Your Selection Depends on TIME
One of the most important criteria to use when deciding between ice and heat is the length of time you’ve been dealing with your pain. There are three classifications for injury/pain based on the amount of time since the onset of symptoms. Acute injuries began within the past 14 days, and typically began with a specific incident or quickly became symptomatic over a very short period of time. Sub-acute injuries are those that began between 14 days and 3 months ago. Many of these injuries we see in practice are those that didn’t respond early to home care measures, such as ice, heat, or stretching, and need further treatment intervention. It doesn’t mean that ice or heat aren’t valuable and shouldn’t be performed – they will do their part in conjunction with treatment to help healing occur. Finally, chronic injuries are those that have been ongoing for 3+ months. They are either injuries that have been mismanaged, have gone undiagnosed and untreated, or they are complex conditions that may not have a cure.
Is Inflammation/Swelling A Factor?
Inflammation is the body’s natural response to injury and infection. When we consider tissue healing, there are generally three phases to the process. The inflammatory phase is the first stage, where the body is responding to the initial onset of damage to the cells within the tissue. This is a critical stage of healing, particularly if there is any bleeding involved with the injury, as there is with moderate to severe strain/sprains. The longstanding school of thought has been that if we can shorten the length of the inflammatory phase, the quicker we can progress onto the second and third stages of healing – the proliferative and remodelling phases. However, some of the most recent research has swayed traditional thinking away from accelerating the inflammatory phase to allow for the body’s natural inflammatory response to properly manage tissue healing. The original developer of the RICE protocol – Rest, Ice, Compression and Elevation, has recently published new guidelines where ice should only be used within the first 6 hours of acute injury, primarily for pain control. The argument is that the research says that ice helps with pain, but does not significantly shorten the healing time of an injury. This has caused an even greater debate in healthcare in recent years and further research is needed.
What Are Your Goals of Using Ice or Heat?
I often ask this question to patients since understanding your primary goal of applying ice and/or heat can often help you make the appropriate choice. Generally speaking, if your primary goal is to reduce pain, ice is the better option of the two. Ice helps to reduce pain by numbing a specific type of nerve fibre in the body that sends pain signals to the brain. By cooling the injured tissue, those nerves lose the ability to communicate up the neurological pathway telling the brain there is pain. Chronic pain, however, might benefit from alternating ice and heat, as you are also trying to promote blood flow while managing pain. What’s important to understand is that as a rule, ice reduces blood flow by constricting the blood vessels in the tissues, where heat allows those blood vessels to relax, increasing blood flow. Patients with chronic arthritic conditions, for example, might benefit from the combination of both, as you want to help reduce pain, but also promote blood flow to help maintain joint and tissue mobility. Lastly, if your goal is to sooth or relax tense tissue and pain is really not a factor, then heat is your best option. Sometimes it’s hard to differentiate between pain and tension. I often tell patients that if you are experiencing tension but the intensity of your pain is 3 or less on a scale of 1-10, then heat can be applied.