A common question that comes up is should I use ice or heat? Is there a best time for one or the other? Or is one always better? We will try and address all these questions.
Ice
Ice can be really helpful within the first few hours after acute injury. Something like a sprained ankle or bending over to pick something up and you hurt your back would be examples of acute injuries. The ice can be helpful to decrease the amount of swelling that will go into the injured area. They have shown multiple times that when we ice the injured area to decreasing the swelling and inflammation, we are actually slowing the healing process down. The inflammation is your bodies way of promoting healing. The reason we ice at all would be to decrease the speed and the amount of inflammation that is occurring. In some rare instances it is more concerning that too much swelling and inflammation can cause other severe problems, but again those are rare instances. So for acute injuries, ice is your best option. Now what should you use for the cold therapy. The best option is a bag of ice. This is your best option because as it warms up it will melt and not overcool the area and cause something like a freezer burn and frostbite to the area. A gel pack can cause frostbite because it will not warm up as fast and could cause more harm than good. Just something to be aware of. The one other time that can be helpful is when the pain is just so much that you want to just numb the pain and using ice can do that well.
Heat
Heat can be more beneficial in the long term. Why is heat better for chronic injuries and after that first couple hours? Heat will speed up the cells and promote the tissue to work faster. Heat will help bring in some of that inflammation, get the cells to clean things up and do their healing tasks, and promote the fluid to move out and then start over again. Cold therapy tends to slow this process down, which is why it is not recommended for long term use. There are studies that indicate different times of effectiveness to switch from ice to heat, but after a couple hours you would be good to switch to heat. Again, the heat is going to help things move quicker and heal faster. Ice will delay some of that healing because it is delaying that inflammation, which is how our bodies will heal.
Another aspect to think of with inflammation is non-steroidal anti-inflammatories (NSAIDs) like ibuprofen. These medications are stopping that inflammation from occurring. Inflammation is your bodies way of healing and stopping that happening with NSAIDs will only delay the healing more. Obviously there is a pain component there and may need to be addressed, but if you can go without taking these NSAIDs for acute injuries you will recover faster usually.
So here is the ideal scenario for something like a back sprain or ankle sprain:
- Ice the area right after it happens
- Elevate the injured area. Keep the injured area above the heart to help the fluid be able to move out
- Compression that promotes pushing fluid back towards the heart
- Optimal loading. This can vary a lot between injuries, but typically complete rest and no movement is one of the worst things you can do.
- After that first couple hours you can now apply heat. The compression tends to heat the area already.
Occasionally alternating ice and heat can be helpful to try and pump some of that fluid in and out, but is not usually as effective as some movement. Typically heat will be your best option after the first day though.
Here is one study supporting ice for acute injuries. This study digs more into the details of both therapies.
Tahoe’s Premiere Sports Chiropractor
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