Heat or Ice?

Have you ever had an injury and wondered whether you should be applying heat or ice? Unfortunately this is a contentious topic with the answer not being so simple. Both can be effective in decreasing pain and helping an injury to heal!

Research is often changing around the efficacy of applying heat or ice, as is the case with many interventions and treatments for acute and chronic pain. For years the common advice from doctors and other health professionals has been to apply ice to the area immediately after injury. A 2012 study by Bleakley et al. stated that there is no scientific evidence that ice helps with muscle recovery. Dr. Gabe Mirkin, the creator of the well known R.I.C.E acronym (Rest, Ice, Elevation, Compression) has now stated that “it appears both ice and complete rest may delay healing instead of helping” (https://www.drmirkin.com/fitness/why-ice-delays-recovery.html).

Ice Therapy:

● Analgesic (decreases pain) short term within the first 48-72 hours

● Decreased muscular strength and performance and should only be used after exercises is completed

● Should be applied for at least 10 minutes

Heat Therapy

● Has an analgesic effect for sub-acute and chronic pain

● Provides a more significant pain relief and returned function compared to ice

● Increased joint range of motion and decreases stiffness

● Should be applied for 10-20 minutes

Heat therapy has several effects on the human body including increases in blood flow to the area. We know for healing to occur inflammation must be present. When muscles and other tissues are damaged your body sends inflammatory cells to the damaged tissues to promote healing. The application of ice to reduce swelling actually delays the healing by preventing the body from releasing these inflammatory cells. This is due to the constriction of blood flow reducing the amount of inflammation physically capable to travel to the injured tissues (Cheng et al., 2017).

Based on current research heat is the preferred method when dealing with acute and chronic injuries. Ice has less research behind it and is less important than we once thought, whereas heat better reduces pain and increases range of motion.

The primary focus post injury should be encouraging patients to return to movement safely again, as soon as practical.

1. Cheng, A. J., Willis, S. J., Zinner, C., Chaillou, T., Ivarsson, N., Ørtenblad, N., Lanner, J. T., Holmberg, H.-C., & Westerblad, H. (2017). Post-exercise recovery of contractile function and endurance in humans and mice is accelerated by heating and slowed by cooling skeletal muscle. The Journal of Physiology, 595(24), 7413-7426. https://doi.org/https://doi.org/10.1113/JP274870
2. Bleakley, C. M., Glasgow, P., & Webb, M. J. (2012). Cooling an acute muscle injury: Can basic scientific theory translate into the clinical setting? British Journal of Sports Medicine, 46(4), 296. https://doi.org/10.1136/bjsm.2011.086116
3. Petrofsky, J. S., Khowailed, I. A., Lee, H., Berk, L., Bains, G. S., Akerkar, S., Shah, J., Al-Dabbak, F., & Laymon, M. S. (2015). Cold vs. Heat after exercise—is there a clear winner for muscle soreness. The Journal of Strength & Conditioning Research, 29(11), 3245-3252. https://doi.org/10.1519/jsc.0000000000001127