Ice or heat for pain and injuries?
If you hurt your back lifting a box at home, would you automatically reach for an ice pack, or a heat pack? if you twisted your knee at the same time, would you apply the same pack there? For years the answer to both has been ice, although in Germany the tendency is to apply ice to the knee, and heat to a sore back. In the past few years it has come to light that there is very little good research(4,5) to back up any of the recommendations that have been given to date. but rather than leaving you more confused, here's what you need to know.
WHY ICE?
You do not have nerves for pain. What exists is a variety of difference nerves responding to change in circumstance, such as being stretched, pressure, temperature change and chemical imbalance. When these nerve endings are stimulated your brain integrates these signals along with environment clues to figure out whether you should have pain, and if so what sort. Ice will have the effect of dulling the output from these nerve endings, slowing down the speed of the nerve signals themselves, and so reducing the amount of information arriving in your brain. It’s been thought that limiting swelling through ice application would speed up healing, there is no proof that this is the case.
HEALING HAS THREE PHASES
ACUTE REACTION
When tissues are damaged there is an initial period of inflammation that can last up to 3 days. During this time fluids flood the injured area, the nerve endings become hyper sensitive, blood vessels dilate, and you tend to experience the most intense pain during this time. Although the joint or tissue swelling that typically occurs during this phase is part of the normal injury reaction, cooling does not speed healing, but appears to delay its start(4,6).
What seems well supported is that heat during this early phase does not help with pain relief, and may encourage excessive swelling.
If ice is applied during a sporting event, and play is immediately recommenced, there is an increased chance of further injury since the cooling reduces your body awareness for coordination(6).
If conversely you use heat on the pain, research(1) into back pain over the last 15-20 years is showing that muscle spasm associated with typical back pain, is almost always your body's natural defence mechanism to the painful injury, and is not the injury itself. So by using heat on the contracted muscle, while it may help to ease the tension in that muscle, you are actually fighting against your body's protective healing response.
But, you may be asking, isn't heat ok to use at some stage? Absolutely! The first stage of healing can last 3 days, and ice is appropriate during this stage if you need some natural pain relief. However once this phase is past heat is often recommended. Since healing is dependent on good blood supply and movement, using heat can keep the muscles more supple and reduce stiffness.
REBUILDING
The second stage of healing is when the body replaces the injured cells and tissues with fresh new ones, but this is accomplished in a rather haphazard way. This phase can last several months depending on the severity of injury, and since everyday activities can re-irritate the injury, you may experience some intermittent swelling during this and also into the third phase. Given what you’ve just read, any recurrent swelling could either just be left alone or perhaps cooled a little.
REMODELLING
The third stage of healing can last up to 12 months for serious injuries, and is when all the fresh tissue is rearranged in the correct direction, so that the repaired tissue functions like new. When this stage is not successfully completed, you can end up with scar tissue, which is typically weaker that normal tissue. Scar tissue is therefore often more prone to recurrent injury.
HOW TO USE ICE & HEAT
We recommend using either for a period of 10-15 minutes, with an hour pause, and then repeat as necessary. A damp cloth against the skin will help transmit the heating or cooling effect more than if done dry. If you cool a cell too much, it can freeze, and since water expands when it freezes the cells can burst. Also heating for too long is generally not recommended, since normal body processes function at 37,4 degrees. When the local temperature changes too much or for too long, these normal processes can be disrupted. Unless you really need either of them the research now suggests the following
CHIROPRACTIC & HEALING
So long as you are still mobile following an injury, get the joint checked for correct movement, and then use it. Research with sprained ankles supports(6) early mobilisation and movement to aide recovery. This is what we have always advocated when you have something injured, especially for the spine. Being checked by your chiropractor as soon as possible will enable your body to heal naturally, without hindrance. At the same time the chiropractic adjustments will de-stress your nervous system and maximise the potential for your body to heal as quickly as it can.
New studies(2,3) are also showing that an adjustment results in the strengthening of your immune system, a vital part of the healing process, so this is an added bonus of getting checked as quickly as possible.
REFERENCES:
1. Neil J. Manipulative therapy and immune response: A literature review of the chiropractic and osteopathic evidence. Clinical Chiropractic 2012;15(3):186.
2. Kolberg C, Horst A, Moraes MS, et al. Peripheral oxidative stress blood markers in patients with chronic back or neck pain treated with high-velocity, low-amplitude manipulation. Journal of Manipulative and Physiological Therapeutics 2014
3. Fryer, G et al. Paraspinal Muscles and Intervertebral Dysfunction. Lit. Review. JMPT 2004:27(4)
4. http://www.macleans.ca/society/the-end-of-the-ice-age/
5.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3396304/
6. Sports Med. 2012 Jan 1;42(1):69-87. Should athletes return to sport after applying ice? A systematic review…Bleakley CM1, Costello JT, Glasgow PD