Ice or Heat?
We get that question every day.
The most frequently asked question we get is: “Should I use ice or heat?” Since the late 1970s, therapists have often treated an injury with RICE (rest, ice, compression and elevation). It’s an easy formula to remember: RICE is nice. Its now common knowledge that nobody believes in rest anymore. You can have hip replacement surgery and be up and walking within hours.
As for ice, there seems to be a bit of debate going on. There’s not much research to show that ice does anything more than numb pain. Icing restricts blood flow to the area which helps numb the pain and keep the initial swelling from getting out of control. But does it work to actually heal the injury? As it turns out, there are no clinical studies of its effectiveness (British Journal of Sports Medicine, 2012). In fact, some studies suggest that icing actually seems to delay recovery from exercise-induced muscle damage (Journal of Strength and Conditioning Research, 2013).
Is it harmful to ice an injury?
When you damage tissue through trauma or develop muscle soreness by exercising very intensely, your body mobilizes your immune system to heal. It’s the same biological mechanism that you use to kill germs. This is called inflammation. When germs get into your body, your immune system sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immune system sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb. 23, 2014). Anything that reduces your immune response will also delay muscle healing. Therefore, ice is counterproductive. Interestingly, Ibuprofen is worse because it actually stops the signal of the inflammatory response.
What about rest?
Blood flow brings inflammatory cells into the injured tissue to start the healing process and the lymphatic system then removes the waste products from the tissue. Muscle contraction is necessary to move lymph and eliminate these chemicals, not immobilization! Recognizing the importance of movement in the healing process is why nobody believes in rest anymore.
So what’s the current recommendation?
For minor injuries keep moving but always within a painless range of motion. If you can’t move the injured area, for example, if your ankle is in a cast, move your toes. Elevate to help the lymphatic system drain and as always, consult with your health care practitioner if you have any concerns.