The age old question. Ice or Heat after injury?

Picture Courtesy Charm City Wire

Ice or heat?  R.I.C.E or M.E.A.T?

One of the most common questions asked by clients is what to use for their injury, ice or heat?  Both have their place, both are beneficial for pain relief, but one may be better than the other.  Ice constricts your vessels helping to limit swelling, and heat increases circulation helping the  healing process by bringing beneficial nutrients and flushing out the waste.   Both heat and ice  also assist in reducing pain because they give our bodies another sensation to contend with.  When ice or heat are applied, our larger sensory pathways kick in and help to overshadow the smaller pain pathways; therefore dulling the effects of pain. 
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Traditionally ice is used 20 minutes on, 20 minutes off for the first 2-3 days after an injury.  This is where RICE comes into play.  RICE stands for Rest, Ice, Compression, and Elevation.  RICE along with NSAIDs or non-steroidal anti-inflammatory drugs such as Advil are often utilized.  However, please consult with your doctor before taking over-the-counter medication, because NSAIDs have been shown to limit long-term bone and tendon healing.  Swelling is at its peak at this point and it should be reduced, or should it?  Reducing swelling will  reduce pain short-term, but our bodies produce this for a reason.  Swelling acts as a natural "splint" causing us to protect the painful area and promote healing when it is most crucial.

Now, the next step depends on the extent of injury and you should consult with your doctor or physical therapist before beginning.  Here, MEAT, another method of dealing with injury comes into play.  Timing can range from the day of with a minor muscle injury to 1-2 months for severe ligament or bone damage.  MEAT stands for Movement, Exercise, Analgesics, and Treatment.  I am a huge fan of early mobilization as long as there is no fracture or surgery requiring a lengthened rest period.  Nothing crazy, but movement targeting gentle range of motion should be initiated early on after injury.  Heat applied for 10 minutes prior to motion can promote circulation and allow greater ease of motion.  Exercise should begin next, starting to strengthen the muscles surrounding the injury site.  The easiest type of exercise is an isometric where you tighten a muscle without moving, like when power lifters pose by tightening their muscles or some of you may know Charles Atlas.  Concentric exercises, followed by eccentric, and finally progressing to full body functional movements with the goal to return to activity.  A is for Analgesic, which means dulling the pain like Tylenol or Acetaminophen.  Tylenol helps to dull the pain without limiting circulation like NSAIDS.  Pain relief promotes improved movement, but Tylenol too can have side effects.  Those with liver problems may want to stick to ice and heat if pain is tolerable.  Again with medication please consult with your physician or pharmacist if you are unsure.  Finally, Treatment that involves mobilization and releases by a skilled practitioner such as a physical therapist, who is an expert in movement will help you return to full function and the activities you desire.   

Unfortunately there is no straightforward answer, but I will try to clarify.  I prefer a combination, as pieces of both RICE and MEAT have their benefits.  Swelling acts like a natural "splint" for a reason during the initial healing process.  At a micro level our bodies need this crucial rest period to heal.  However, do not wait too long because humans are the best at compensating and will often find other ways to function, which is not always the best.  Ice can and should be used early on for the first 2-3 days after injury then a combination of heat and ice can be used to promote circulation during the rehab process.  

Heat or Ice? Both!