Solving the Mystery of Heat vs Ice

"Should I use heat or ice"? This is a question that I get asked almost daily. It’s no surprise that there is confusion when you hear different answers from different sources. Hopefully the following sentences will aide to alleviate some of the confusion. Not long ago Dr. Mirkin who created the acronym so widely utilized, “R.I.C.E. (rest, ice, compress, and elevate)”, recanted his position and in its place provided some good suggestions. You can read his brief article here (RICE). He revised statement proclaims that anything reducing inflammation does not help healing but actually HINDERS healing. This includes the use of popular treatments such as ice, NSAIDs, or Ibuprofen. It is important to understand the body uses the natural process of inflammation as a protective mechanism and to ultimately heal injured areas. We are well oiled machines and these mechanisms are already designed to heal.

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Avoiding ice is one way to encourage blood flow to an injury. Another method to expedite recovery and increase blood flow is movement. I encourage my athletes to utilize an active recovery strategy versus pure rest. Passive recovery or immobilization has been found to be less helpful than active recovery post workout (here). It prevents buildup of lactate and onset of delayed onset soreness. Examples of active recovery include safe stability/ mobility exercises, light resistance biking, low impact elliptical, or an easy swim in the pool. Movement is life and promotion of blood flow is the key.

Now that I’ve discussed avoidance of ice, what about the use of heat? Heat further Increases blood flow and inflammation. This can make your injury even more uncomfortable and cause increased pain and swelling. In this case, additional heat on top of an inflammatory process is excessive. Active movement as above helps to flush the inflammation.

I’ve also received questions about heat or ice for post workout recovery (independent of injury). Studies have found that heat is not good for recovery. It is not helpful to prevent delayed onset muscle soreness as shown in the study linked here (DOMS). This may surprise you and switch your mindset. Don’t reach for a heating pad first after a heavy workout.

Lastly, contrast therapy has been a popular treatment and recovery method. Contrast therapy uses alternating cold and warm agents. Blood constriction is temporary and once the ice is removed the vessels dilate. In a nutshell, this vasoconstriction followed by vasodilation flushes good cells in and bad cells out promoting healing and recovery. Contrast therapy has been proven helpful in this study for runners (here). It aides recovery when applied in an alternating fashion for periods of 6 minutes. Practically, I recommend to my patients icing no more than 10 minutes to reduce pain and aide recovery after a difficult workout or with an injury. Then as the area reheats and movement occurs the area will be allowed adequate blood flow for healing. There is no need to ice for periods of 20 minutes or longer.





Kristin Sykes, DPT