Ice Ice Maybe?

Before I get into this, I need to clear up two things.

1. When I use the term 'Ice' or say, 'use ice' I am of course ONLY referring to frozen water. Whatever you do, DO NOT take those terms out of context.

2. let's just get it out of the way:

An obvious yet somehow necessary gag to put at the top of a discussion on anti-inflammatory protocol

There, now that this blog has a soundtrack, we can get started. 

Should I use ice or heat?

As Chiropractors, we get asked this a lot. There appears to be a lot of confusion out there about what you should use, when and why, and that confusion is not just limited to the general public! 

There is a lot of debate and conflicting info about ice vs. heat amongst different health care professions and even between practitioners within the SAME profession, so it is little wonder that when people are injured, they aren't sure what to try. 

In this post I will attempt to explain a bit of the ins and outs of the issue, as well as some of the  the common sticking points in the discussion and ultimately, try to give a summary of the basic approach you could try, based on the best and most current research I am able to get my hands on. 

So, if you are the type of person who just wants to get a few tips WITHOUT having to go through the rest of it (and to be honest, I don't blame you if you do), then please feel free to skip down to the bottom of this post where I will summarise the main info in bullet point form. 

However, if you're like me and you're kind of into the back ground of things, then please read on. 

So why would I use ice or heat anyway?

Full disclosure...this will not be an exhaustive explanation of how inflammation works because that would be WAY too much info to put in this blog and to be honest I really couldn't do the topic justice with my explanation anyway (however, if you would really like to geek out and marvel at just how incredible the human body is, and get a much more complete picture of what is happening at a cellular level in detail, I suggest you check out a video called "Basic Inflammatory Response". Be warned though, videos like this are only the start of a fascinating rabbit warren so be sure to have a clear afternoon for all the other info you'll want to follow it up with).

To EXTREMELY oversimplify the situation: 

1. You injure yourself
2. Your body detects the injury
3. Chemical signals are released to signal to your body to begin healing and cleaning the injury up.
4. The chemicals also cause more healing factors in your blood to come to the area/slow down in the blood stream at the site of injury and help to clean up/heal
5. The resulting 'inflammatory Soup' causes redness, swelling and alterations of movement at the affected site as well as activation of nerves that carry information about the damage to your brain where it is registered as being painful.

As stated above, this is a very simplified version of events that skips many steps in the process but I feel gives you an idea of the situation. 

The most important take home message though? The body is very smart and so it does all this to HELP you, so we want to allow healing to occur as much as possible without hindering the healing process too much.

The reason then that we employ heat or ice is to limit the levels of swelling and discomfort you have to experience, while allowing all these steps to occur and let you live your life while your body gets on with the task at hand. The cooling or heating of tissues is used to constrict or dilate blood vessels in order to modulate the inflammation to inhibit or help the healing factors to arrive at and move on from the site of injury.

Heat and ice have the added bonus of having relatively few side effects compared to their pharmaceutical counterparts, something I find clients are generally very keen to avoid having to take where possible.

Kieran, you haven't answered the question yet, do I use heat or ice? 

That depends on the injury. 

Generally speaking, we use ice for acute injuries (i.e. injury that has only occurred in roughly the last 48 hours) and heat for more chronic injuries (i.e injuries arising more than 2 weeks ago). 

In yet another simplification, we use different modalities because in the early stages of injury, the inflammatory soup is different to one that has been around for a longer period of time. In the gap between 2 days and 2 weeks, you can use ice or heat, or ice AND heat. 

You can however have a chronic injury that you exacerbate, in which case you might need to act like its a new injury and switch back from heat to using ice on it again. 

By now I am sure you can see why so many people can become confused as to what they should do. Don't worry, Ill still give that summary below. 

Does it matter where the injury is? 

No, that shouldn't be a factor.

In the past, some health professions have prescribed ice for acute inflammation for everywhere on the body EXCEPT the spine. For some reason they appeared to have forgotten that the spine is made up of joints, ligaments, tensions, muscles, blood vessels that have the same characteristics as other areas of the body. 

So, in cases of acute injury and pain in the neck and/or back, you should still use ice like you would on a knee. 

Some important points to remember...

As I have said, this is not an exhaustive discussion of this topic, and there is still a lot of argument among researches and practitioners as to the best practice for ice or heat (just type ice vs heat into Google and you'll get a sense of what I am talking about) I am just attempting to summarise what I have discovered from the best sources of research information I can find, as well as my experience with clients with acute and chronic injury in practice. 

Other important points to remember are:

• It appears that crushed ice in a bag is more effective than traditional cooling packs
• Do not return to activity immediately after using ice
• Don't use ice for more than 20 minutes of constant contact/ 
• If you have any questions or concerns about your injury, contact your health practitioner immediately.
• If either of the approaches make you feel worse, stop using them immediately and contact us to discuss your options. 

In Summary:

• Ice for acute injury (roughly under 48 hours old).
• Use ice for 10 minutes on, 10 minutes off, repeat as often as you like.
• Heat for more chronic issues (especially for injuries over 2 weeks old)
• You can alternate heat and ice for 10 minutes of one, 10 minutes of the other 
• There is no hard and fast rule, these are tools designed to make you more comfortable so let your body be your guide. 
• I would still recommend avoiding heat for acute inflammation.
• Do not just put up with pain or even just hope for the best with an injury, the earlier you act the better your prognosis. 
• Call us at Align to have a chat about your injury and discuss how to get back on track. 

If you're the type of person who would like to know where the information I have talked about here came from, please feel free to contact me at the practice at any stage and I will send you through the details of the research articles I have used, 

I will be keeping my eye out for newer, more definitive research and promise to update this post if anything new comes to light.

If you have any other questions or concerns, please do not hesitate to get in contact. 

Kieran