Ice or heat compress for an injury? This is probably the most common questions I get asked in sports medicine. Not only is this a controversial topic between doctors and therapists around the world, but the opinions also seem to vary by country and modern research.
Most trainers, doctors and physiotherapists would agree that the common way to approach an acute injury is the famous P.R.I.C.E. therapy (Protection, Rest, Ice, Compress, Elevate). As for more chronic pains, the choice seems to be debatable. But what’s best?
The body’s natural healing response:
The body always responds to an injury with a predictable inflammatory response that includes pain, heat, swelling and redness, as the first step towards healing. The release of chemicals and the compression of nerves in the area of the injury cause pain. Swelling is the result of the increased movement of fluid and white blood cells into the area of inflammation letting your immune system know to bring extra attention to the injury. The pain and swelling can keep the athlete from using the injured part, serving to protect it from further injury. Redness and heat are caused by increased blood flow. Your body’s only desire at this point is to rest and recover.
A TCM perspective:
In Traditional Chinese Medicine (TCM), we view any sort of physical pain as a blockage, a stasis of Qi (energy) and blood to an area. This excess blockage of Qi and blood can be caused by an external trauma to a specific area such as a sport injury, a fall, or an accident. There’s also chronic pain due to poor circulation occurring from conditions caused by a deficiency of Qi & Blood or even Cold stagnation. This long term pain (over 6 months) can be felt in overuse of tendons, ligaments, joints and even bone such as in tendinitis or backaches.
So let’s go back to our initial question of the topical application of Heat or Cold for an injury.
Ice will definitely reduce the swelling, inflammation and pain for a certain amount of time but is this the right strategy? Cold physiologically causes dilation of the more profound arterial system, bringing fresh oxygenated blood to the injury and superficial vasoconstriction, which has an anti-inflammatory and analgesic effect. Although this might feel good after injuring yourself, this turns off your body’s natural healing response thus putting the healing on hold. Putting topical cold compress to the affected area for an extended amount of time delays the deep down healing that needs to happen for a full recovery. This also gives your body a false sense of health and you might go back into action too soon, resulting in chronic nagging injuries or all too often arthritis later in life.
The physiological effects of heat therapy on the other hand, augments your body's healing response. Increasing tissue temperature, just like your body’s natural response to an injury, stimulates vasodilation and increases blood flow which promotes healing by increasing the supply of nutrients and oxygen to the site of the injury. Although this seems counter intuitive to what we’ve been told to do, you should put heat immediately on the site of injury to increase blood flow and tissue repair. Although heat may increase symptoms such as light throbbing, swelling and redness at the beginning, rest assured this temporary discomfort will actually speed up the healing process and allow the area of injury to heal up much better and faster in the long run. Heat usually feels soothing right away on an injury, just how a hot shower makes your whole body feel good.
Turn up the heat with treatments:
Today in a Traditional Chinese Medicine (TCM) clinic, we use acupuncture & moxabustion along with infrared TDP lamps to help increase the flow of Qi and Blood and relieve pain. We use a combination of warm blood moving herbs, such as turmeric and ginger, taken as an internal herbal remedy tea to remove stagnation & relieve pain. There’s also topical ointments and medicated plaster like my favorite Zheng Gu Shui ointment also created with warm blood moving herbs. All these common warm treatment therapies used in TCM significantly helps accelerates the healing process from acute to chronic injuries.
In my experience, when my patients start putting heat on their injuries, their pain is reduced significantly and they recover much faster. If thousands of years of empirical evidence of Traditional Chinese Medicine is not enough to convince you then try it for yourself. It’s OK (but not ideal) to put cold for the first few hours to relieve the immediate swelling and pain if it feels good but then switch to heat to rev-up the healing.
My favorite heat therapy is the electric plug-in heat pad which produces dry-heat. You can easily find one at any drug store and control the heat output with the different settings. They usually go for $25-$40 and will last many years. They are also very practical for menstrual pains, sore back, stomachache or any other physical pain. Use it for about 20-30 minutes a 3-5 times a day on the affected area where the skin should turn warm and pink.
I’m definitely a try it to believe it type of person and I really wish I knew this earlier on in my snowboard career as it would've saved me a lot of unnecessary lingering pain and faster healing time.
Listen to your inner doctor, your body’s wisdom always knows what is best for you.
Dr. Dominique Vallée, TCM, R.Ac