FAQ - Do I use heat or cold to relieve pain from carpal tunnel syndrome (tendinitis, tennis elbow, other repetitive strain injury)?

Both heat and cold offer therapeutic benefit for relieving the pain associated with repetitive strain injuries. Here are some guidelines to help you choose which will work for you. Try both and see which works the best.

Caution: Be careful with both heat and cold if you have impaired sensation or impaired circulation. Do not use an intense heat on an acute or very swollen area. A mild heat or cold packs may be used effectively.

Hot Packs

• Increase circulation and blood flow
• Are good for chronic pain
  
• Increase flexibility and relax muscles
  
• Reduce muscle spasm from guarding or protective positioning and tonic muscle contraction
  
• Are good to use prior to exercising
  
  
  • Apply pack for 10-20 minutes
    
  • May cause more swelling if heat is too intense
    
  • Use carefully, especially if sensation or circulation is impaired

Paraffin Dips

• A more intense heat than a hot pack as hot wax coats the joints
  
• The mineral oil in the paraffin lowers the melting point of the wax so that the temperature is better tolerated than water at the same temperature
  
• Good to help soften scars
  
• Good for arthritic joints
  
• Home units are found easily and cost is now reasonable
  
• Use carefully. Avoid use if sensation or circulation is impaired. Do not use over open wounds.

Contrast Bath

• Increases circulation
  
• Decreases Swelling
  
• Decreases pain
  
• Good for acute pain
  
  
  
  • Use two basins of water, one with hot water (about 100 degrees - on the warm side but not burning) and one with cold water (about 55-65 degrees - cold but not freezing).
    
  • Place hand in the warm water for 3 minutes followed by cold water for 1 minute.
    
  • Alternate 4-5 cycles.

Cold Packs

• Reduce acute swelling
  
• Decrease pain
  
• Good for alleviating post-activity or post-exercise soreness
  
• Cause a temporary reduction in flexibility
  
• Use carefully, especially if sensation and circulation are impaired
  
  
  • Apply cold packs in 10-20 minute intervals until the tissues feel cold or numb and the skin is slightly red. Use a thin towel layer between the cold pack and the skin.
    
  • Because cold decreases flexibility, let the tissues warm up for about 20 minutes before performing exercise or intensive hand activity after using cold
    
  • An inexpensive way of providing cold is to use a bag of frozen corn (frozen peas work as well, but may become mushy if used frequently). Mark the bag "for therapy" and do not eat the corn once it has been defrosted and refrozen.
    
  • You can also use a good, leak-proof freezer bag to freeze 3 parts water to 1 part alcohol (any type of alcohol will do). The alcohol prevents the water from freezing completely making a slush that can be wrapped around the painful area.

Ice Massage

• More intense than a cold pack
  
• Good for small areas of superficial inflammation and tenderness
  
• Use carefully. Avoid use if sensation or circulation is impaired.
  
  • Freeze water in a small paper cup or Styrofoam cup (or use an ice-cube).
    
  • Tear off the lip of the cup until a small portion of the ice is exposed.
    
  • Massage the painful area with small, circular strokes (never hold the ice still over the area).
    
  • Initially, the area being massaged will feel very cold, then achy, then as if it is burning, then numb.
    
  • Stop the ice massage once the area is numb.

Everyone in the clinic loves these cold packs. They are durable, do not leak, will not puncture, are comfortable, and conform well to bony areas. The Velcro strap is a nice addition to hold them in place when you are on the move. Buy at Amazon.com.

Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.