Heat vs Cold
I get asked this question a lot. Should I use ice or should I use heat? And, like any crafty clinician not giving a straight answer immediately so I have time to think, I answer that question with a question? What are you using it for? Or, it depends?
The earliest known research including the concept to ice following an injury was found in 1978 with the coined terminology RICE (Rest, Ice, Compression, Elevation). The idea that ice or cold acts as a vasoconstrictor for our blood and therefore will reduce the amount of swelling that occurs after an injury. As well, anecdotally the ice was found to numb the pain and therefore allowing the injured person to feel better and hopefully return to play/work sooner. Over the years the RICE has changed to (P)RICE with the P standing for Protect. 34 years later this evolved into POLICE (Protect, Optimal Loading, Ice, Compression, Elevation. Eventually finishing with the current acronym that is being used by trainers and Rehab professionals after an injury is PEACE & LOVE (Protect, Elevate, Avoid anti-inflammatory drugs, Compression, Education, & Loading, Optimism, Vascularization, and Exercise. In 42 years the acronym for best management of injuries has changed from RICE to PEACE & LOVE. Effectively removing Icing and Rest as a component due to the fact that many people would almost rest excessively and worsen their injury.
The removal of ice stemmed from the fact that ice may actually be inhibiting your natural healing process. After an injury our body will send inflammatory cells (macrophages) which release the hormone Insulin-like Growth Factor (IGF-1). These cells initiate healing by killing off damaged tissue. Although when ice is applied, we may actually be preventing the body’s natural release of IGF-1 and therefore delaying the initiation of the healing process (3).
Heat on the other hand has never been included in the post injury acronym due to the fact that heat acts as a vasodilator which would inherently increase swelling if that was already a problem. However, research into the management of acute and subacute back pain indicates that heat can be a valuable adjunct in the management of pain following an acute injury to the low back as participants in a study that used a heat wrap saw significant reduction in pain after 5 days. While another trial in the same review found that use of a heated blanket significantly decreased pain following its immediate application after acute or subacute injury to low back (4). In addition research regarding deep heat like that found in Finnish dry saunas, hot water immersion such as a jacuzzi, and steam rooms has an added benefit of activating protein synthesis by way of heat shock protein cells.
With the use of deep heat as a stress on our bodies research suggests that we see increases in peripheral vasodilation, activation of heat shock proteins, increased cardiac output and reduction in vascular resistance.
Personally, I prefer heat when dealing with aches and pains. Is heat always right and cold always wrong? Probably not. Most of the time I recommend whichever you prefer or can tolerate best. However, after a Rotator Cuff repair, ACL reconstruction or another traumatic surgery performed, a little bit of ice is understandable to reduce some pain and limit excess swelling to allow those joints some movement in the rehab process.
If I was to sprain my ankle right now, would I jump in the sauna? Again, probably not, immediately at least. I would follow the current recommended acronym of (PEACE & LOVE) Protect the area, Elevate it if possible to help with swelling, Avoid anti-inflammatory drugs, Compress with bandages or bracing, and Educate or Re-educate myself on healing times and injury expectations. Then begin gently Loading the area as tolerated, remember to stay Optimistic about a return to normal, promote Vascularization via heat or massage and continue Exercising in ways that are possible.
So next time you find yourself in this situation after an injury remember to show yourself a little PEACE and LOVE and if you have any questions as to the best way to do that you should contact your local Physical Therapist to direct as to the best way to rehab your injury. Or if you are in the Salt Lake area come in and see what we can do for you at Freedom Physical Therapy.
(1)Mirkin, G. & Hoffman, M. (1978). The sportsmedicine book. (1st ed.). Little Brown and Co.
(2)Dubois, B. & Esculier, J-F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 54, 72-73.
(3)Mirkin, G. (2014, March 16). Why Ice Delays Recovery. https://www.drmirkin.com/fitness/why-ice-delays-recovery.html
(4)French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. A Cochrane review of superficial heat or cold for low back pain. Spine (Phila Pa 1976). 2006 Apr 20;31(9):998-1006. doi: 10.1097/01.brs.0000214881.10814.64. PMID: 16641776.
(5)Brunt, V. E., & Minson, C. T. (2021). Heat therapy: mechanistic underpinnings and applications to cardiovascular health. Journal of applied physiology (Bethesda, Md. : 1985), 130(6), 1684–1704. https://doi.org/10.1152/japplphysiol.00141.2020
