Heat it or ice it: When should you do which?

Easy right? Well, apparently not! And if I am honest, it isn't difficult to see why with people giving conflicting advice. In order for us to understand, when to use which, let's started at looking at the one effect both have on the human body in a direct manner:

Heat Heat enlarges our blood vessels or vasodilates. This means that the vessels are widened and therefore more blood can be passed through that vessel at that given time.

Cold Cold shrinks our blood vessels or vasoconstricts. This means that the vessels get narrower and therefore less blood can be passed through that vessel at that given time. It also helps to reduce swelling. Let's bear in mind another process, The healing process.

Whenever the body comes under any type of injury, the body will go The Healing Process. There are effectively four stages:

1. Bleeding

Fairly self explanatory. Depending on the type of injury, this can last a few days or not at all. This could be an open wound or a bruise.

2. Inflammation

Again, fairly self-explanatory. IE: Swelling happens around the trauma site, usually quite quickly once the bleeding has stopped. Depending on the trauma type, can be several days in length or not at all!! The area is usually quite puffy.

3. Proliferation

Probably not a self-explanatory phase. This is probably what most people would understand as the actually healing process. Whereby the trauma site is repaired over many weeks, depending on the trauma. This is the longest phase in the process. Imagine a fractured bone healing or a torn muscle re-knitting together.

4. Remodeling

The final stage is effectively, polishing up stage 3. In stage 3, only temporary collagen is laid down, to allow us to get on with our daily lives as quickly as possible, but in the remodeling stage, the body lays down stronger, more pliable collagen to make like new. This can take months, into years. Imagine the fractured bone now becoming as good as new or the muscle being completely healed.

It is quite apparent why this is important when we think about when to use hot or cold in the healing process, knowing what effect it has on our blood vessels. Heat increases them, cold shrinks them. Therefore you would not be alone if you read that and thought:

"Ice in the early stages, then move onto heat" However!! Stage 2, the inflammation stage is an essential part of the healing process. It needs to happen. You might have read the above and thought, I would put ice on in the early part of an injury, because it reduces blood flow and helps reduce swelling. One thing I missed out above was, heat can help reduce swelling too! But, our body swells for a reason!

And this is where sometimes the confusion lies. People tend to treat the time-frame and not necessarily the injury. Not always when we feel pain, have we actually damaged something. A tight, over-active muscle isn't damaged. It's tight! So why would you put ice on it just because it is an acute (new) injury? Has it swollen? Has it bruised?

I always use the analogy of ice cream! Ice cream can be either hard or soft, depending on what temperature you have it at. If you took an ice cream out into the summers sunshine, it would melt and get softer. If you took that ice cream tub and put it back into the freezer, then it would go hard again!

If your injury looks, what I call "angry" IE: Swollen, bruised, maybe signs of infection, then put ice on it. If it hasn't got signs of that, then put a source of heat on it. We're warm blooded after all, so it feels nicer to us. We respond better to heat.

Heat can ease aching joints, improve tissue elasticity, act as a great pain relief, reduce muscle spasms, reduce oedema and of course, increase blood flow.

More often than not, any pain is caused from an over-active or tight muscle and therefore needs heat and stretching. If there is a significant mechanism of injury, then we should be thinking about putting ice on it. Don't treat the time frame, treat the injury. As always, if you are still unsure, always seek advice from a clinician who has the skills and the knowledge to advise you appropriately.