Ice or heat?

It’s the million-dollar question and it’s a hot topic for debate amongst many practitioners.

If we have had a sprain, strain, bruise, pull or tear – and we want to reduce the pain – do we use heat or ice? The answer to this question comes down to what tissue is actually injured. Is it the muscle or the joint and what is the nature of the injury? It also depends on how recently the injury has occurred, and whether the injury is layered on top of an old injury (chronic in nature) or whether it is something that has happened for the first time (acute in nature).

When an injury has been sustained, early on in the process, there is usually evidence of soreness and swelling and this is a good indication of inflammation. Inflammation is a process by which the body’s innate intelligence releases inflammatory cells to protect and repair in the injured tissues. When there is evidence of swelling, it is best to use ice. For example – for a sprained, swollen ankle, ice is the appropriate remedy.

Ice causes the blood vessels to constrict, the swelling to reduce and dampens the inflammatory response. It is important to be mindful of where the ice is applied and for how long. It is a good idea to apply ice to the affected area for 10 minutes, then keep the ice off for a subsequent 20 minutes. Then you can apply ice again following a 10 minute on, 20 minutes off rule. Looking at the ankle for example, it is a complicated joint structure – made up of three major bones and relies on at least 7 ligaments for stability. Though there are muscles such as the calf muscle that connect onto the ankle joint, there is mostly joint and ligament tissue involved in an ankle sprain.

As a general rule of thumb, when an injury is described as a deeper ache and is not accompanied by obvious swelling or redness, then the pain is leaning more towards being muscular in nature and the application of heat can be quite helpful. When a muscle is injured, some of the fibres that make up the muscle have been torn. The larger the number of torn muscle fibres, the worse the injury and the longer the recovery time.  Sometimes the swelling in a muscle is harder to detect and less of an obvious sign when compared to a joint injury. This does not mean the inflammation is not there.

An obvious sign for muscle injury is muscle spasm or bruising. Icing is definitely helpful in bruising; however, icing can cause more damage to a muscle that is already is spasm. Icing can cause the muscle to go into further spasm and increase the pain. Heat is a good method of treating muscles that are in spasm, however on the flip side, heat can also exacerbate the inflammatory process.

There is not a hard a fast rule for when heat and ice should be used, however as a summary joints such as the ankle, knee, elbow, wrist, where there is limited muscular tissue, the best way to reduce inflammation is to use ice. For area of the body such as the neck, spine, pelvis where the muscular tissue is more dense, using a heat is a better way to go. However, both heat and ice need to be applied in moderation and it’s always best to speak to a healthcare professional for advice. You can find some more information on this topic on the arthritis foundation website too.