What Up Doc? Ice or Heat?
We hear this one a lot: one doctor told me ice, another told me heat, my friend told me I should alternate ice and heat… So really, what should you be doing? Why are we having you do it anyway?
Let’s start with icing, because it is still the go to in our acute care rules like the RICE and POLICE methods. Ice does several things very well. First, it causes an initial contraction of our blood vessels, which limits blood flow slightly and allows a decrease in acute inflammation. Essentially, this means we can get your inflammation down a little bit! It also slows nerve firing temporarily, and this can be one of the possible mechanisms to why it can decrease pain. More importantly, ice is such a direct input to the nervous system that it overwhelms the area of the brain processing input from your injured region, effectively numbing the area! In cases of acute, severe pain, this numbness can be extremely helpful in allowing us to stay moving, and as movement is indicated as being helpful after many injuries like strains and sprains, this is a great step to take!
Okay, but why heat? Well, in cases of many soft tissue issues, inflammation control is not our goal except in the very short term. What is more irritating in most injuries is something called “muscle guarding,” a reflexive response around injuries in which our muscles stay “on” for long periods to keep a joint more rigid and protected. Unfortunately, that action itself can actually increase pain! Constant warm temperatures can actually allow these regions to relax, and the constant input to the local nerves works by a similar mechanism to ice in that it can still numb the area and allow our body to move and focus on something else!
So which should you use? Well it depends, of course! In the very early phases after an injury, namely the first 1 to 2 weeks, inflammation control is a big deal! In those cases, periods of just 10 minutes of ice is considered best, with 30-60 minutes off in between (that’s right, you can throw out the old 20 on 20 off rule!) to help with this issue and allow continued movement. Our goal with this protocol is to keep the deeper tissues cool without maintaining a constant constriction on your blood flow, because while we want inflammation out we still need blood there for healing! If we want some level of constant lowered temperatures, however, alternating with heat really does not make sense does it? I have yet to see compelling evidence for this practice scientifically either, so you will almost never see me recommending this practice.
In more chronic conditions, usually further out than 2 weeks, I usually notice a switch to heat. Along with the pain decrease and relaxation effects, this actually encourages circulation, which in chronic injuries is actually a very very good thing! Again, about 10 minutes is usually plenty, and we still get that great analgesic effect of pain control!
So are ice and heat okay? Absolutely! When you use which is less simple than it used to be as we learn more about the body and medical science, but hopefully you have a good idea now of which to use when!