Even in traditional physical therapy for injuries the hot vs. cold
debate still exists. Also keep in mind most of the research on this is on
trauma.   The two biggest concerns in an injury with edema is keeping
motion and decreasing pain. Therefore treatment of decreasing edema
focuses on both. So only some of the principles apply with engorgement:
excess amount of fluid and pain.
And like so much of what we do the answers are not cut and dry and vary
with each situation.
Here might be some info to help. And by all means just the tip of the
iceberg.
COLD reduces inflammation and reduces outward fluid filtration , but
decreases pain and tissue extensibility. I would extrapolate that
therefore the increase fluid of engorgement would not go out but it
really helps the inflammation and pain. Bonnie- the decrease tissue
extensibility is usually the reason one gives to not  massage a cold
breast. If something is not plyable it can snap so to speak.
HEAT increases blood flow and also helps with  fluid filtration, and
increases tissue extensibility and but can increase inflammation.
Therefore massage works well with heat but heat can make the inflammation
worse.
Some therapists like to use both with a 3:1 up to 5:1 minute ratio of
heat to cold to address both. Or heat, then massage( and I would add then
nurse),  then ice.
Clear as mud?

Jill Andrews OTR,CHT, LLLL
Louisville, CO

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