Thermal modalities: heat and cold. A review of physiologic effects with clinical applications.

Thermal modalities are safe, simple, inexpensive, and easily taught for self-application. Their efficacy has been demonstrated in anecdotal, clinical, and basic physiological research reports. Topical thermal modality application has potential therapeutic effects on three areas of physiologic functions in soft tissue disorders: 1) Local circulation/metabolism; 2) Local neuromuscular and musculotendinous function; and 3) Nociception, including local and central neural activity. Knowledge of the physiology of the modalities and the pathophysiology of these disorders enables the occupational health nurse to use them appropriately. Topical heat application is often more easily accepted, while cold application is less favorably accepted. Physiological findings, however, indicate that, for topical application, cold application has much greater potential for restorative, therapeutic effect, while topical heat is almost exclusively limited to palliative effects. By educating and encouraging employees in the self-application of these modalities the occupational health nurse promotes self-efficacy in health care, providing an alternative to reliance on prescription or OTC medications.