The simple question “should I ice or use heat for this?” is asked in my office multiple times a week. It is a good question, and I’d like to provide some clarity.
The answer is always situational, and it depends on a few factors:
1. Is the injury new (24-48 hours), chronic or is it a re-injury?
2. Where is the injury? Neck, lower back, ankle, shoulder, elbow, etc…
3. Is the injury tendon, muscle, ligament, or nerve related?
4. Is there swelling and how bad?
New evidence is suggesting that heat and compression is a better choice when it comes to injuries that are not moderately to severely swollen, and to injuries that involve mostly muscle.
Ice is traditionally used to decrease inflammation. The way this works is to reduce blood flow to the injury which in turns reduces the amount of inflammation that gets to the area. But think about that for a second, if you are reducing blood flow you are also reducing the ability to flush out the injury as well as reducing the ability of your immune system (healing cells) to repair the injury.
While this may be good when there are large amounts of inflammation, reducing blood flow to certain injuries can extend the healing time. We want healing cells to get to the injury to start the process of repairing the tissue.
Let me answer the original questions above:
1. New injuries should still be iced within the first 24-48 hours. This also applies to re-injuries of old conditions. Chronic conditions (I.e.- injuries older than 6 weeks) should be heated. Heat for up to 20 minutes one time per hour.
2. Lower extremity structures respond better to heat. This is largely due to the foot, ankle & leg requiring muscle contraction to aid in blood flow return to the heart. Blood tends to pool into the lower leg when you are not moving. I am sure people have heard to contract your legs while flying to prevent blood clots. Icing the lower leg can reduce blood flow to the area which reduces the amount of healing cells to the area. Heat and compression will help get blood to the area and move blood out of the area. The exception to this would be swelling. For instance, I would initially ice a severely sprained ankle for 1-2 days.
3. Muscle and bone have good blood flow, while tendons and ligaments have little blood flow. This means that tendon and ligament injuries take much longer to heal. Athletes have been instructed to ice structures such as the Achilles, which is a tendonous structure. Because tendons have poor blood flow, icing the area starves the structure of blood flow, nutrients, and reparative cells. If icing is a must, contrast therapy would be better (alternating ice with heat). Icing can also freeze the tissue. Freezing the tissue can cause unnecessary inflammation.
4. Swelling is better controlled with compression. However, this is a time when ice should be used. Excessive swelling, especially in the leg, should be diagnosed immediately. To ensure there is not a blood clot. If a blood clot is suspected, compression is initially a contraindication. Signs and symptoms of clots in the leg are:
- Redding of the tissue
- Severe sharp pain in the leg, especially when weight bearing or lightly squeezing the leg
- Feeling of warmth in the leg
- Obvious size difference in leg when comparing to the other leg
The trick with all of these is timing. Heating should only be done 15-20 minutes on the hour. Icing should be limited to 10-15 minutes. Contrast therapy is great: ice for 5-10 minutes then heat for 5-10 minutes.
Recently, there are developments with icing/cryotherapy and compression therapy for recovery. Recovery would be defined as the time used following a long hike, bike ride, cross-fit, HIIT, etc.… If you are interested in what those therapies are, send me an email and we can chat.
**As always, a proper diagnosis should be reached first. These are general guidelines and should never replace a physician’s recommendations.
Dr. Derek Gearhart
