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Heat vs Ice?

Should I use ice or a question I'm frequently asked in clinic and many are usually surprised when I suggest heat! This is a question I am sure is posed to nearly all Sports Massage Therapists.

First of all lets understand the definition of pain. Simple isn't it? Something that hurts a lot or a little? The International Association for the Study of Pain have a new definition of pain:

An aversive sensory and emotional experience typically caused by, or resembling that caused by, actual or potential tissue injury. Sounds complex because the management of pain is complex

Pain Science or pain management is big news because of the opioid epidemic, we have a better understanding that pain killers are addictive and often don't work in the long term.

Pain is usually described as either Acute or Chronic Pain. Acute pain refers to short term pain and lasts no longer than 10-12wks; spraining your ankle,or post surgery are good examples. Chronic or persistent pain is defined as long term, pain that is experienced despite the use of medication or treatment and/or sometimes there isn't an a clear reason as to why someone is experiencing chronic pain. Some forward thinking institutions are now suggesting that pain is much more complex and is made up of social, physical and psychological factors called the biopsychosocial model and this is a subject for another blog!

So you are in pain and you've been told to use Ice to ease it. R.I.C.E. became P.R.I.C.E - 'Rest Ice Compression' and 'Elevation or Protection Rest Ice Compression and Elevation' are pain management protocols created by Dr Gabe Mirkin in 1978. He wrote a book called Sportsmedicine Book and this became so popular that organisations such as the NHS recommend this protocol. However in 2015 Dr Mirkin reviewed the protocol in light of recent pain research and now recommends the use of heat as a alternative to ice for pain management, particularly chronic pain. Kind of makes sense doesn't it....heat feels not so good!

Ice is really good if you are in so much pain that you can't move, because ice is great becuase its a natural pain killer, it numbs the area and reduces the inflammation. BUT to heal you need heat, you need the inflammation in the affected area because this speeds up the healing process.

Dr Mirkin writes The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1. Ice delays the healing process and impacts strength and performance.

The next question I'm frequently ask is 'why do footballers or athletes take ice baths' and the BBC have an interesting response to this 'Ice baths might be useful for a quick recovery between events during a competition, but not if you want muscles to get stronger in the long-term'.

There are supporters of using ice as a method to reduce inflammation such as the Wim Hof Method, I've not tried it so cannot recommend it from personal experience but what I can say is there isn't enough science and therefore evidence to support the use of ice in pain management.

So my answer is always the same if you feel you gain some benefit from using ice particularly if you have recently experienced an injury then by all means use ice, it does provide short term pain relief. For long term pain relief I suggest using a hot water bottle, wheat bag that you can warm, a warm towel or hot bath all will ease pain and discomfort. Once the pain has eased and its safe to do so, gentle exercises will help to ease the pain.

There are many methods to reduce chronic or persistent pain; these include breathing techniques, exercise/strength building, myofascial release, deep tissue massage, stress management, osteopathic manipulation, trigger point therapy, EMMETT Technique and relaxation techniques. If any of these are of interest to you please email me at to discuss or you can book an appointment at Complete Balance

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