To Heat or To Ice-The Verdict Is In
We have received this question quite a bit from patients, isn’t it best to ice? The answer is...it depends on the type of injury and how long after sustaining it the ice is applied.
Delayed-Onset Muscle Soreness (DOMS)
Let’s face it, we’ve all been there. Perhaps we’ve pushed it at the gym a little too hard trying to build those Arnold-like biceps, or it’s our first workout in say, possibly a year. You feel great after the workout, those endorphins are pumping, but come the following day and the day after that, you can barely put your shirt on without cringing in discomfort. That’s DOMS, also described by some as “muscle fever”. This discomfort is caused by micro-damage to the muscles, sustained during repetitive muscular contractions. The more difficult the type of contraction, i.e. eccentric, the more micro-damage will occur.
Best treatment for DOMS suggested by the latest research? HEAT, applied within 24hrs after the workout or activity for approximately 20 mins has been shown to have the best outcome.
Why? Heat increases circulation. This will allow the body to rid itself of the damaged cells and promote the influx of nutrients to the area to help it heal faster. Heat also increases the elasticity of a muscle, allowing it to relax.
Fun fact: By completing another workout a few days later, you will notice you aren’t as sore as after the initial one. This is called the “repeated-bout effect”. It is your body’s decreased response to it’s stimulus, or in this case workout.
For DOMS, think heat and a second LIGHTER workout.
Think hot baths instead of ice baths. Bubbles or candles, we’ll leave that up to you.
Acute Sprains or Strains
We’ve also likely been there.
Acute sprains or strains are injuries to the ligaments and muscles, respectively, that have occurred within the past 0-4 days. These differ from DOMS in that there is muscular damage that is no longer considered “micro”. This means there are more significant signs and symptoms upon examination other than “discomfort or soreness”.
Signs & Symptoms could include: bruising, swelling, redness, warmth, pain, decreased motion, decreased strength or functional ability, and a potential visible defect i.e. slightly inverted ankle at rest or bulge of a muscle.
Best Treatment for an Acute Sprain or Strain suggested by the latest research? ICE applied within 24 hrs of an injury over heat for 20 mins on, 1 full hour off.
Why? Ice decreases blood flow and inflammation to an area. Since the injured area already has an influx of fluid, reducing it vs. enhancing it is key. Too much fluid to the area will cause it to become stagnant, prevent the injured cells from leaving, and nutrients from being brought to the area for the healing process to take effect.
In acute injuries, you also want to delay return to activity as an early return can negate the healing that is occurring.
For an acute injury that has some or all of the above signs and symptoms, think ICE and REST.
Chronic injuries are those classified as lasting longer than 14 days. This is where things get tricky. You may be in pain, but there may not be swelling. You may have decreased ROM, but your shoulder isn’t warm. What to do? In this case, the area hasn’t healed yet and inflammation is no longer present therefore new blood flow and nutrients are required. The best way to do so would be to apply heat and promote tolerated movement of the area as well. This will help it regain strength and function. If no improvements are seen, speak to your health provider. A re-evaluation may be warranted with a change in treatment plan which can include sending you for diagnostic imaging or referring you to a specialist for consultation.
For a chronic injury, think HEAT with gradual increase in exercise or activity.
Quick tip for all injury types listed, “moist heat” or “wet ice” will help penetrate faster. Happy recovery!