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Ice or Heat?

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heat vs ice

We often hear the question “Should I use ice or heat to treat my soft tissue injury?

For many years, most of us have been taught to R.I.C.E. for acute injury. Rest, ice, compression, and elevate. Ice does decrease swelling and pain. However, is it really in our best interest to reduce our body’s natural inflammatory response with ice or will that only slow down the healing process?

Let’s take a look at the inflammatory response to injury. First, there is an initial trauma. Then vasodilation occurs allowing more blood flow to the injury site. This brings up leukocytes and macrophages (types of white blood cells) to clean up the injury. More fluid at the injury site causes swelling or edema, pain, and limited range of movement. The lymphatic system then drains out this fluid and waste (broken down tissue) so that the healing can commence.

What does ice do? It decreases circulation and can block this regenerative process. The addition of ice may even increase leakage of interstitial fluid back into the tissue. Neither Traditional Chinese Medicine nor Ayurvedic medicine recommend ice for injury as a treatment protocol for these reasons. They both encourage flow for healing.

It’s a bit of a misnomer that inflammation is bad. Taking anti-inflammatory medications (which can be really hard on the gut) or ice to completely decrease the swelling may not be the most therapeutic approach. Yes, inflammation causes decreased range of motion and pain. This is your body’s way of telling you to rest it. It’s true, inflammation does need to clear out so as not to damage surrounding tissues. However, we should be supporting our body’s natural drainage process to encourage healing, rather than trying to restrict it.

So what do we recommend?

Remember that every case is specific. Always ask your practitioner what they would recommend for your particular injury if you are unsure.

An epsom salt bath is safe and therapeutic for all injuries. Epsom salts or hydrated magnesium sulfate work by drawing toxins out of the body to enhance healing.

You can also assist lymphatic drainage by elevating, compressing, and gently moving the affected area.

Heating pads for muscular spasm can help relax the tissue by increasing circulation.

Should you ever ice?

Short duration icing for a maximum of 10 minutes (so as not to inflict frostbite) to an acute injury (like an ankle sprain) within the first 48 hours does decrease the pain. However, it can also decrease that therapeutic swelling we already discussed. If you do feel that the pain relief of cold would be beneficial to you, try following it up with gentle compressions to get the blood flowing again.

This 2004 study on the effects of cryotherapy (cold therapy) for soft tissue injury states that “based on the available evidence, cryotherapy seems to be effective in decreasing pain,” but evidence is scant for any further conclusions:

To conclude, we recommend encouraging your body’s natural healing response to treat your injury. Compression and gentle pain free movement of the affected area may be the most beneficial to your injury. Use heat to relax muscles and encourage lymphatic drainage. Use your ice sparingly and for short duration if need be for pain relief.

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