This seems to be one of the most common questions I hear in my clinical practice, and it’s important that I try and share this information with a larger audience so I can hopefully lay to rest this ridiculously popular age-old question. Before I begin, I want you to pay close attention to the information and exact wording in this article, and then I want you to share it with as many people as possible. Again, I’m not saying my advice is 100% correct, but I’m going off of the latest research that we have in the medical world today.
I would like to answer this question in two parts:
A. It Depends.
In a rough sense, the common thought is to use Ice for Acute Injuries. This is usually within the first 24-48 hours, and it’s primarily to moderate pain and swelling. After that, you want to use heat to promote more blood flow into the injured area and improve mobility. Of course, there are some special exceptions to this.
This article does not apply to surgery or major trauma (fractures, open wounds, etc.). That would be entirely dependent on the type of surgery/trauma and what the surgeon or physician have recommended based on the factors surrounding that. Consult with them.
Ice has been used classically to “decrease inflammation”. What most people don’t realize is that, while often painful, inflammation is a very normal part of the healing process. The swelling, redness, and pain is a response by the body sending cells to the injured area to begin the healing process. If we apply a large amount of ice to an area for a prolonged period, we are limiting the body’s ability to send those repair cells to the site of injury. Even Dr. Gabe Mirkin who originally coined the term “RICE” recanted his 1978 statement in 2015, now stating that “Subsequent research shows that rest and ice can actually delay recovery. Mild movement helps tissue heal faster, and the application of cold suppresses the immune responses that start and hasten recovery. Icing does help suppress pain, but athletes are usually far more interested in returning as quickly as possible to the playing field. So, today, RICE is not the preferred treatment for an acute athletic injury.” (1)
So we just want to heat everything? While heat can help to improve blood flow to a certain area, the massive surge of inflammatory cells is not always the most comfortable. If you have an acute injury and it is still actively swollen/red/painful, I probably wouldn’t recommend heat as it can increase the pain level. However, for chronic aches and stiff muscles, heat can usually help to loosen those tight muscles and help us to get moving.
Which leads to the most important thing: GET MOVING. In Gary Reinl’s book, he instead replaces the RICE acronym with ARITA - Active Recovery Is The Answer. “Active Recovery” (aka general low-intensity movement) has demonstrated the best results when compared against ice or heat in clinical trials. By actively moving our body and more specifically the area of injury, we are stimulating blood flow and helping to shuttle the excess lymph (white blood cells associated with inflammation and immunity) and stagnant blood out of the injured area. This in turn will help to cycle fresh fluids into the area. All of this helps to naturally reduce swelling, pain, and improve mobility. I use the famous quote “Take the garbage out, bring the groceries in”.
For example, instead of icing your knee pain, try going for a brief walk or cycling on a stationary bike with no resistance for 10 minutes.
Now for the long-awaited part B answer to the question: Drumroll please
B. It Really Doesn’t Matter.
The research has shown that neither Ice nor Heat have any significant clinical effect on the healing process. Ice has been shown to temporarily slow the healing process (2), and heat on an acute injury has been shown to temporarily increase pain. However, outside of skin irritation or damage by prolonged application or applying it at extreme temperatures, you really aren’t going to do much to change the healing process.
Lastly, some people just generally don’t respond well to one or the other, regardless of what type of injury or what stage of healing you are in. Therefore, I would recommend not using it at all or trying the alternative if one doesn’t work for you.
In conclusion, if ice helps to take the edge off temporarily with an injury that is roughly less than 48 hours old, then it might be suitable. However, prolonged periods of icing are really just for your pain tolerance and are probably going to cause a minor delay in your overall healing time. As for heat, I recommend it solely to help warm up a muscle group to get you MOVING. If there is anything you can take away from this article today, I would like you to remember ARITA: Active Recovery Is The Answer! (1)
If after all of this you STILL aren’t satisfied, then contact me personally for your specific condition and I would be happy to set up a Consultation to guide you further through your healing process!
In Good Health,
Dr. Colton Korne, DC
References:
Reinl, G. (2013). Iced! The Illusionary Treatment Option, 2nd ed. United States of America: G. Reinl
Mirkin, G. (2015, September). Why ice delays recovery. Dr Gabe Mirkin on Health. Retrieved from www.drmirkin.com/fitness/why-ice-delays-recovery.html.
Mika, A., Oleksy, Ł., Kielnar, R., Wodka-Natkaniec, E., Twardowska, M., Kamiński, K., & Małek, Z. (2016). Comparison of two different modes of active recovery on muscles performance after fatiguing exercise in mountain canoeist and football players. PloS one, 11(10). https://doi.org/10.1371/journal.pone.0164216