We are presented with many options for any given situation. In the immediate aftermath of an acute injury – say a sprained ankle – making the choice of Ice vs. Heat seems like a monumental task. There’s only two options (minus Doing Nothing), but we want to get it right. So, which is it?
To quote an Indiana Jones film: “Choose wisely, my son…”
When you’ve sustained an injury, there is often resulting inflammation and swelling, and you’re left with pain and stiffness. The injured soft tissue creates a series of chemical events called the Inflammatory Cascade. Part of that event is an increase in fluid and inflammatory chemicals in the area. The thing that most people don’t know is that it’s supposed to happen – it’s there for a reason. The purpose? Tissue repair. Then why are we rushing to stop it – with ice, heat, or anti-inflammatory medications? Good question!
The inflammatory process is all good for a short while. However, the influx of fluid – swelling – can also cut off the transport of oxygen and nutrients to the injured and surrounding tissues. A prolonged inflammatory process can linger and wreak havoc on joints and muscles. So, some management is in order.
In This Corner… Ice!
The choice between using ice and heat as a modality has cranked up considerably in the last decade. The classic acronym RICE was developed for managing the acute injury: Rest, Ice, Compression, Elevation. These are all sound principles to mitigate swelling and pain. And ice is a very effective analgesic, by slowing down pain signals in nerves. Ice acts as a vasoconstrictor – it causes blood vessels to get narrower and to reduce the leaking effect of extra incoming fluid in the area.
Think of it this way: in a highway construction zone, traffic is controlled by decreasing lanes down. But here’s the catch: it creates a traffic jam. Yes, less fluid is seeping out, but it also means that some of the waste product is having a harder time exiting the area. That doesn’t sound like a good idea, does it?
And In This Corner… Heat!
So – if ice isn’t (theoretically) good for acute injuries, then heat must be the answer, right? Heat is a vasodilator, which increases the blood flow to an area. It helps with muscle relaxation and increases soft tissue elasticity. As a vasodilator, it can help to open the blood vessels more in order to remove swelling and waste products. Lots to like there – if only on principle. While heat may not be ideal for an acute injury, it’s great for muscle pains, joint stiffness & aches, and arthritis.
Best Of Both Worlds
A great solution in sub-acute situations (injuries that are more than two days old), is to use BOTH – a technique called Contrast Bath. Alternate 15 minutes of heat with 15 minutes of ice, which is one round. Repeat for 2-3 rounds. This approach helps to bring new blood flow in, remove waste products, decrease pain and promote mobility.
The Final Word
When a patient asks me in the clinic if they should use ice or heat, we discuss these principles. I will still typically advise ice for an acute injury to help limit swelling and reduce pain, and recommend heat for joint stiffness and muscle aching. I’ll also say: “Use the one that makes you feel better!”. Whether you’re using ice or heat, please make sure to limit your time to 15-20 minutes. DO NOT sleep with an ice pack or heating pad on, as it is possible to get a burn from either. (Yes, ice burns are possible!) And more importantly, make sure that there is a protective layer between the ice or heat and your skin surface. Do not use either if you don’t have proper sensation in that area.
While both ice and heat are great tools to have in your “self-treatment toolbox”, it’s important to know when to seek help. Seek immediate medical help if you’ve sustained a serious injury, or if your pain is not resolving. If you’ve got questions about your injury, simply call us at (646) 430-5717, or email us at firstname.lastname@example.org. We’re here to answer your questions and help you return to your active life!
Mark M Lusk, DPT, OCS, CSCS, CFMT