Treating shoulder pain using heat and ice
Shoulder pain can often be effectively managed with a combination of heat and ice.
Shoulder injuries can be extremely painful, and the shoulder is one of the easiest parts of the body to re-injure. Shoulder damage can often benefit from heat and/or ice therapy. Some of these techniques can be done by your clients at home, allowing them to manage their own symptoms while not in the clinic.
Safety tips for using heat and ice
Don’t apply heat or ice directly to the skin
It’s important to remember not to use cold next to dry skin. Put either oil with a plastic bag over it or oil and a wet towel on your skin first, and then apply the cold pack. This is to prevent you from getting frostbite because ice can burn your skin. It’s also a good idea not to put heat directly on your skin unless it is only warm. A heating pad next to dry skin can burn you if the heat is extreme. To prevent this, put a towel in between your skin and the heating pad.
When not to use heat or ice
There are a number of situations when ice and heat should not be used. These include having poor circulation, skin with lesions or scratches on it, nerve damage, skin with a negative reaction to hot or cold, an infection, or diabetes. In addition, never put heat or cold over an open wound or an area that is bleeding.
If you’re pregnant, you should avoid taking a very hot bath or putting heat near your abdomen area. There are other conditions when using heat and ice is inappropriate, so always check with your doctor or health professional before you begin treatment.
Frozen Shoulder
How and when: apply a cold pack to the top of the shoulder for about ten minutes before bed each night.
Frozen shoulder can be not only highly uncomfortable for clients but also challenging for early career therapists to treat effectively. Many manual therapists struggle to find effective treatment strategies, which is precisely why we developed a treatment sequence specifically for frozen shoulder.
When it comes to its managing symptoms at home, frozen shoulder - and shoulder inflammation generally - is best treated locally with a simple ice pack. Interestingly, a study in Korea concluded that patients suffering from adhesive capsulitis (AC) of the shoulder can benefit from whole-body cryotherapy (see below).
During the acute phase of frozen shoulder, the patient suffers from night pain and spasms. There is also chronic inflammation. The long head of the biceps tendon is often characterized by both acute and chronic symptoms. Treatment should involve icing the top front of the shoulder for about ten minutes before bed every night.
Osteoarthritis
How and when: apply a cold pack to inflamed areas for 20-30 minute intervals every 4-5 hours. Apply a heat pack to ease muscle pain for 20-30 minutes at a time.
Hot and cold therapy is very effective in the treatment of arthritis. Doctors suggest treating the inflammation and pain associated with arthritis by using both heat and ice along with a range of other complimentary treatments. You should use heat before you do exercise and cold after exercise - which is also an effective tool for managing arthritis, as it can help to strengthen muscles and improve flexibility.
To deal with pain and inflammation, use an ice pack for 20-30 minute intervals every 4-5 hours.
Heat relaxes the muscles and reduces pain. You should only use a heat pack for 20-30 minutes at a time. Wait at least an hour before applying the pack again, or you may cause tissue damage.
If your joints are swollen, do not apply any heat at all. If you have nerve damage, you should avoid hot and cold therapy altogether.
Calcific Tendinitis
How and when: alternate heat and ice in 15 minute intervals a few times each day.
Calcific tendinitis is an inflammation resulting from an accumulation of calcium deposits in the rotator cuff tendon or subacromial bursa. The causes of the condition are still unknown - at best, there is broad consensus that it’s not caused by trauma or overuse and that it can only rarely be attributed to systemic disease.
Curiously, the pain is generally not felt while the calcium deposits are accumulating - only when they are reabsorbed into the surrounding tissue. This resorptive phase of the condition causes an inflammatory reaction. It is this reaction that can be managed using a combination of heat and ice.
When managing symptoms at home, clients should alternate heat and ice to reduce pain and aid the healing process. Starting with cold, alternate cold and hot packs in 15-minute intervals a few times each day until you feel the pain diminishes.
Bursitis, biceps tendonitis, impingement, and rotator cuff tendonitis
How and when: apply a cold pack for 15-20 minutes per day every three to four hours.
Bursitis, biceps tendonitis, shoulder impingements, and rotator cuff tendonitis are all conditions that cause inflammation, which can then be managed using cold packs.
Putting ice on your shoulder helps reduce inflammation and pain. Use a cold pack for 15 to 20 minutes every three or four hours. After a few days, when the pain and inflammation have improved, hot packs or a heating pad may help relax tightened and sore muscles.
Cryotherapy
Another form of cold therapy is cryotherapy, which involves freezing part of the skin with liquid nitrogen. This method has been used to treat tissue damage since the 17th century. It is very effective in constricting the blood vessels and decreasing inflammation, pain and spasms.
Cryotherapy is used to treat a number of problems, and is even used in surgery to remove the prostate and by dermatologists to remove skin lesions. There is also full body cryotherapy, where the patient enters a chamber cooled with liquid nitrogen for a short period of time – around 3 minutes. During the treatment the patient is dressed only in a bathing suit, but wears socks, gloves, and protection for their ears and mouth to prevent frostbite.
This procedure diminishes pain because it stimulates the body to release endorphins. Patients report positive, healing effects for a number of mental and physical conditions including stress, shoulder pain, muscle and joint pain, rheumatism, and fibromyalgia.