Ice or Heat – What Should Be Used For Injuries?

Is ice really a panacea for an injured muscle? Or, does it prolong healing and even contribute to possible complications?

So, you’ve got an injury, or perhaps just a painful muscle group. Do you grab the ice out of the freezer or should you go for the hot water bottle and tiger balm? Most of us will probably reach for something cold. The medical profession has it drilled into our minds that ice helps sore muscles.

Do you remember the acronym, RICE?

R – rest
I – ice
C – compression
E – elevation

The RICE acronym was coined by Dr. Gabe Mirkin in 1978. In that same year, he published his research in the quintessential sports medicine text titled The Sports Medicine Book. Since that time, health professionals throughout the world have iced injuries. Remember the last time you sprained your ankle? What did you reach for? Ice and Advil are the likely at-home remedies.

Does the evidence still point towards icing as an effective treatment strategy? Or, does icing actually prolong the injury and potentially lead to complications?

Why do we ice?

Icing an injury has become standard practice because it helps to alleviate pain caused by injured tissue. When we ice an injured area of our body, we reduce the volume of blood flowing to that area. This can reduce the swelling and inflammation that causes pain. Additionally, ice can reduce nerve activity which also helps to alleviate pain.

And having less pain is better, right?

Unfortunately, it’s not that simple. Less pain does not equate to enhanced recovery. Icing may actually slow the recovery of our tissues.

“Do you honestly believe that your body’s natural inflammatory response is a mistake?”
– Dr. Nick DiNubile, Editor in Chief of The Physician And Sports Medicine Journal

In fact, a summary of 22 scientific articles found almost no evidence that ice and compression hastened to heal an injury over the use of compression alone. (1)

What does ice do to injured tissue?

What happens when you catch a cold?

If you’re like most of us, you get a lot of mucus production. A runny or congested nose could be considered the hallmark sign of the common cold. All that mucus produced by your body is a type of inflammation. When you injure muscle tissue, a similar inflammatory response occurs – your body sends cells that create swelling and inflammation.

When your body creates inflammation in a tissue, specific white blood cells called macrophages arrive on the scene. These white blood cells release a hormone called insulin growth factor (IGF-1). (2) IGF-1 helps your body to heal/repair damaged tissue. When ice is applied to the injured area, this prevents the cells from releasing IGF-1. Which in turn prolongs the healing process. (3) Healing requires inflammation – the very stuff you suppress when you decide to ice an injury.

Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow. Remember, it is the flow of blood that brings in the insulin growth factor. After icing, the blood vessels do not open again for many hours. This can cause the tissue to die from decreased blood flow and can even cause permanent nerve damage. (4)

What else delays the healing of injured tissue?

If you reduce inflammation in injured tissue, you delay healing. Therefore, anything that reduces your immune response will also prolong your injury. Thus, healing can also be delayed by: (5, 6)

• Cortisone-type drugs
• Almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen
• Immune suppressants that are often used to treat arthritis, cancer, or psoriasis
• Applying cold packs or ice
• Anything else that blocks the immune response to injury

What should you use instead of ice?

You’re now aware of the damaging effects caused by stopping your body’s natural inflammatory response. You’ve stopped using ice and Advil for injuries. Now, what do you use to replace them?

If your injury comes about from an activity, the first step would be to stop the activity that caused the injury. Next, think about elevating the injured body part (if possible). This will help to minimize swelling and thus decrease pain levels. Ensure that you get examined by a practitioner familiar with sports injuries – this way you can rule in (or out) fractures, dislocations, and other serious injuries.

After any serious injury has been ruled out, add a compression bandage to the injured area. Once swelling has begun to decrease, it is time to add heat therapies. My personal favorites include magic bags and liniments. Other options include hot water bottles, warming patches, hot tubs, and electric heating pads.

So the next time you get injured, make sure you leave the ice in the freezer. Instead, pop that magic bag into your microwave and get your blood flowing!

Also published on Medium.