Is it Better to Use Ice or Heat?

It never seems to be clear whether or not to put ice on an injury or to put heat on an injury, so does it even matter? Is one better than the other? The answer to both of these questions is YES! The following two scenarios will illustrate which one is best to use and why.

SCENARIO #1: A runner who normally runs on very flat even surfaces decided to run outdoors on a bumpy gravel road. While running he steps in a little pothole and falls. He gets up, but his ankle is now throbbing and he has to hobble his way home. He goes to get x-rays and nothing is broken, but the doctor said he sprained his ankle. For an ankle sprain should he ice it or put heat on it?

ANSWER: In this case, he should put ice on his ankle. This is a prime example of what is called an acute injury. An acute injury is an injury that takes place due to a specific event. There was no build up to an ankle sprain since previously there was no pain nor complaints. So acute means it happens fast usually due to an accident, such as stepping in a pothole.

So why should he use ice? Ice causes vasoconstriction of the blood vessels, which means that the blood vessels shrink in diameter. It is beneficial to have narrow blood vessels after suffering an acute injury to prevent inflammation and swelling from settling into the area. The coldness also “numbs” the nerves in the area, which slows down the nerve signals that are telling him that his ankle hurts, which will give him some relief. In addition to icing after an acute injury it is important to remember the mnemonic R.I.C.E. for remembering how to treat an acute injury. R stands for rest, which is needed after an acute injury to help with the healing process. I stands for ice, C stands for compression (wrapping the ankle), and E stands for elevation of the foot. ICE all work together to reduce the pain, inflammation, and swelling in the area-too much swelling causes compression on the nerves making the injury more painful and slows down the healing process.

SCENARIO #2: A runner who has been running practically their entire life is suffering from an achy and nagging knee pain. However, this knee pain has been a problem for years. This is an example of a chronic injury. Chronic injuries are most commonly due to overuse and usually present with an achy or nagging type of pain. Should this chronic injury be iced or have heat applied?

ANSWER: For a chronic injury, heat needs to be applied to the aching site. Heat allows for vasodilation of the blood vessels, which will increase the diameter of the blood vessels allowing for increased blood flow to the area. Increased blood flow to the area will allow for healing. However, in the case of an acute injury, increased blood flow would be detrimental since it would be contributing to the swelling. Swelling is not present in chronic injuries. Heat is beneficial before exercising because the warmth will relax the muscles and decrease the stiffness allowing the joints and muscles to move more freely. 

Hopefully these two scenarios have illustrated when it is appropriate to use ice and heat, since these two have different effects and benefits.

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