Before a good answer can be given we must first understand what inflammation is and how it works with the body.
A basic definition of inflammation is the appearance of Heat, Redness, Swelling and Pain in and around an area of the body.
Inflammation is our body's response to disease, illness, infection or trauma. It is part of the body's immune system's first line of defense. When the body detects a foreign invader/substance or trauma it begins a chemical reaction. The resulting substances from the White Blood Cells are rushed to the site through an increase in blood flow. This increase in blood flow is seen and felt as heat and redness. Due to the rapid increase of the volume of immune substances in one area fluid can leak into the surrounding spaces which is then noted as swelling. The expansion of tissue and the response to this tension on the surrounding tissue can activate local nerves to transmit a pain response. As long as this event is short term/acute the process is reparative. In the short term inflammation helps an injured area by increasing oxygen, proteins and other nutrients, destroying pathogens and toxins, and delivering repair materials and molecules.
In general there are 3 phases of healing. Inflammation which can take between 1-3 days. Then Proliferation occurs which is the process of repair and requires a sufficient and proper supply of oxygen, nutrients and fibroblast. Finally is the Maturation phase which happens once the surface of the wound is closed.
The immediate response in the inflammatory phase is a contraction of the damaged area's blood vessels to prevent an excessive amount of blood loss. When the area switches to active inflammation the blood vessels dilate. Vessel dilation helps to increase the flow of blood and increase the level of oxygen and nutrients.
However, if inflammation goes on past 3 days it then is considered chronic and could then become damaging to the process of healing. The key factors in an area remaining in a state of healthy repair vs unhealthy is the degree and duration of blood vessel dilation, degree of permeability of blood vessels to properly regulate the amount and type of fluid, proteins, leukocytes into the healing area. For a healthy repair response blood vessel dilation should begin within 30 mins after the initial constriction of the blood vessels and the closure of the wound.
The main factor when determining when to use ice vs heat comes from the timing of the area requiring the blood vessels to be in a state of constriction vs dilation. If the blood vessels remain constricted for too long then the delivery of oxygen, nutrients and fibroblast is delayed and healing is thus delayed. However, blood vessels constriction does reduce or eliminate the experience of pain by inhibiting the communication of nerve impulses in the affected area. Sometimes it is necessary to initially inhibit the transmission of pain in order for the brain to allow the person to begin to calm down and thus direct the energy toward repair rather than defense.
For many years the Gold Standard was set by Dr. Gabe Mirkin who developed the concept of RICE= Rest, Ice, Compression and Elevation. Due to the surfacing of new research Dr.Mirkin has now begun to alter his stance on ice. The key factor in the change came with the discovery that the macrophases (part of the immune cascade) produce as substance called Insulin-like Growth Factor (IGF-1) which is the determining hormone for healing. The presence of this factor is required for both wound healing and muscle/soft tissue damage.
When discussing soft tissue or muscle issues/damage, I believe we must now be considering whether the area is experiencing fascial dehydration rather than blood vessel damage or fiber damage. We would start by learning if there was a direct incident of trauma i.e. cut, hit or fall that could have resulted in broken bones or damaged tissue. With a lack of contact trauma we then ask for an indication of tissue damage such as sign of broken blood vessels, bruising, redness, swelling or heat. If none of those signs and symptoms are reported but rather the person speaks of being unable to pin point the pain, there being a sensation of burning or pulling or a sharp stabbing pain that comes and goes and if these symptoms come following a minor task such as bending over to pick up a towel, repetitive motion tasks or after extreme exercise then we more then likely are dealing with a circumstance of fascial dehydration.
Ice is a tricky substance to use when treating the body because just like inflammation or any other beneficial thing too much of a good thing can lead to trouble. Ice is also tricky when used on an area which has signs of inflammation because the indications ice has been left on an area too long is redness, swelling, tingling and pain. See the problem? We usually know the negative affects of prolonged cold as an area turning blue, purple or black. These are extreme signs and if you see these it is too late. The other more settle sign is a white appears with a surface hardness. Again you don't want to get to this stage because that means you will lose the surface tissue due to cell death.
Alrighty, so you are now probably saying OK Colette get with it and tells us when and how we should use ice.
In general, if you are experiencing pain and you feel called to use ice, I would recommend using an ice cube and gentle rubbing it over the painful area. As the ice begins to melt stop and pat the area dry. This gives you a chance to determine if the pain is beginning to decrease. I would not do more that three passes and no longer than 10 mins total of ice in one area. If the area is too big or you are not able to reach it to move the ice cube then use an ice pack, bag or strap but only allowing it to remain in any one area for no longer than 10 mins and staying closer to 5 mins or less is ideal. By doing this you will be able to reduce pain, start taking the nervous system into a parasympathetic state which will calm the body and remain within the optimal time frame for the initiation of vessel dilation and the production of IGF-1.
If there is no pain then it is best to avoid ice!
New research involving the recovery time and performance of athletes now also offers more reasons to avoid ice. These studies show ice can reduce an athlete's strengthen, speed, coordination and endurance. In my opinion we must again consider fascia. When we understand fascia is in every cell of the body, it runs through muscles fibers and it has 10 times more nerve ending in it than muscles carry; it makes sense that if the vessels flowing through it are constricted, then it will become dehydrated and without fluid there is less nerve communication. Less nerve communication means there will be a decrease in the sensation of strengthen, there will be a delay in motor response leading to a decrease in speed, there will be miscommunication from one area to another resulting in poor coordination and finally with nerve inhibition there will be muscle fatigue which means a decrease in stamina or endurance.
Ligaments and tendons are a form of fascial tissue and they have less blood vessels than muscles. The limited number of blood vessels makes these tissues prone to delayed healing when compared to muscles and other soft tissue injuries. From what you now know about ice you see that icing these tissue will only decrease an already compromised state of wound repair.
When looking at duration of ice application we must bring our attention to research as far back as the 1980s that revealed the body will remain cold for several hours following stagnate ice of only 20 mins. When the body remains cold for this long the nerves again will decrease in conduction and can lead to permanent damage with the appearance of nerve palsies. However, if after icing, the area is rewarmed soon enough the risk of damage is greatly reduced, if not eliminated all together. This then speaks to the benefit of contrast thermal therapy. One can either accomplish this through a contrast shower or topical application in which one alternates cold, hot, cold, hot. If there were pain one would start with hot, cold, hot, end hot. If there was swelling one would start with cold, hot, cold, end on cold. In either case you would only apply the cold for no more than 10 mins.
Now for heat. You want to avoid heat where you see acute inflammation. If there is already an increase in blood flow, redness, and swelling you do not need heat. Heat will only further dilate blood vessels and increase the inflammatory response.
Warm moist heat is the best when it comes to tissue repair. Using a hot water bottle, whirl pool or hot tub are the best options to providing a soothing environment to stimulate the rehydration of fascia and the relaxation of contracted muscles. Water conducts heat better than air, with better conduction the heat is retained longer and can penetrate deeper into the muscle layers. The heat then is mimicking the inflammatory process of dilating blood vessels which increases blood flow and the delivery of oxygen and nutrients which allow the muscle to recover faster. Dry heat such as from an electric heating pad can actually dry out the skin. Dry skin leads to dehydrated fascia, dehydrated fascia leads to pain. The best results are to apply the moist heat for no longer than 30 mins at any given time.
In conclusion, when trying to decide between ice and heat your choice will depend on how much you can tolerate pain and if there is swelling present. To achieve the best and longest lasting healing results and performance when it comes to sports, avoid ice unless there is pain or swelling. In those cases do not use ice for longer than 10 mins and if possible alternate ice with moist heat. Moist heat is your best options when it comes to general, chronic muscle tension.
I hope you were introduced to new information and you find this information helpful.
Remember, I always advise you see a doctor if you suspect you have injured yourself so we know for sure if there is any bone damage or other serve tissue damage.
www.colette.massagetherapy.com
