Dr. Scott Schreiber is the only certified rehabilitation specialist and Double certified Chiropractic Physician in the state of Delaware, and while many people claim to be passionate about what they do and helping others, they can’t hold a candle to Dr. Schreiber. He has dedicated his professional life to advancing the fields of nutrition, chiropractic and rehabilitation while also maintaining a very close one on one relationship with each and everyone of his patients; designing personal action plans to help them become their healthiest selves. You can learn more about him here.
Heat or Ice
Many of my patients often ask whether to use heat or ice after an injury. Many have their own ideas or recommendations from others; however the science regarding ice and heat has remained the same. So which one should YOU use? Of course, the answer is not black and white. It all depends on what stage of healing your body is in.
The three stages of healing
The initial stage of healing is the inflammatory phase, followed by repair and remodeling. During the inflammatory phase, the first last 3-5 days following an injury, you may have swelling, redness, and heat coming from the site of injury. During this stage, specialized cells, called fibroblasts, begin laying down connective tissue to seal off the area from additional fluid or infections. This is very similar to a scab. During this phase, ice should be applied to reduce the amount of inflammation, so that the fibroblast can do their job effectively. Ice reduces inflammation by constricting surrounding capillaries. It should be included in addition to rest, compression, and elevation (RICE).
Are all ice applications the same?
Anything that will reduce temperature will have the same effect as ice, however, standard applications include ice cubes, gel packs, or even frozen peas. These all can be used to achieve the same effect; however other chemical compounds, such as dry ice or cooling sprays, such as those used to remove warts should not be used.
Ice should be used for no longer than 20 minutes and allow 30 minutes between each application. During the ice application, you should feel, in this order, cold, burning, aching, and numbness. You can use it as much as you feel you need during the first seventy-two hours after an injury, but for no more than twenty minutes per application window. The reason is that after twenty minutes the body will dilate the capillaries as a response to the cold temperature. When this happens more blood and inflammation enter the area that you are trying to control. I have had patients fall asleep or lay on ice for extended periods and they are in more pain than when they started due to the increased level of inflammation. In addition, doing this will prolong recovery time.
What about Heat?
Heat can be applied during the repair and remodeling phase of injury. It can be used from seventy two hours after an injury until healing is complete. When using heat, make sure that you allow enough towels or blankets between your skin and the heating element to prevent burns. I have seen many patients that leave it on for hours close to the skin and end up with second degree burns. The rule for heat is the same as ice, apply for twenty minutes and take off for thirty. Any more time after twenty minutes will result in increased inflammation. Never use heat initially regardless of how good it feels. There have been several studies showing that if heat is applied before ice, injury recovery is lengthened. In traditional rehabilitation settings, moist heat is used. It can be applied to any area of the body as long as patients can tolerate. In addition, modalities such as infrared, diathermy, and ultrasound are forms of heat therapy. There is very little evidence showing one form is better than the other, or if one method gets to deeper tissue. Also, there is little evidence showing that heat as any therapeutic effect after 6-8 weeks after the initial injury.
What about contrast baths?
Contrast baths are submerging a body part in alternating hot and cold water. The theory suggests that heat will dilate the blood vessels, followed by vasoconstriction brought on by the cold. In addition, lymph vessels also respond to temperature changes. Contrast baths may help facilitate the movement of lymph since the lymphatic system lacks a central pump. Contrast baths gained popularity in the 1990’s however there has not been sufficient evidence to say that they are superior to ice or heat. In fact, there is not much evidence stating that is does anything rather than change skin temperature.
What about topical applications?
Topical applications have their own place in pain management and inflammation. They may contain ingredients that appear to heat or cool the skin, but do not actually change skin temperature or promote or reduce inflammation or blood flow by the same mechanisms. They mitigate pain via separate mechanisms, which can be very helpful.
So Doc, what should I do?
Simply put ice for the first 3-5 days, followed by heat. If you have a flare up of a previous injury with signs of inflammation, treat it as a new injury and begin with ice followed by heat.