There is a long debate over the years about what is better for injuries - heat or ice? Years ago, the answer was universal, ice for acute injuries and heat after 3 days. Some people say, alternate between using ice for 20 minutes and heat for 20. Do you remember the acronym RICE? Rest, Ice, Compression, Elevate. This was long purported as the solution for your pain.
Most of these heat or ice for injury thoughts were rooted in the idea that ice causes vasoconstriction and thus decreases blood to that area while heat causes vasodilation and thus increases blood to that area. While that basic principle is accepted as valid, the question is - how does this translate to helping musculoskeletal pain? Does the heat or ice penetrate deep enough to affect the area you are having an issue?
In our clinic, we like to use the current research to guide choosing heat or ice for injuries in our treatments. Current research is poor to support the use of ice or cryotherapy in the treatment of musculoskeletal pain. The patient outcomes are not consistently improved by using it. While some patient’s felt it was helpful, others got nothing out of it. While the research is also not great for the use of heat, it is better than the use of ice. There are a lot of factors that need to be considered when choosing between the two (what part of the body, is it acute or chronic, how deep does the ice or heat penetrate the injury, etc.)
The general guidelines that exist state that you should use heat for muscle pain, tightness, and chronic pain. Ice can be used in instances of acute pain, especially if the part you’re using it on is superficial (ankle, wrist, etc.)
It is important to not use either for too long. Tissue can only get so hot or so cold. If you heat or cool it for longer than about 20 minutes, you’re not going to gain anything and likely put yourself at risk for burning yourself.
We typically instruct patients to use heat, not ice, in nearly all injury situations of muscle pain. This is due to the promotion of muscle relaxation, the increase in blood flow to the area bringing nutrients to heal the tight and injured tissues. Although these effects may be minor, they seem to be helpful in most cases.
We typically instruct patients to use ice for 20 minutes in two situations: if you are in 10/10 pain and need to bring it down for a bit. This will typically dull the pain temporarily. The other situation is when you are struggling to fall asleep due to pain. Typically, the ice will numb the area for about 20-30 minutes allowing you to fall asleep. Remember, heat instead of ice for injuries is most commonly recommended.
While the research is not strong, the general conclusion is that you should use either if you find it beneficial. Researchers have recently come up with a new acronym to help.
PEACE and LOVE
In the acute phase of an injury, the first 48-72 hours, follow the PEACE acronym. This acronym is designed to get your pain levels down and avoid making the injury worse.
P - Protect -- all injuries need protection while they heal
E - Elevate -- in an attempt to help decrease swelling, raise the injured part above the level of the heart if possible before adding heat or ice to the injury
A - Avoid Anti Inflammatories -- Anti-Inflammatory medications have recently been shown to have a negative effect on the remodeling of soft tissue injuries. The inflammation process has a purpose in healing and fixing the tissue.
C - Compress -- Adding some compression to the area can help drain the area of excessive swelling
E - Educate -- You should learn how to avoid reinjury, how to promote healing, and how to set realistic recovery expectations
After the initial acute phase has passed, musculoskeletal injuries need LOVE more importantly than ice or heat on the injury. This acronym is designed to get you moving again, promote healing, and restore strength in the area.
L - Load -- Most tissues need to be placed under appropriate load to strengthen the injured tissue and to circulate fluid in the joint.
O - Optimism -- Recovering from injury requires a mental state to support the healing process. If you become negative, depressed, or fearful, recovery will be delayed.
V - Vascularization - Choosing pain free activities that challenge the cardiovascular system can help to get blood flowing to the injured tissues. The focus here is not on heating the injury, but rather getting blood flow to the cells.
E - Exercise - Getting active care, restoring proprioception, mobility, strength, and resuming exercise will help to rebuild the injured tissues and avoid future reinjury.
The good news is, there is a lot of strong evidence to support the use of class 4 laser therapy on both acute and chronic injuries. Class 4 laser is shown to have a strong positive effect on both pain levels and function outcomes in muscle and joint injuries. Read more about the use of class 4 laser therapy in Boulder, Colorado.
If you are experiencing pain and want to know if heat or ice will be best for the injury, come in today for an evaluation and treatment. We will give you pain relief and then teach you how to apply the PEACE and LOVE acronym to your situation.