Answering the Age Old Question: Heat or Ice or….?

When you are in the throws of a new injury, one of the most important concepts you need to know when performing self care is whether an injury needs to be iced, or if it should be heated. Both therapies are very inexpensive, and easy to perform, but their effectiveness hinges on the correct modality with the correct timing.

In my chiropractic practice, while I do neither therapy in my office, I often make recommendations for my patients on how to best care for themselves. Both therapies work pretty well in making people feel better, but as we know, feeling better is not the same as healing better.

Here’s what conventional wisdom has to say on the subject:

• Ice new injuries (within 24 hours) for pain control. If you suffered an injury to your shoulder, elbow, knee, back, neck, etc. Using ice for 20 min at a time can help numb the area rather than using anti-inflammatories.
• Heat – muscular injuries, old injuries, spasms, stiffness

Is there a better approach to recovery?

Conventional wisdom has helped a lot of people effectively deal with the pain of injury. However, many of my patients are looking for ways to recover faster, not just get out of pain. When you see the body as intelligent and self-healing, then the picture of recovery has to change.

Inflammation is the tool that the body uses to repair damaged tissue. Although it can be painful and irritating, all of the swelling, heat, and pain that you feel from an injury are critical components of the healing process.

• The rush of blood into the site of injury brings white blood cells into the area so that it can get rid of damaged tissue and germs.
• The swelling isolates the inflammatory response to one part of the body so any potential bacteria or germs are kept out of your blood stream.
• Pain sends signals to create temporary immobility at the site of injury to prevent any additional sprain or strain of the ligaments and muscle tissue.
• Heat slows down bacteria growth and increases the activity of your white blood cells

So if this inflammatory process is important for healing, why would we want to steer the body in the opposite direction? Is that potentially setting us backwards?

The answer is a resounding….maybe.

While ice and anti-inflammatories are incapable of shutting off the inflammation process completely, there are small case studies working with elite level trainers and athletes that show that icing, cooling, and resting too much may delay recovery.

A new model of recovery takes a look at the effects of tissue compression and mobilization on injury recovery. Instead of waiting for nasty scar tissue to form in oblong shapes to build up on your joints, we want the scar tissue to mold in the same way that the original healthy tissue formed. Though it is certainly full of controversy, high level consultants and therapists like Dr. Kelly Starrett are finding improved outcomes with some of the best athletes in the world.

By increasing joint approximation (putting your joints closer together), increasing proprioception, therapists are finding that they can increase range of motion in a damaged region without increasing pain. As the joint moves better, then the lmitations of that nasty scar tissue can be buffered as the individual recovers.

Tools like the voodoo band and joint sleeves allow for better joint approximation and proprioception during times of injury.

So does that mean you should ditch the ice and heat argument?

Of course not.

When you have severe swelling and a tremendous amount of pain, then icing and medicating are certainly better than having your brain exposed to a barrage of severe pain signals.

But if you are suffering from the effects of a weekend warrior and over-use, then perhaps a different model is called for to keep you moving in the right direction.