The two most widely used techniques in the field of sports medicine, physical therapy, chiropractic, and various musculoskeletal rehabilitation professions.

Most clinicians favor the use of ice to reduce swelling, inflammation, and pain, while others favor the use of heat to relieve pain and relax the spasmodic muscle. This opposing recommendation creates uncertainty and confusion on whether to use ice or heat to relieve pain and speed-up recovery.

Unlike most medical disciplines, clinicians and acupuncturists that are trained under a Chinese medical model have always favored heat and would normally shy away from ice. It has been speculated that ice was not readily available during the time this medical model was developed; therefore, practitioners and doctors had to find ways to relieve pain and optimize recovery without its use. Some argue that this bias towards heat that current day Chinese medical clinicians and acupuncturists have is simply out of convention. This may be true, but it is not without consideration of clinical efficacy and scientific research. Modern research suggests that the application of ice has minimal benefit at best and may even delay recovery.

Modern research suggests that the application of ice has minimal benefit at best and may even delay recovery.

RICE METHOD – THE GOLD STANDARD?

It has become common knowledge that an injury to a muscle or joint can benefit from the RICE method. The RICE method, which stands for REST, ICE, COMPRESSION, and ELEVATION, was coined and developed by Dr. Gabe Mirkin in his 1978 best-seller Sports Medicine Book and has been standard of care for musculoskeletal injuries. Recently, Dr. Mirkin has repealed his recommendation on the use of ice. In a statement written by Dr. Mirkin, he states, “Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping [1].”

Several studies support Dr. Mirkin’s new stance on the use of ice. A systematic review of randomized control trials published in the January 2004 issue of the American Journal of Sports Medicine suggests the minimal benefit of ice as therapy, “There was little evidence to suggest that the addition of ice to compression had any significant effect” [2]. In addition, the August 2013 issue further suggests the ineffectiveness of ice on recovery, “we provide evidence that this cooling procedure failed to improve long-term recovery of muscle performance” [3].

“we provide evidence that this cooling procedure failed to improve long-term recovery of muscle performance.”

THE ROLE OF INFLAMMATION

To understand why ice is proving to be ineffective in recovery, it is important to understand the role of inflammation in the healing process of the human body. Although, chronic inflammation is deleterious to health, acute inflammation is necessary to trigger the body to go into repair mode. Without an acute inflammatory process, the body is not aware that damage has occurred, therefore, will not direct any resources for healing and recovery.

HOW DOES ICE DELAY RECOVERY?

Ice prevents the inflammatory process to take its normal course by inhibiting blood flow to the injured site through a process called vasoconstriction – the narrowing of blood vessels. Without normal blood flow, our body cannot send nutrients to the site of injury for repair and at the same time, the metabolic waste that builds up during the injury cannot circulate out of the injured site. The January-February 1995 issue of the American Journal of Sports Medicine suggests that blood flow is inhibited with the application of ice, “A small but consistent decrease in blood flow and metabolism appear to be obtained with as little as 5 minutes of ice application.” [4]. Furthermore, the vasoconstriction or narrowing of blood vessels caused by the application of ice continues long after its removal. The September 2015 issue of Knee Surgery Sports Traumatology Arthroscopy Journal states, “…the condition of reduced blood flow persists long after cooling is stopped and local temperatures have rewarmed towards the normal range, indicating that the maintenance of vasoconstriction is not directly dependent on the continuing existence of a cold state” [5]. This restricted blood flow and altered metabolic activity compromises full recovery.

E

This restricted blood flow and altered metabolic activity compromises full recovery.

CHINESE MEDICAL PERSPECTIVE

The Chinese medical model works with the body’s mechanism of healing and supports its natural process. As mentioned above, the natural course of healing requires an acute inflammatory process to trigger the body’s repair mode. Therefore, inhibiting this natural process by using ice is generally not recommended by a clinician or acupuncturist trained under a Chinese medical model. Instead, the application of a topical herbal liniment, poultice, or paste is preferred during the acute phase of injury, while heat is applied during the chronic and repair stages to encourage blood flow and promote the natural repair mechanism of the body. By raising the temperature of the skin and its underlying structures, the body increases metabolic activity allowing optimal recovery so pain relief can take place. Conversely, by decreasing temperature, the body slows down metabolic activity – delaying repair.

E

By raising the temperature of the skin and its underlying structures, the body increases metabolic activity allowing optimal recovery so pain relief can take place.

DOES ICE HAVE ANY ROLE IN MUSCULOSKELETAL INJURIES AND CONDITIONS?

The application of ice may have a role as a short-term strategy for pain relief and to reduce swelling during the initial onset (within the first few hours) of injury or trauma. For example, an athlete that was just injured and needs to stay in the game. In this situation, it is more important to get the athlete back in the game with minimal pain and swelling than to worry about optimal recovery. Because the goal in this instance is short-term pain management, the application of ice to the injured site may benefit the athlete so he/she can finish the game. Outside of this scenario, it would be advantageous to focus on long-term pain relief and full recovery by allowing the repair process of the body to take place without the intervention of ice.

OPTIMIZING RECOVERY

In order for full recovery and long-term pain relief to take place, it is necessary to work with the body’s natural healing mechanism. It is important to realize that the unpleasantries of an injury happen for a reason: inflammation occurs to trigger the body to go into repair mode; swelling occurs to immobilize the area and protect the joint or surrounding structures from further damage; pain occurs to provide us feedback to limit our movement until some level of muscle repair or joint stability has taken place. Therefore, to aggressively eliminate swelling, inflammation, and pain with an intervention, such as ice, wouldn’t be to our advantage. Of course, it is important to have some level of comfort while recovering, but to completely eradicate these symptoms during the repair process would go against the body’s natural process.

CONCLUSION

So, which is better – Heat or Ice?

It comes down to what your goals are.

The application of heat is an effective strategy for long-term pain relief, full recovery, and chronic injuries, while ice can be appropriate – although not ideal –  for short-term pain management and acute care.

It’s important to mention that when ice is used, it should be limited within the first few hours of injury/trauma. Additionally, heat should not be used while there are visible signs of swelling and inflammation.

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ABOUT THE AUTHOR: Cris del Rosario is an integrative licensed acupuncturist and a certified strength and conditioning specialist. He specializes in pain relief, preventive care, and chronic conditions. Cris has a private practice in San Diego, CA. Find Cris on Twitter @icrisdelrosario.

QUESTION: What has your experience been with using ice or heat to recover from an injury? Let us know at the comments section below.