To ice or to heat an injury

[hardcore iv]

I've read in some old-school health books, Jethro Kloss', Back to eden, to apply heat on sprained ankles and similar injuries as it will increase blood flow and healing nutrients to the injured area, but it's conventional wisdom to ice it in order to reduce swelling. My athletics coach was at a coaching workshop where a physiotherapist said, off the record, it was better to apply heat, and the main reason to ice would be if the injured person was a haemophiliac.

My personal experience with this was at VF week last year where I sprained my ankle and then spent several hours soaking in some hot springs. I didn't really notice any difference in healing time from the times I've iced it, but I was able to lift the next day.

What do people think about this?

[ninearms]

IME cold to reduce swelling, then heat to restore movement. However, somewhere in the depths of this site there's a Gelert megapost (or two) explaining both approaches.

[JP]

if the swelling causes pain or reduces the range of motion it would make common sense to ice it.

but if not, the heat feels nice

[Blond.Bee]

I vote both.
I ice as soon as possible after the injury (on and off) then bandage it and use a heat pack when I need to get moving, usually the next morning. If its still bad the next day I'll repeat. It works but I don't know why sorry!

[Gelert]

IME cold to reduce swelling, then heat to restore movement. However, somewhere in the depths of this site there's a Gelert megapost (or two) explaining both approaches.

LMGTFY.

The way it works is this.

You injure yourself, by whatever means, you incur yourself a soft tissue injury. Your body responds by mounting an inflammatory response - the doctors who get latin call it rubor, dolor, calor, tumour.

This isn't for laughs or because your body is set up to be annoying, it's got an useful point. The redness and heat come from increased bloodflow to the area. The tumour (swelling) bit comes as plasma and leukocytes infiltrate tissue. The dolor comes from the fact that there is pressure and heat being put on the affected body part.

The bloodflow is there to get the plasma and leukocytes to the problem, and they're there to help fix it. At the heart of it, inflammation is well-meant. Inflammation is the dark side of healing processes, crudely put. Unfortunately, it tends to be too aggressive, and results in pain and further tissue damage. This is why we control it.

The reason why I mentioned the 24h-48h cut off for RICE and brufen, in line with accepted, evidence based medicine guidelines is that within that 24-48h period after injury or aggravation, laying off RICE (or HI-RICE, PRINCE, RICER, variations thereof) is usually indicated, as if it has been done correctly, the worst inflammation is past, and decreasing bloodflow is at the cost of delivery of nutrients, growth factors, removal of wastes and the beneficial side of inflammation. This is why we allow some degree of subacute inflammation.

The trouble with RICE is that it is epically misunderstood within the general sporting public as people think it means what it says on the can.

People interpret it as licence to sit at home watching daytime TV with the body part elevated, bandaged very tightly and packed with ice (more often than not, applied directly to the skin...)

Which it should never be. Even when RICE is applied, R means not doing anything that causes acute pain, not arse on sofa, Ice is only applied for up to 20 minutes, tops - the rest is off to allow bloodflow and prevent ischaemia - Compression, should be done gently, and the E bit should not limit you to the sofa.

It's a first aid procedure for acute inflammation due to soft-tissue injury, not a cure-all. This is why RICER is a better acronym - the final R standing for "Refer" - go to the doctor.

Essentially in a soft tissue injury you get swelling, which is both good and bad. You ice it for short periods in the first 24-48h post injury/aggravation to control the swelling and reduce pain. But afterwards, carrying on with the ice is A Bad Thing as it stops the good aspects of swelling - extra goodies and healing bonuses - from getting to the site of injury.

Btw, ice should only be applied indirectly (i.e. insulated by a towel, etc.) for up to 20 minutes and the injury site allowed to warm up properly all by itself. The aim is to cool the injury, not freeze it.

It should also not be applied less than 2-3h before the start of exercise otherwise it will be difficult to warm up the area and you run a greater risk of further injury as a result.

Subsequently, warm packs etc can be done as common sense dictates.

[Clem Snide]

Nice post.

The problem with the RICE thing is that no-one is told why they're doing it, hence the mis-use.

A (usually sensible) boy I train with pulled something in his upper arm a while back and told me he kept it wrapped in ice for four days solid, so it was totally numb the whole time. He just thought it was what you do. Now he's dead*.


*Not really, but I thought that boring anecdote needed jazzing up a bit.

[JonQ]

A physiotherapist I used to see strongly adviced on using ice. I tried it and since haven't used heatpacks at all - they temporarly relieve my muscle pains but in the long run, seems to worsen injuries. I take it this must depend on the type of injury you've got, but my muscles seem to overall like ice much better. If there's inflammation, only ever use ice, as heat (or massage) may make it spread.

Ice also improves blood flow, only it does so in the deeper tissues and not merely the superficial ones. This also according to my wise physiotherapist.