To ice or to heat?… That is the question!

By: Leslie Tempest

“Should I ice or should I heat?” may be the most common question we get early in our time with a client. It can be difficult to remember what you’ve heard, or maybe you’ve heard several different things from different people. Well, the answer is… it depends (and that may be why it is a frequently asked question)!

It’s a commonly held belief that ice is the way to go, especially in an acute situation. The acronyms RICE (Rest, Ice, Compression, Elevation) or PRICE (Protect, Rest, Ice, Compression, Elevation), commonly taught in first aid courses, both feature ice as an early management strategy but do not discuss heat. We have long believed that icing an injury in its early phases will help reduce swelling, inflammation and pain, all of which we have decided are bad, and thus make it feel better which should promote healing. Ice is, in fact, very good at these things, but evidence suggests that we need to reconsider whether we really want this result.

Studies have shown that injured tissue that is iced has less pain and swelling, but also has less tissue regeneration and remodelling. This indicates slower and less complete healing than tissue that was not iced. It would seem that by successfully interrupting the normal, natural and necessary inflammatory process, we are inadvertently interrupting the healing process!

So, what about the use of ice? Ice is a very effective analgesic, so using it to help reduce acute pain can be helpful in making something quite painful feel a little better. However, to have this effect alone, the length of time tissue is iced should be quite brief. Icing for no longer than 10 minutes at a time will not cause the tissue temperature to drop and thus will not have a significant effect on the inflammatory process. As for swelling, compression and elevation are effective in the early days of an injury, but once the acute phase has passed, the best way to manage swelling is through motion.

Now, what about heat? As we all know, heat is more soothing than ice and promotes relaxation and comfort. It also increases blood flow to an area in the short term and increases tissue softness or extensibility. However, this means that heat is pro-inflammatory, in contrast to ice which is anti-inflammatory. Early in tissue injury we do not need to increase the inflammatory process any more than it occurs naturally—our bodies are very good at this! However, later on in the healing process, heat may be helpful to promote more activity in the tissue and encourage it to become more supple. Heat can also be an effective analgesic, so it is a fine choice for helping to make things feel better if needed.

So, there you have it: ice early, briefly and often at the outset, but only to make injury feel better; avoid prolonged cooling that will disrupt the healing process. Heat it later if you need a little help getting things moving or to settle aching, tension and stiffness. Simple, right?!

For more help with this and other common injury related questions, please contact us at ProActive Rehab—we are here to help you!