Heat Pack or Cold Pack: Which works best in Trigger Point Therapy?

Hot and Cold Packs For The Treatment of Trigger PointsShould a therapist use heat or cold in addressing their client’s trigger points? To answer that question, we first need to understand the effects that heat and cold applications have on the body.

Heat/Cold Modalities and Local Circulation

Both modalities act primarily to affect local circulation in the tissues. The application of a hot pack or heating pad, causes the blood vessels in the skin to dilate or “open-up”. This allows blood to flow more freely and acts to rapidly distribute the heat being applied throughout the body. The end result of this process is that very little heat penetrates to the muscles lying underneath the skin.

The application of cold packs to the body surface does just the opposite; it causes the local blood vessels to constrict, drastically reducing the amount of blood circulating in the region. With circulation impaired, cold can penetrate much deeper into the body tissue, easily chilling the underlying muscles.

When To Use Heat Packs

While it is doubtful that the application of a heat pack has any theoretical effect on the muscle harboring the trigger point(s), clinical experience has demonstrated that clients receive some benefit from it, especially if they have more established or chronic complaints. I typically advise patients to apply heat to the muscles I have treated after their appointment with me. The use of a heating pad for a 20 minutes on-20 minutes off-20 minutes on regimen can help to flush metabolic wastes that have accumulated from trigger point activity. Dr. Travell also advocated the use of a heating pad on a client’s abdominal region, prior to treatment, to promote blood circulation throughout the body and relax the client.

When To Use Cold Packs

The application of cold is useful in cases of acute injury where tissue swelling is likely to occur. It is also useful in deadening neurogenic types of pain; such as the physical compression of a nerve from a herniated spinal disc. As I rarely see patients immediately after an injury, or refer them immediately in cases of neurogenic pain, I rarely use or advise the use of cold packs in my practice. More often I advise against the use of cold packs because they can chill a muscle and aggravate latent or active trigger points within the muscle.

4 Comments Already

  1. Erlich Phua - February 11th, 2011 at 10:21 am

    Does it make any difference whether the pack is wet (wrapped in a damp towel that has been dipped into warm water) or dry (applied directly or on a dry towel)? Do you think using an infra-red lamp after treatment would help? I’ve come across some on the market that give off a nice warm glow.

  2. Dr. Laura Perry - February 11th, 2011 at 11:54 am

    @ Erlich,
    Good questions. Using a heating pad that is designed for wet application is the preferred method, as the water assists in the conductive transfer of heat to the skin. Regarding the use of infra-red lamps, I really don’t have any practical experience with this modality. I would think these lamps might actually work better than heat packs or heating pads, especially the far-infrared lamps, because the heat could theoretically penetrate to a greater tissue depth. I will have to look into this further, thanks for bringing it up.

  3. Tony Friese - November 12th, 2011 at 6:36 am

    I liked that tidbit about heating the abdomen to encourage an increase in systemic circulation-I hadn’t heard that before…very cool! :)

  4. safeint - August 12th, 2013 at 5:28 am

    Just for info, I have been using those dry, material covered (like hot-water bottle in shape and sold as a dry hot water bottle) and are placed in a microwave for about 2 minutes and are just as warm and as good as the small little stuffed pads that were heated in a special heater that the Chinese therapists use after therapy. Easy to use and can be washed – Stephen

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