It’s the age-old question, “should I use ice or heat for an injury?” Just about every new patient that walks into our office asks if they should ice their injury. Usually followed up by, “I can never remember when to use which one.” And to be honest it has taken me a long time to conclude. So buckle up everyone. The answer might not be what you’re expecting.
Starting with a quick rundown of the healing response, you’ll be able to add “physiological experts” to your resume. This is of course in addition to being able to put “epidemiological expert” on your resume after the Covid-19 outbreak.
The healing process is the same regardless of the tissue. Once an injury occurs a signal that there has been tissue damage is sounded. In response, the inflammatory response is activated. Inflammation in the short term is a good thing. It is the body’s triage response. The body increases the size of the blood vessels which brings in more blood. This blood brings damage control like macrophages that eat up any foreign objects or break down any damaged tissues. Healing factors swoop in with repair materials such as a stiff scar tissue called collagen type 3. The collagen type 3 fiber stabilizes the damaged tissue until the body has repaired itself enough that it isn’t needed. At this point, a new more pliable type of collagen, collagen type 1, replaces its stiffer counterpart.
Ok, now that you are all experts in healing, let’s move on to whether you should ice or heat. We’ll start by asking you all a question. How long has icing as a treatment been around? It’s the age-old treatment after all right? The answer has to be thousands of years right? Don’t worry this one got me too. It hasn’t been that long. Until the 50s/60s access to ice was a rarity before freezers became commonplace in households.
So how did icing get its start? The first successful reattachment of a severed appendage gave icing its start. The doctor put the appendage on ice to slow the inflammatory process. Part of that process is the breakdown of damaged tissue and if it doesn’t have something to repair to it starts to decay.
Unfortunately, the role ice played in this groundbreaking success wasn’t explained well by the media at the time. The reports of the reattachment success boiled it down to ice helped the injury. From there ice sort of permeated into our world and got conflated with everyday injuries. Around that time a doctor came up with R.I.C.E as a method to treat acute injuries. Rest, Ice, Compress, Elevate. Make sense right? You don’t want to stress that injury.
Medical schools, PT schools, chiropractic schools, etc, all seemingly started teaching icing as a treatment without requiring the initial research into its true benefit. There are plenty of articles that show how deep the cooling effect is. Plenty that shows how long each area can tolerate ice. And numerous that show that ice slows inflammation. But, none that shows that it has any improvement in healing time.
Ice As A Treatment
What does ice do when it’s applied? When it is placed on the body, it causes blood vessels to constrict. Therefore, lessening the amount of blood that is in the area. It also slows the movement of other fluids. This has consequences. It delays the healing response time and it slows the removal of fluid causing swelling. The reason it is perceived to be helping is that it numbs the area. Numbing results in temporary pain relief.
Fun fact, the doctor that authored the R.I.C.E. method continued his research and discovered the consequences of icing as well and went as far as to publish that his original method should not be used because of the delay in healing.
Heat As A Treatment
So you might be thinking, “OK. Fine. Never liked ice anyways. Great article. I’ll go heat my injuries now.” Well, not so fast. Heat isn’t bad. I don’t mind people using heat. It causes pain relief as ice does, it also increases blood flow which helps the healing process. It’ll even help loosen up the surrounding tissues a bit. But, what it doesn’t do is anything for the function of the area. The damaged tissues need to be increasingly stressed to adapt to their future demands.
Movement As A Treatment
“Great! Ice is out. Heat is ok… Guess there’s no winning.” Wrong again. One of the best things for most acute injuries (aside from broken bones) is movement. Movement does wonderful things. It constantly helps bring in new blood flow. The contraction relaxation of muscles helps flush out the built-up fluid from any swelling. The pull on the tissues helps encourage proper tissue formation by breaking up the stiff type 3 collagen fibers and demonstrating the need for the long-term elastic type 1 collagen fibers.
Of course, there is a balance to strike. Too much movement and you may cause more damage or delay healing. But too little and proper healing may not be achieved. The key is to lightly stress the area without lasting pain. A little pain during the movement, stretch, or contraction is fine, but a pain that lasts for 20 or more minutes is too much.
If the injury is severe, start by simply contracting the muscle. See if the pain abates once the contraction is over. If so, you can do several contractions every hour or two. Once that becomes easier, slowly start increasing either the strength of the contraction or add small movements to it. You can also add light stretches. Continue to do these movements and stretches, progressing to resisted or weighted movements. Regularly test it to see if you should increase where you currently are. By doing this it will, work on blood flow, decrease swelling, break up the temporary scar tissue, properly orientate and adequately lay down the stretchy collagen fibers, and get you back to normal.
I’m sure your head is spinning by now. It took me a while to accept that ice or heat isn’t the cure-all. You see MLB pitchers icing their shoulders once they’re removed from a game or MLS players icing their ankles if they’ve rolled them. But what you don’t see is all the work their chiros, trainers, and PTs do or all the training they do afterward. Or in other words, all the movement they do.
Ice and heat have penetrated deep into our lives. The fact they make the pain cease temporarily makes it all make sense. But unfortunately, a closer look at ice or heat shows their faults. Movement is key to these smaller injuries. Remember ice is used to delay healing so we can reattach stuff to the body. If ice is being used to slow healing it doesn’t make sense that it would also help to heal an injury as well. So remember the next time you injure yourself, move as soon as you can. Start small and progress from there. If it makes you nervous or you aren’t sure what to do, schedule a visit with us. We’ll get you headed in the right direction!
Tom Cotter, DC, DACRB