I’ve hurt myself, do I apply heat or ice?
Damien Ryan 01/08/23I am constantly asked in the clinic whether to put an ice pack or heat pack on an area after you’ve hurt it. What might come as a bit of a surprise, my answer most of the time is actually heat instead of ice and here’s why.
Firstly, we’ve all heard of RICE (Rest, Ice, Compression, Elevation) as a response to an acute injury. Did you know that a Harvard physician coined this term in 1978? This method has been used worldwide ever since. Did you also know that the same Harvard physician in 2013 withdrew these findings and stated it actually stunted tissue rehabilitation? He wrote, “subsequent research shows that ice can actually delay recovery. Mild movement helps tissue to heal faster, and the application of cold suppresses the immune responses that start and hasten recovery. Icing does help suppress pain, but athletes are usually far more interested in returning as quickly as possible to the playing field. So, today, RICE is not the preferred treatment for an acute athletic injury.”
So if icing a body part delays healing, why do I feel better when I ice an area of pain? Ice is used for pain modulation (numbing the area). Ice numbs a region and vasoconstricts (narrows) blood vessels to reduce swelling. This reduction of swelling will reduce bleeding occurring at the site but will also delay healing properties reaching the area of dysfunction, therefore, delaying the overall healing process.
A study found comparing a group that iced an injury immediately after and a group that didn’t showed that “at 28 days post-injury, the regenerating muscle of the “no-icing” group was 65% larger than the icing group! In addition, the researchers found significantly more scarring compared to the untreated muscles. Research shows that ice actually delays muscle repair after injury gives us direct evidence that ice can ultimately lead to increased scarring!”
So why do I apply a heat pack? A heat pack has been shown to improve the range of motion within a joint, decrease muscular spasms and promote blood flow to the area.
So a general rule for when to use either heat or ice is as follows:
- If you need to reduce swelling from direct trauma (boxing, contact injury – like a corkie) or you need to reduce pain at a site – apply ice.
- If you want to reduce muscle spasms, improve range of motion, and promote blood flow to a region – apply heat. This is why we have an infrared sauna at Limbr!
For example, you’ve hurt your low back, it’s locked up and you are struggling to move. Applying the theory above, placing ice on the low back region will trigger muscles and blood vessels to constrict and your stiffness may even increase! Placing heat on the region will soothe the region, reduce muscular spasms and help you symptomatically before coming in and seeing any of the excellent practitioners at Limbr to help you out!
This is obviously a very basic rule of thumb and doesn’t cover all injury types and how to acutely manage each injury so please when in doubt, always consult with your health professionals. Some very specific considerations need to be made for pregnant women or people suffering from vascular conditions also.
As always, we are here to help so don’t hesitate to reach out.
References:
– Mirkin G, Hoffman M. The Sports Medicine Book. 1978. Little Brown & Co
– Takagi R., Fujita N., Arakawa T., Kawada S., Ishii N., Miki A. (2011). Influence of icing on muscle regeneration after crush injury to skeletal muscles in rats. J. Appl. Physiol. 110, 382–388.
– Reinl G. Iced! The illusionary treatment option. 2nd Edition. Gary Reinl. 2014.
– Squat University, Don’t Ice Walk it Off!, https://squatuniversity.com/2020/03/23/dont-ice-walk-it-off/