Heat Therapy

Injury type: Acute

Category: Lifestyle Options

Rating: Not effective

What is it?

Heat therapy involves the application of a heat causing agent to the body. Heat may be applied to the tissues directly by a heat pack or cream, or indirectly by a ray lamp. Tissue heating may also be caused by other forms of electrotherapy, but these are discussed separately.

How does it work?

The application of heat to a tissue such as muscle is thought to increase the blood flow to that area, possibly facilitating the healing process by delivering the required cells and nutrients. Heat may also increase the elasticity/extensibility of connective tissues, thus reducing muscle tightness and/or spasm. The sensation of heat within the tissues may distract the brain from pain sensations that might be coming from the same region (the so-called pain gate theory), thereby providing further pain relief.

Is it effective?

There is conflicting evidence on the use of heat therapy in the management of whiplash. A systematic review¹ which updated evidence on passive physical modalities reported no new evidence associated with the effectiveness of heat therapy. Based on historical and current evidence base, it was recommended that heat therapy is ‘likely not helpful/ not worth considering’ as a management option for recent grade I-II whiplash. However, a rapid review² synthesising evidence from highest level primary studies, systematic reviews, and well-conducted clinical practice guidelines reported that heat (and ice) may assist in reducing pain in the initial treatment of neck pain including whiplash. Multiple clinical practice guidelines³ for the management of whiplash also stated conflicting recommendations relevant to the use of heat (or cold) therapy, ranging from ‘recommended’ to ‘insufficient evidence’. When heat (or cold) therapy is included as part of multimodal care (along with manual therapy, exercise and psychological strategies), one randomised controlled trial included in a systematic review⁴ reported a statistically but non-clinically significant improvement in self-rated disability for recent grades I-III whiplash, compared with education.

Are there any disadvantages?

Care should always be used when applying heat to the body. It is imperative not to over heat the tissues as this may cause a burn or tissue damage. You should never lie directly on a heat pack, rather the heat pack should be placed on your body. Heat therapy should not be used in the first 48-72 hours after an injury as it can increase the amount of swelling in the area and exacerbate symptoms. People with altered sensation should not use heat therapy, and there are certain other conditions where heat therapy is not advisable. Seek advice from your doctor or treating therapist if unsure.

Where do you get it?

Heat therapy can come in various forms, and there are many different brands. Heat packs, creams and lamps are available via numerous retail outlets such as department stores, medical suppliers, pharmacies/chemists, or over the internet.

Recommendations

Based on currently available evidence, the use of heat therapy following whiplash injuries cannot be recommended due to conflicting scientific evidence. More research is required.

References contributing to the treatment rating

Hurwitz, E, Carragee, E, Van der Velde, G, Carroll, L, Nordin, M, Guzman, J, Peloso, P, Holm, L, Coˆte, P, Hogg-Johnson, S, Cassidy, D & Haldeman, S 2008, ‘Treatment of neck pain: noninvasive interventions; results of the bone and joint decade 2000–2010 task force on neck pain and its associated disorders’, European Spine Journal, vol. 17, no. 1, pp. 123-152.

Motor Accidents Authority, 2001, Guidelines for the management of whiplash-associated disorders. MAA, Sydney, Australia.

Motor Accidents Authority, 2007, Your guide to whiplash recovery in the first 12 weeks after the accident, 2nd ed. MAA, Sydney, Australia.

3. Parikh P, Santaguida P, Macdermid J, Gross A, Eshtiaghi A. Comparison of CPG’s for the diagnosis, prognosis and management of non-specific neck pain: a systematic review. BMC musculoskeletal disorders. 2019 Dec 1;20(1):81.

Spitzer, W 1995, Chapter 8.2.2: QTF Recommendations for Clinical Practice, viewed 30 October, 2007, .

2. Strudwick K, McPhee M, Bell A, Martin‐Khan M, Russell T. Best practice management of neck pain in the emergency department (part 6 of the musculoskeletal injuries rapid review series). Emergency Medicine Australasia. 2018 Dec;30(6):754-72.

4. Sutton DA, Cote P, Wong JJ, Varatharajan S, Randhawa KA, Yu H, Southerst D, Shearer HM, van der Velde GM, Nordin MC, Carroll LJ. Is multimodal care effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration. The Spine Journal. 2016 Dec 1;16(12):1541-65.

Verhagen, A, Scholten-Peeters, G, Van Wijngaarden, S, De Bie, R & Bierma-Zeinstra, S 2007, ‘Conservative treatments for whiplash’, Cochrane Database of Systematic Reviews, Issue 2, Art. No.: CD003338. DOI: 10.1002/14651858.CD003338.pub3.

1. Wong JJ, Shearer HM, Mior S, Jacobs C, Côté P, Randhawa K, Yu H, Southerst D, Varatharajan S, Sutton D, van der Velde G. Are manual therapies, passive physical modalities, or acupuncture effective for the management of patients with whiplash-associated disorders or neck pain and associated disorders? An update of the Bone and Joint Decade Task Force on Neck Pain and Its Associated Disorders by the OPTIMa collaboration. The Spine Journal. 2016 Dec 1;16(12):1598-630.