To Heat or To Ice, That is the Question
I often ask patients during our initial visit with one another if they have tried ice or heat, in an effort to help with their current discomfort. I also frequently get asked in return which they should be using. The ultimate answer is ~ it depends! Neither ice nor heat is inherently better or worse than one another, however there are injuries for which ice is more beneficial and vice versa. In any case where the answer begins with “it depends”, there is a lot of grey area. I am hoping to make it a little more clear for you.
Inflammation is a natural part of the healing process and therefore is not something we want to interfere with for long periods of time. A by-product of the inflammation process is pain and ice can be an effective natural analgesic. On the other hand, ice generally inhibits the inflammation process by restricting blood flow, therefore its use following injury should be limited. The take away here is that ice is good to use initially during the early phases of injury to help limit swelling and take the edge off the pain. However, its use should be limited to the first 48 hours following injury. This is especially true if the damaged tissue is either a ligament or a tendon. These tissues have a limited blood supply naturally, so decreasing blood supply further by adding ice will slow down their healing. Therefore, it is best not to use ice with minor sprains or in the early stages of tendonitis, if possible.
Heat, on the other hand, increases blood flow and decreases muscle tension. If you are experiencing muscle tightness or joint stiffness during the later stages of an injury or as a result of chronic pain, heat is most likely your best bet. Since heat dilates blood vessels, heat should not be applied to swollen areas, as increased pain and swelling can result. Keep in mind that some deep structures may be swollen without being visible to you. Moist heat is the best type of heat to use. Examples of moist heat sources include warm/hot showers, hot tubs, moist heating pads, and hot packs that can be heated in the microwave.
Additionally, R.I.C.E. (Rest, Ice, Compression, and Elevation), the once widely accepted pneumonic in the world of sports medicine, has been replaced with the pneumonic M.E.A.T. (Movement, Exercise, Analgesics, and Treatment).
• MOVEMENT: Movement should be limited to motions that will help remove fluid from the area without increasing pain.
• EXERCISE: Exercise should be appropriate for the injury and should be rehabilitative in nature.
• ANALGESICS: Analgesics can be a multitude of things. Examples are ice and or heat (depending on the stage/category of your injury as indicated above), topical analgesic therapies, or pharmaceuticals ~ all supervised by a professional.
• TREATMENT: Treatment refers to professional manual therapy - massage therapy, chiropractic care, physical therapy, acupuncture, etc.
In combination, all four components of M.E.A.T. will help decrease the time you spend healing, and will help you return to activity faster. It is important to work with a professional through the stages of M.E.A.T. so that all treatments are appropriate, monitored, and effective.