Published on Dec 19, 2018 and last reviewed on May 27, 2022 - 4 min read
Fomentation is the use of hot or cold packs to relieve pain at the location of an internal injury. This article explains its various applications.
When you injure yourself while doing everyday activities like walking or running, you should ice it. Swelling will occur after 24 hours, but during the first five days, the icing should be done for less than five minutes every one and a half hours. Some injuries will respond to icing alone, while others will benefit from a combination of icing for two to three minutes followed by hot fomentation for the same time. It is preferable, to begin with, icing if the injury is too old or chronic.
Ice cubes wrapped in a cloth or commercially available ice packs can be used for this. If the damage is to the wrist or elbow, always use a crepe bandage, and if it is to the ankle, always use an anklet.
When the injury or pain affects a large area, such as the lower back or knee, hot fomentation should be used. Hot fomentation relieves lower back pain faster than icing. This must be done with a commercially available rubber hot bag or hot packs that can be reheated in the oven. The heat provided by the commercially available electric bag will not be sufficient to penetrate. Back discomfort, knee pain, and eye irritation are the areas where they work best.
A hot water bag is all that is required for knee and shoulder pain, such as osteoarthritis of the knee or frozen shoulder. If the patient is nondiabetic, only ten minutes of hot fomentation is required, and seven minutes if the patient is diabetic. The temperature should be lukewarm, not scorching. After fomentation, always use a local pain reliever ointment. If the portion is the lower back, always wear a lumbosacral belt, and if the knee is osteoarthritis (OA), always use a knee brace.
Following an accident, it is a common confusion whether to use cold therapy or warm the region. The answer is dependent on the nature of your injury.
Icing therapy is used to treat acute injuries. Acute injuries are those that occur as a result of stressful events such as a fall, twisting movement, or direct blow, and are painful right away. Bleeding, inflammation, edema, and discomfort must all be addressed when an acute injury occurs. Ice should be used immediately to cool the tissues, reduce their metabolic rate and nerve conduction velocity, and produce vasoconstriction of the surrounding blood vessels.
Depending on the size of the area being treated and the depth of the wounded tissues, ice should be applied for up to 20 minutes at a time. It should be reapplied every one to three hours on a regular basis. You may want to alternate cold and heat treatments after the first three to five days of an acute injury, once the bleeding has ceased and there are no signs of inflammation. That is, administer cold therapy for ten minutes before applying heat for ten minutes. As the vasoconstriction generated by cooling reverses when heat is provided, increasing the blood flow to the area, resulting in a rush of blood to the damaged tissues. Before using this approach, make sure all bleeding has stopped. Blood is essential for giving the body all of the energy and nutrients it requires to restore itself.
Some of the conditions that can benefit from cold treatment include the following:
Recent acute injury with swelling.
Hot fomentation is used to treat chronic injuries. Chronic injuries normally appear out of nowhere. They develop gradually over days, weeks, or months and are frequently caused by overuse or biomechanical abnormalities. An acute injury that fails to heal owing to a lack of or inadequate care can potentially result in a chronic injury.
Hot water bottles, a warm moist cloth, a heated massage, or commercially available heat pads should be used for 15 to 20 minutes of hot fomentation therapy. If a hot or warm water bottle or any hot application is used, make sure you cover your skin with a proper layer of protection to avoid burns.
Heat should be utilized to assist relax tight, hurting muscles and joints, increase the suppleness of ligaments and tendons, and promote blood flow to the area in general while treating chronic ailments. Heat treatment can also be used before exercise to warm up muscles and increase flexibility in chronic ailments.
Hot fomentation is used for a variety of purposes. They include
Muscle spasms and aches.
Upper and lower back pain.
Stiff, tender, or swollen joints.
Earache due to infection.
The only time ice should be used on chronic injuries is after exercise, to reduce any residual swelling.
When handled incorrectly, both ice and heat have the ability to cause mild, transient injury. Inflammation can be exacerbated by heat. Ice can increase tightness and stiffness symptoms, as well as worsens the discomfort.
Both ice and heat are ineffective or even harmful when used when you are already shivering or sweating, respectively. The brain may perceive an excess of either as a threat, but the icing is more so, and when the brain perceives a threat, it may also increase pain. Most people seem to see ice as more dangerous.
Icing muscular pain should be avoided at all costs, as it may not be visible. You could think your back is hurting, but it could just be a muscle ache. Trigger points (painfully sensitive places) are often misdiagnosed as iceable injury or inflammation. When you ice trigger points, though, they may burn and pain much more. This is especially common with low back and neck discomfort, which are conditions that individuals frequently try to treat with ice.
Another particularly hazardous combo is heat and inflammation. When you apply heat to a new injury, it will worsen.
Icing muscular pain should be avoided at all costs, as it may not be visible. You could think your back is hurting, but it could just be a muscle ache. Trigger points (painfully sensitive places) are often misdiagnosed as iceable injury or inflammation. When you ice trigger points, they may burn and pain much more. This is especially common with low back and neck discomfort, which are conditions that individuals frequently try to treat with ice.
Another particularly hazardous combo is heat and inflammation. When you apply heat to a new injury, it will worsen.
Both heating and icing perform adequately in their own specialties. Icing is a great option to reduce swelling within the first three days of injury. Whereas heat works best in joint pains and helps relax stiff muscles. However, neither of them should be used for more than 15 to 20 minutes.
To manage pain, heat works best. Heating augments the blood and nutrient supply to the affected region, working effectively against morning stiffness and muscle and joint pains. Individuals with moderate pain may benefit from longer heat therapy sessions lasting up to two hours. However, heat is contraindicated in acute injuries.
Infection shows five cardinal signs of inflammation., one of which is ‘calor’, referring to heat from active infection or inflammation. If the injured region feels warm, never use heat as it may worsen the infection. It is best to ice the injury, and then when the inflammation has decreased after a few days, one can use heat to increase the blood flow, which provides the essential components for healing.
Swelling is caused due to bleeding in the injured area, and heat increases the blood flow, a combination that is counterproductive to swelling management. It is best to use ice on swelling for at least 72 hours post-injury, as cold slows the blood flow and also aids in reducing the swelling and the associated pain.
Following a muscle tear injury, ice should be used to manage the initial swelling. Later on, several steps may be taken to hasten the recovery process, including:
- Optimum hydration.
- Drink tart cherry juice.
- Increase and improve sleep.
- Use compression bandages but do not cut off circulation.
- Continue with low-impact exercises.
- Increase protein intake.
In non-infectious injuries and chronic pains, heat therapy works the best. Heat dilates the blood vessels and improves the blood supply of the affected region. This increases the nutrient supply and hastens the healing process. Additionally, heating removes the lactic acid from the muscles allowing them to relax. Heat can also relieve stiff joints and sore muscles.
Heat is better in all aspects for treating tight or sore muscles. This is mediated in two ways. Heat improves the blood supply of the affected region, thereby increasing the nutrient supply. And heat also removes the accumulated lactic acid from the muscles, after which muscles can unclench. A combination of both ways helps relieve tight muscles.
Not always, but alternate heat and ice packs bring their own set of benefits to the table. It is advisable first to use ice to reduce the swelling. Once the initial swelling subsides, heat can be used. Sometimes, just one therapy may not be enough to provide complete relief, and then alternating therapy might be the most beneficial option.
Heat should never be used on infected injuries as it can worsen the infections. It has been reported that for every 5 degrees Fahrenheit rise in temperature, the risk of cellulitis increases by 3.5 percent. Applying heat to an infected area can also increase the risk of spread. Heat may be applied only when the initial inflammation and swelling have settled down; till then ice pack may be applied.
Cold temperature and ice induce vasoconstriction or collapse of the blood vessels. Due to this phenomenon, the injured site does not receive the required nutrients for recovery, nor do the inflammatory chemicals required for natural recovery reach the site of injury.
Using contrasting temperatures has been proven the most effective way for muscle recovery. One can stand under a cold shower measuring around 53 degrees Fahrenheit for about one minute and then turn up the water temperature to 104 degrees Fahrenheit for three minutes. Alternating this for about four cycles can help with muscle recovery.
Ice packs may help with the pain, but they do not help with infections. Rather, icing can make the situation worse by creating a backflow in the lymphatic drainage system. After an acute injury, one may ice the area for not more than 20 minutes.
Hot fomentation has a direct effect on the vascular flow to the affected region. The byproduct of this is increased vascular flow and reduction of lactic acid in the muscles. The former step brings in more nutrition to the area, while the latter unclenches the muscle. A combination of both ways can bring relief to joint pains and muscle stiffness.
Hot fomentation should be done using hot water bottles, warm damp towels, heat rubs, or commercially available heat pads. The user must ensure to have a layer of protection over the skin to prevent burns. The therapy should not be continued for more than 15 to 20 minutes.
Last reviewed at:
27 May 2022 - 4 min read
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