Ice or heat?
For what seems like centuries people have been using the acronym RICE. Like when Neanderthals would roll their ankles running after (or from) prey they would get their hands on some glacier ice, prop their foot up for a week, and just watch the inflammation melt away (pun intended). If somehow you have been able to avoid this acronym, RICE stands for Rest Ice Compression Elevation. So, when you’re injured you should not do anything, freeze it, throw on an ACE bandage, and get that area above your heart. Fortunately for all of us, science has started to change this paradigm.
Even when I was learning this in school it didn’t make sense. Doesn’t the lymphatic system clear inflammation in the body? Doesn’t the circulatory system bring cells to help heal damaged tissue? Don’t the lymphatic and circulatory systems constrict when it’s cold? Doesn’t inactivity cause loss of motor control? Isn’t inflammation just a sign that things are healing? We were taught all these things in school BUT we were also taught RICE. It didn’t make sense. However, I only have problems with half of the concept of RICE, not the whole thing. My issues arise with the rest and ice.
First off, is inflammation bad? Inflammation is actually the byproduct of immune system cells trying to heal something like a torn tendon. When something like a muscle or tendon tears, the ends of the tissue release markers into the blood that trigger an immune system response. The cells that show up to repair and remodel the tissue (via the circulatory system) consume parts of the damaged tissue and as a byproduct, produce inflammation. This inflammation helps to cushion the area, (we often call it swelling) providing some protection, but it also carries away the waste from the repair.
Inflammation is not typically the culprit causing the area to hurt. This is because as tendons, muscles, bones, or ligaments get damaged, the nerves that run through them tear and you have exposed nerve endings. Only if there is an extraordinary amount of swelling and it is limiting the amount you can move, or it is putting pressure on the nerves and exposed nerve endings will inflammation actually be the cause of the pain.
So why not ice?
The body’s response to ice is constriction of blood vessels, basically stopping or slowing blood flow in the areas of exposure. Why would you want to stop or slow the process of delivering healer cells to an injured area if it is going to help? On the other end of the process, the lymphatic system (which is a passive system relying on the pump provided by muscles to move lymphatic fluid through the system) will also constrict with exposure to decreasing temperatures, basically locking in inflammation. It is the lymphatic system’s responsibility to clear the waste created by the healing process. Once the circulatory and lymph tissue are constricted, it is like standing on both ends of a hose and wondering why new water can’t get in and old water cannot get out.
Yes, you want some inflammation present and you want that inflammation to clear once it’s done its job. This can be done by keeping the circulatory and lymphatic systems around the area free and open. This is easier accomplished by heat which causes vessel dilation. But there’s something even better than heat. Because it is argued that heat does not penetrate deep enough to actually cause dilation as deep as it may need to, say in the case of a deep hamstring tear; something better is needed. The answer you are looking for is….
MOVEMENT. Yes, the opposite of rest. Remember the lymphatic system is passive, relying on muscle pumps and gravity to move the fluid through the system. But Dr. Mike my ankle fricken hurts after I sprained it, I do not want to move it. Relax my friend, the movement does not need to occur directly at the joint or area that hurts. In this case of the all too common ankle sprain, you would produce isometric contractions of the calf to use the muscle pump (see no movement at the joint), and then some isotonic contractions of the quad and hamstring (movement at adjacent joints) to really get the fluid moving up to the lymph nodes and ultimately to the kidneys to be peed out (don’t ask how this happens, this will turn into a novel).
So what’s ice good for besides cooling down your tequila?
Ice, or cryotherapy, is very effective at decreasing the rate at which nerves send sensory signals to the brain. Think of it this way. We know that pain is an OUTPUT of the brain, created in there after it has received information from the sensory systems and determined that it either wants you to stop what you are doing, or change what you are doing. So ice can slow or dull the rate at which the sensory signal gets to the brain. It’s like eating ice cream. If you eat a big cup of ice cream, the taste (output) will become more dull as you eat more. This is because the sensory nerves on your tongue, or “taste buds” have gotten cold and their firing rate has decreased. If an area is hurting, but there is no swelling, it would be wise to use ice. It can be good for dulling or numbing pain when inflammation is not present or needed such as delayed onset muscle soreness or chronic pain. But usually I tell my patients not to use ice if there is ever any doubt (see paragraphs above).
- Inflammation is needed.
- Inflammation is a byproduct of the healing process.
- Ice prevents/slows the clearance of inflammation.
- Heat opens up circulatory and lymphatic vessels.
- Movement causes muscle pumps which move lymphatic fluid through the system.
- Elevation and compression will also assist in keeping inflammation under control by assisting in lymphatic return and preventing inflammatory build up at the injury.
- If you are injured and there is swelling, use CHEM.
- If you hurt but there is no swelling, use MICE
Obviously there are exceptions to every rule, including different types of arthritis and/or fractures. The information included in this is not intended to treat or diagnose any medical condition, and if you have been injured or are in pain, we urge you to seek a licensed medical professional.