Movement is Medicine: The Great Debate – Ice vs. Heat

There has been a long-term debate about the use of heat or ice post injury. There has been much confusion surrounding the issue and health care and sports medicine practitioners have spent years educating us on which to use when. Conventional thinking has been that ice should be used in the first 24-48 hours post injury to decrease inflammation (swelling) and pain. In 1978 Dr. Gabe Mirkin coined the term R.I.C.E (Rest, Ice, Compression, Elevation) and this idea became the gold standard in the treatment of acute injuries and post surgery.

Over the years many studies have looked at the role of ice in decreasing inflammation and pain, and aiding in recovery of tissues. Aggressive re-search in the last 1-2 decades has been progressively proving or disproving conventional wisdom and theories that we have held as truths. This updated information is slow to spread and it is challenging our long held paradigms. An example of the difficulty of shifting paradigms is a well known statistic that physicians, 75 percent of the time when making recommendations, will use the information they learned in school. My guess is you could insert any health-care practitioner into that statistic. While this may be a great topic for a future column, the take-home message here is that we must stay current in our clinical application.

What is becoming increasingly more evident is that we may have gotten it wrong over the last several years of using ice as our “go to” post injury. Even Dr. Mirkin is changing his course of thinking and current research is backing him up. A 2013 study in the American Journal of Sports Medicine, showed that although icing delayed swelling it did not improve recovery time from muscle injury. And a 2004 systematic review comparing recovery following ankle sprains, found that ice and exercises may result in quicker recovery, however there was no evidence that ice and compression resulted in faster healing times.

So why not ice?

Damage to tissue from trauma, injury, or even overuse/soreness from intense exercise sets in motion a biological event to promote healing of the injured tissue. This event is called “inflammation.” Inflammation starts the healing process by bringing cells to the injured area that release a hormone called insulin-like growth factor (IGF-1). This hormone sets in motion the healing and recovery phase for the tissues. Applying ice during this time and reducing swelling may potentially delay or slow healing by preventing the release of IGF-1.

Icing also constricts blood flow to the area thereby reducing the flow of the healing cells of inflammation. The blood vessels may not open again for many hours after using ice.

Current thinking is that anything that reduces inflammation, things like cortisone type drugs, pain relievers and non-steroidal anti-inflammatories, may also delay healing times.

Using ice for minor injuries may reduce pain and help athletes get back into the game. Of greater concern may be that some research has shown that if you ice for more than 20 minutes, there is an immediate decrease in strength, speed and coordination of the athlete.

Here are Dr. Mirkin’s current recommendations for icing post injury:

If injured, stop exercising immediately.
If pain is severe and you cannot move the injured part, or if you have had loss of consciousness, seek medical attention.
Rule out broken bones before beginning to move the injured part. Open wounds should be cleaned and checked.
Elevate the injured part to use gravity to help minimize swelling naturally
If the injury is limited to muscles or other soft tissue, compression may be helpful in reducing pain and minimizing swelling.
It is OK to apply ice for up to 10 minutes, remove for 20 minutes repeating once or twice. There is no reason to apply ice more than six hours after injury.
If injury is severe, follow your health-care practitioner’s advice on rehabilitation. It is important to get moving as soon as possible post injury.

We still use ice in our physical therapy practice to help manage pain. We have also implemented some additional tools such as taping to help decrease inflammation by assisting the lymphatic system. Most importantly we get the area gently moving as soon as possible allowing the body to perform the physiological process of healing.

If you have any questions about this article, contact Dr. Chris Telesmanic, PT, DPT, OCS at chris@alliancehealthfresno.com. Learn more about movement, fitness and health in this space each week or by visiting www.alliancehealthfresno.com, or calling 478-5833.

This article first appeared in the Hanford Sentinel, Movement is Medicine column, written by Alliance Health.