Should I use heat or ice on my injury?

Heat and cryotherapy (ice) are commonly used in the management of pain; however the efficacy of such treatments – especially the use of heat, is still being questioned in the literature.

Part of the reason why injuries hurt is due to the body’s inflammatory response to tissue damage.  Inflammatory molecules and cells called cytokines and macrophages are transported through the blood to an injury site. Macrophages “eat” up the damaged tissue and other responses occur in the body to help “patch” the injured area. While the inflammatory response is a good thing, in the case of sudden injury, the body will jump into action quickly sending all sorts of cellular messengers and molecules needed for repair to the area. This sudden increase in fluid and cells results in swelling and heat production, which causes the release of another messenger molecule appropriately called Substance P – the body’s pain signal. Substance P sends a pain message to the brain and also signals the body to create more inflammation – this pain-inflammation cyclical response is tough to break!

As a general rule, ice is recommended in the case of acute injury as ice helps to limit inflammation and stop the pain-inflammation-pain cycle.  Heat is not recommended for inflammation as heat actually encourages inflammation rather than control it. So when in doubt use ice!

Using ice is probably the best thing that you can do for yourself after an injury, but there are other techniques to help with inflammation that we can provide to you in the office. One of these is Graston technique. Your chiropractor can apply Graston therapy using a special technique to flush excess inflammation from an injured area.  Spinal manipulation therapy can also help control joint inflammation. When a joint’s motion is reduced, inflammation builds up in the joint, resulting in pain and tightening of the surrounding muscles. Specific joint manipulation performed by a chiropractor can impart motion to the area, allowing the joint to move and effectively “pump” the inflammation out of the joint – relief!

Heat isn’t all bad though…..

Heat can be used to relax tight muscles as it increases the extensibility of tissues.  Studies have shown that 20 minutes of moist heat application produced significantly greater muscle flexibility than static stretching (holding a stretch) for 30 seconds.  This finding indicates that when heat is applied prior to stretching we can get better results.  If you have a muscle injury, a good protocol is to apply heat for 10-20minutes, then stretch and (if needed) perform strengthening exercises followed by at least 10 minutes of ice to bring down the inflammation.  A good way to help remember when to ice and when to heat is to think of a piece of steak, if it’s frozen, you can’t stretch it, if you heat it up it will stretch a bit, so heat before stretching and ice after activity.

Warming up muscles prior to activity is important as cold exposure results in decreased muscle force production, and increased time to peak force. This means the muscle is not capable of producing as much force and takes longer to produce force so injuries can happen more easily!  Remember this when enjoying activities outdoors this winter and warm-up before vigorous activity.


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