new habit, the most challenging part about for Betsy was adherence. “I started out really strong for the first week but then the weekend hit and falling out of my daily routine made it more challenging to stay diligent,” she says. Sound familiar?

In order to stay consistent, Betsy found three different techniques to be most helpful: routine, external accountability, and increased accessibility. “I found using an alarm worked really well. I set an alarm for 9:15 every night to remind me.” (As an added benefit, myofascial release can also help to improve parasympathetic nervous system activity, allowing us to mentally and physically calm down so our bodies can regenerate. Soft tissue work in the evening can set you up for a great night’s sleep!)

Betsy shared her goals with her fiancé, finding that having “someone to hold me accountable, who knew to remind me if I hadn’t done it for the day” helped to keep her on track. The last thing she found to be helpful? Relocating her foam roller. “I ended up putting it next to the tv,” says Webb, “so that when I would sit down to watch tv at night I would see the roller and be reminded to use it.”

So is it worth the time? After the two weeks were up Betsy’s body was thanking her. “Foam rolling is something I know I should do more of, especially for my thoracic spine, but never was able to get into a routine." Like so many of our patients, Betsy saw tremendous benefit from going back to the basics: “After the first week I felt good but not too much different, but a full two weeks really started to make a difference in how I felt from a mobility standpoint.” The true payoff for myofascial release work is in the consistency. Studies have yet to show if any of these improvements in flexibility and tissue quality have longterm effects once treatment is stopped. “I fully intend to maintain this behavior. As I saw with the two weeks, the longer I remained consistent the better I felt,” states Webb.

Our vote? Yes to myofascial release!

Looking for Dr. Betsy Webb? As of July 1st, she will be practicing in the Chicago Area!

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Superbill Best Practices

Choosing to work with a provider not covered by your insurance has advantages and disadvantages. It can be gratifying to do your research and select the practice that best meets your needs, and in some ways, simplified to know exactly what you owe from the start. However, paying the full amount for services can add up.

Every patient is eligible to receive itemized medical receipts, or superbills, detailing their care with us. These receipts can be submitted to most insurance plans for reimbursement consideration, as well as qualify for select employee wellness incentives or tax credits. Because reimbursement costs the insurance companies money, the process is often tedious. We’ve put together our top four suggestions on how to maximize your returns, taking full advantage of your plan:

1. Gather your paperwork

Most insurance companies still require you fill out a paper application with your plan information to mail in along with your superbill. We recommend printing and filling out one application, leaving the date blank. Make copies of this, and reuse for each submission adding the individual dates each time. 

2. Read the fine print

Double check which payment options you select for your reimbursement. Some forms offer the choice to make payments to the providing clinician instead of the patient, aka YOU. Selecting the wrong option could require you to wait much longer to receive payment. 

3. Increase your odds

Submit your receipts individually, as soon as you receive them. It's a 6 week process, at minimum, and your insurance could require more information from your clinician.Having to resubmit decreases your chance of payment.

4. Pay it forward

Share any feedback from your insurance company with our team. Remember, they are looking for any reason to not pay out on claims. If they don't cover the services billed, we can work with you to better understand what they will cover in the future

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As the Director of Operations + Patient Success, Shannon navigates our Out-of-Network team. After pairing you with the best provider for your goals, she continues to be an essential part of your care by ensuring you have all the information you need for insurance claims.

For specific questions, or for help managing an existing claim, schedule a call