Heat Vs. Ice
One of the most common questions I receive from patients is whether to use heat or ice when injured. When a new patient first visits my clinic, I always ask patients what relieves their pain and often, heat or ice is on this list. In the past, clinicians and healthcare providers have used acronyms to help remember what to do when injured and frequently heat or ice has been included in such acronyms. Let’s get down to the facts on what heat and ice do, and when to use them more effectively.
In the past, RICE has been used to describe four steps to take when an injury takes place. This was first introduced by Dr. Gabe Mirkin in 1978 to assist and manage acute soft tissue injuries. RICE stands for Rest, Ice, Compression, and Elevation. In 2014, Mirkin actually recanted his support for the RICE method, highlighting that inflammation is actually essential for healing and too much ice may delay recovery.
RICE has evolved over the years, so let’s take a look at its journey.
RICE added a P to the beginning, using PRICE to highlight the need to protect the injured anatomy from further injury. POLICE is another acronym that stands for Protection, Optimal Loading, Ice, Compression, Elevation. Again, Ice included in the modalities and steps for injury management. METH then started to be used which stands for Movement, Elevation, Traction, and Heat. You can see the shift here from ice and rest to move active and heat based modalities. In 2019, PEACE & LOVE was introduced to differentiate between acute and chronic phases. PEACE stands for Protection, Elevation, Avoid anti-inflammatories, Compression, Education. LOVE stands for Load, Optimism, Vascularization, Exercise.
Let’s take a further look into the physiological rationale behind using ice versus heat.
When using ice or cryotherapy, this cold temperature causes a reaction in the body leading to vasoconstriction or narrowing of your blood vessels. This reduction in blood flow can worsen swelling and pain. Ice can help reduce pain caused by delayed-onset muscle soreness (DOMS) within 24 hours post exercise, but the caution would be related to reducing protein synthesis (repair). The other risk would be damaging tissue (frostbite) if used incorrectly (too long or direct contact with skin). Ice should always have a moist layer between the skin and the ice compact to prevent any superficial damage.
Heat on the other hand promotes vasodilation, or opening of the blood vessels, improving blood flow, reducing stiffness as well as muscle spasms. Heat can be effective for both chronic pain and DOMS within the first 24 hours post exercise and beyond. Heat may be contraindicated within the first 48 hours as inflammation should also not be increased. Overused heat can also lead to myositis ossificans which is the body putting calcium down into the soft tissue that is injured.
You may be saying to yourself at this point, “well, I am still not clear on what to use and when”. Cold used during post exercise can reduce pain within 24 hours but the differences between cold and heat aren’t significant. Cold should be used mainly for pain management, but should be used minimally as not to slow down the healing and repairing process that goes along with inflammation. Heat should be used with when dealing with DOMS, after the first 24 hour period. Prolonged use of ice or rest should be avoided for soft tissue injuries. Think ice right away but minimally and only for pain. Think heat further along and more for stiffness.
You can also try contrast therapy for more chronic conditions or for arthrosis (chronic arthritis). This looks like using ice and heat in cycles to balance chronic inflammation but also providing heat to improve blood flow and mobility.
Regardless of your heat or ice decisions, remember that the newer acronyms also mentioned loading and movement as being encouraged more than prolonged rest.
When thinking about dosage, start small and give yourself small breaks. Following a few cycles of 15-20 min on then off, will allow you to stay in tune with your body, giving it what it needs. Always let your tissue warm up again after finishing with ice before doing any rehab or movement testing. Remember that the stretchy part of bread dough is the protein, and the more you arm it up the more it responds like any stretchy, organic material.
Takeaways for this blood would be:
Ice early, heat later
Careful with timing and dosage
Think of minimal ice for short term pain relief
Think of heat for long term movement and healing
Don’t forget to incorporate movement into recovery
Regardless of all of the above, don’t forget to listen to your gut. Go to emergency if you are at all doubting yourself. Seek out professional care from your family doctor, your physiotherapists , chiropractors, massage therapists, pharmacists, and anyone else licensed. Good care during the initial stages of an injury can make all the difference!
For more information, please email hello@madetomove.ca or book an appointment with one of our team at madetomove.ca.
