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

We have been taught for a long time and it is 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) which are commonly taught in first aid and other first responder courses both feature ice as an early management strategy but do not discuss heat.
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So many people ask us this question.  It may be the most common question we get early in our time with a client.  I suspect this is because it can be difficult to remember what you heard or you have heard several different things from different people that you may have asked.  Well, the answer is…it depends (and that may be why it is a common question!)

We have been taught for a long time and it is 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) which are commonly taught in first aid and other first responder courses both feature ice as an early management strategy but do not discuss heat.  This is because 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.  It turns out that ice is, in fact, very good at these things but the evidence has suggested that maybe we need to reconsider whether we really want that result.  Studies have shown that injured tissue that is iced has somewhat 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, then, that by successfully interrupting the normal, natural and necessary inflammatory process, we are inadvertently interrupting the healing process!  Funny how something we have long held to be helpful is turning out not to be so.  So, what about this use of ice?  Ice is also a very effective analgesic so using it to help reduce acute pain can be helpful in making something that is quite painful feel a little better.  However, to have this effect alone, the length of time tissue is iced needs to be quite brief.  Icing for no longer than 10 mins at a time will not cause the tissue temperature to drop and thus will not have a significant effect on the inflammatory process.  This approach can be helpful for pain but not disruptive of the healing process that you want.  As for swelling, compression and elevation are effective for this 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?  Well, as we all know, heat is more soothing than ice and does promote relaxation and comfort.  It will also increase blood flow to an area in the short term and increase tissue softness or extensibility.  As such it is pro-inflammatory, contrary to ice which is anti-inflammatory.  Early in tissue injury we do not need to increases the inflammatory process any more than it occurs naturally – our bodies are very good at this process!  However, later on down the road it maybe helpful to get a little 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 later in the healing process 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!  705 788 1480   www.proactiverehab.com   [email protected]

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