Ice or Heat?

Ice or Heat?

Should I use ice or heat?

The simplest answer really depends on whether the injury is inflamed or not? How do you know?

Injuries resulting in bleeding and/or swelling (inflammation)

Examples of injuries which involve bleeding or swelling are typically more traumatic, i.e. result from a specific incident, accident or event. Examples might include:

  • Sprains (e.g Ankle sprain)
  • Contusions (blunt trauma e.g corks)
  • Muscle strains (NB: a strain and a tear are the same thing).

Using strains as an example; when a muscle tears, blood and damaged cell contents are released into the local area. As a response, your body reacts by constricting the capillaries taking blood away from the area. This engorges the injured area with a build up of blood and proteins, chemicals and fluid leak out of the capillaries. These inflammatory mediators are necessary to help mop up damaged cells and start the healing process. The net result of this ‘inflammatory response’ is:

  1. Swelling – fullnes, heaviness, puffiness
  2. Redness
  3. Warmth
  4. Pain – increased sensitivity of the nerves in that area to touch, pressure and movement

In these situations, we should employ the term “Do no HARM”, an acronym for:

  • No Heat (increases bleeding/swelling)
  • No Alcohol (leads to more bleeding/swelling)
  • No Running (or exercise which increases blood flow to the area)
  • No Massage to the area (irritates local tissue, increases bleeding/swelling)

We should also use the term POLICE, which stands for:

  • Protect the area from excess loading (no running on a sprained ankle duh!
  • Optimal Loading (gentle movement within your pain free range)
  • Ice helps to reduce the amount of swelling into the area through vasoconstriction (constriction of blood vessels in the local area), thereby reducing the amount of sensitivity and pain as a result. Ice could be as simple as frozen peas, a bucket of ice water or as complex as a Game Ready machine used in the clinic.
  • Compression (assists vasoconstriction to minimise swelling and provide a positive pressure to push swelling in to the lymphatic system to be removed from the area). This could be an elasticised bandage or other compressive garment such as tubular form or product like co-ban, depending on the body part injured.
  • Elevation (as above, move the swelling away from the area). An injured body part left in a dependent position

Peripheral joints (i.e. hands, ankles and knees) have less vascularity (blood flow) meaning the cold can penetrate deeper, increasing its effectiveness. Using a cold-water bath (or bucket) for these joints can also allow you to maintain movement while icing the joint, which is good to prevent the joint “stiffening” and creating a “vascular pump” to help take the inflammation away from the area.

An injury with no specific cause, or a recurrent ache or pain

  • Some common conditions such as low back or neck pain often do not involve swelling, bleeding or even identifiable tissue damage (unless there is direct trauma involved).
  • Regions of the body like the lower back also have layers of deep muscle and a good blood supply. This means ice/cold will not penetrate as deeply, and therefore will not be as effective at reducing pain. This means that you are likely to get more benefit from a relaxing hot pack, to reduce local muscle spasm in the area.
  • Another consideration is that our central nervous system can become “wound up”, in conditions such as low back pain. We often stiffen up and become rigid in our movements which further compounds the problem of a “stiff and sore back”. In these situations, heat can help calm down our nervous system, which will help reduce our threat levels, in turn, reducing our pain levels.

Take home message

  • Ice is good for acute (<48 hours time frame) injuries that involve swelling & bleeding. Avoid heat (and stretching) in situations of obvious inflammation.
  • Heat is good for aches & pains such as with back or neck pain or general muscle overactivity and spasms.
  • When in doubt, USE ICE! Ice and heat both reduce muscle spasm, but ice will prevent excessive inflammation if it is present.

Tom James, Physiotherpaist

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