Ice vs Heat: Should I Use Ice or Heat for Musculoskeletal Injuries?

At Brunswick Chiropractic, one of the most common questions we hear is, 'Should I use ice or heat for my pain?' Whether you've tweaked your back during gardening, woken up with a stiff neck, or pulled a muscle during sports, knowing whether to reach for the ice pack or heat pad can make a significant difference in your recovery.

The Science of Temperature Therapy: A Two-Part Guide

There's so much valuable information to share about temperature therapy that we've decided to split this topic into two comprehensive guides.

In this first blog, we've explored the science behind ice therapy, when to use it, and how it helps control inflammation in those crucial first hours after injury. Stay tuned for next week's blog, where we'll dive into the warming world of heat therapy - including its benefits for chronic conditions, how it enhances muscle recovery, and when it might be your better treatment choice.

Understanding Ice Therapy: Your Guide to Cold Treatment

When you've just injured yourself, one of the first questions that comes to mind that musculoskeletal healthcare professionals get asked is often 'Should I use ice?' 

Heat and ice both have important roles to play, but they have vastly different effects, and times for application.

Should I use Ice or Heat for musculoskeletal injuries?

Let’s start by looking at ice:

Ice therapy (also called cold therapy, or cryotherapy) is best used immediately after an injury has occurred to help control inflammation. It is best suited to soft-tissue injuries such as sprains (joints), strains (muscles and tendons), and swelling.

Ice therapy works as your body's natural 'pause button' after an injury. Decreasing blood flow to the site of injury lowers the temperature of the tissues, lowering the metabolic demands of the cells.

It achieves this by:

  • temporarily reducing the activity of sensory nerves called nociceptors. Your brain perceives signals from nociceptors as pain. The result is pain relief
  • reducing muscle spasm
  • causing vasoconstriction of arterioles and capillaries, which reduces fluid buildup that leads to swelling
  • reducing the immune response by reducing the number of leukocytes, granulocytes and macrophages that migrate into the area of injury

Ice therapy works as your body's natural 'pause button' after an injury.

What does the research say about the use of ice therapy?

  1. It can control excessive swelling of acute musculoskeletal injuries, such as sprains, strains and contusions within the first 6—12 hours post-injury
  2. Ice therapy can provide some relief for migraine headaches when applied to the head and neck
  3. It can assist with acute rheumatologic flare-ups, such as gout
  4. It can assist post-operatively after total knee replacement. It can provide effective pain relief without the side effects or risks associated with opioid medications

Can control excessive swelling of acute musculoskeletal injuries

From RICE to P.E.A.C.E.: The Evolution of Injury Care

Many of us have heard of the R.I.C.E. acronym (Rest, Ice, Compression, and Elevation). This was created by Dr Gabe Mirkin in 1978.

RICE is still taught in many first aid courses to this day, but science now tells us that this is outdated and that the application of ice after 12 hours post-injury is likely to slow recovery and increase scar tissue formation. 

Current recommendations are not to prevent inflammation but to regulate and control it to assist with recovery. The RICE acronym is no longer used — the evidence now supports P.E.A.C.E. and L.O.V.E.

  • Protect the area immediately following injury
  • Elevate the injured area, above the level of the heart if possible, to reduce swelling
  • Avoid anti-inflammatory medications (they have been found to significantly slow recovery, not speed recovery)
  • Compression of the site to control swelling
  • Education about the injury and recovery process

… and…

P.E.A.C.E

L.O.V.E.: The Active Approach to Recovery

  • Loading of the injury.
    RICE dictated rest, but controlled loading and use of the injured area speeds recovery. It is very important to seek advice from a musculoskeletal healthcare professional who will determine which exercises are safe and helpful, and which ones may cause more injury.
    This process is divided into stages that you will progress through to increase the range of motion of the injured part, improve proprioception (your brain’s accurate awareness of the position and movement of the injured site which helps prevent re-injury), strengthening of stabiliser and primary movement muscles, improve power, and finally rehabilitation of sport-specific skills
  • Optimism —injuries can affect you psychologically and emotionally, especially if recovery is likely to be a slow process. We now know that depressive symptoms can actually delay recovery
  • Vascularisation — by loading the tissues through rehabilitation and assisting healing, the injured tissues will improve their vascular supply
  • Exercises are important after loading of the injured area. Exercises aim to re-incorporate the injured tissues back into whole-body activity

L.O.V.E

Are there any contraindications to using ice?

Avoid ice therapy if you have:

  • Impaired circulation
  • Raynaud’s disease
  • Cryoglobulinaemia (blood contains cold sensitive antibodies)
  • Haemoglobinuria (losing blood in urine)
  • Peripheral vascular disease
  • Hypersensitivity to cold
  • Cold urticaria (itchiness in response to cold)
  • Complex Regional Pain Syndrome (CRPS)
  • Skin anaesthesia (inability to sense the effect of ice application)
  • Regenerating nerves, open wounds or burns (may worsen tissue damage)

When to avoid ice

Safe Application Tips

Some important points to remember with ice therapy:

Inflammation is not a bad thing. It is the necessary first step in your body’s healing process. We don’t want to stop inflammation, we just want to keep it under control. An over-exuberant inflammatory response is what causes problems, such as excessive tissue damage and delayed recovery.

NEVER apply ice directly to your skin. This can actually kill your cells. Wrap the ice or ice pack in a t-shirt, tea towel or similar. Regularly check your skin and limit the application to 20 minutes maximum.

Use Ice safely

Understanding When and How to Ice: Your First Step in Recovery

While ice therapy can be a valuable tool in your immediate injury recovery toolkit, it's crucial to remember that timing and proper application are key. The evolution from RICE to P.E.A.C.E. and L.O.V.E. protocols shows us that managing injuries requires a comprehensive, evidence-based approach. If you're unsure about using ice therapy for your specific condition, our experienced team at Brunswick Chiropractic is here to guide you through your recovery journey.

Stay tuned for next week's blog, where we'll explore the warming world of heat therapy - including when it's most effective, how to apply it safely, and why it might be the better choice for your particular condition. Understanding both ice and heat therapy will empower you to make informed decisions about your recovery and overall wellbeing.

Use Ice in an evidenced approach

Need personalized advice about your injury management? Contact our friendly team at (03) 9388 1233 to book an appointment with one of our experienced practitioners.

Dr Gerard Keown

Dr Gerard Keown started practice in 1997 as a remedial massage therapist and went on to complete his Bachelor of Health Science as a Naturopath in 2003, before finally completing a Masters Degree in Chiropractic at Macquarie University in 2010. He also has a special interest in headaches and neck pain.