Whether you’re dealing with an old, nagging injury or a new one; it’s normal to wonder how important icing is and whether doing it will dramatically affect your recovery. We’ll discuss the use of ice in the context of acute and chronic injuries to help you feel prepared for either scenario.
If you experience a soft tissue injury, such as an ankle sprain or muscle strain, it has been common practice to immediately apply ice to the area. This intuitively makes sense as it helps to reduce pain and swelling, which both tend to be high in an acute injury. In 2020, an opinion paper introduced the acronym PEACE and LOVE as an alternative approach to acute soft tissue injuries. We have covered this topic previously, but in short, it recommends avoiding anti-inflammatories, including icing, due to the claim that they may slow down healing. However, this opinion piece references studies that may not be as applicable to muscle or ligament injuries. Current best practice studies for ankle sprains indicate that icing can be beneficial but should not be used as a stand alone treatment. It should always be combined with exercise for maximum benefit.
With these competing viewpoints, what is the right course of action? Based on current evidence, if you sustain a sprain or strain, it is likely best to use ice in the first few days post-injury to help reduce swelling and pain. There is little downside to using ice in the first few days with significant upside if it helps you get moving faster due to pain relief. However, ice should not be the sole method to improve your symptoms. The goal is to use ice to help you get up and moving a bit faster so that you can perform gentle movements that don’t aggravate your symptoms.
Many people have old injuries that continue to nag them. A common question in these cases is which is better to help improve pain levels: ice or heat? The good news is that it probably doesn’t matter which one you pick. There are only a few smaller studies on the difference between ice and heat in acute pain and even fewer on chronic pain. Even in these acute pain studies, there is no significant difference in pain relief from ice or heat. This suggests that both are likely similarly effective in reducing pain, and the choice of which to use is ultimately up to each individual.
You can use some tips to determine if you might respond better to ice or heat. If your pain often feels like a tightness or stiffness, it may be better to start with heat as this sometimes creates a feeling of more flexibility and movement. If your pain is sharper or more piercing, you may be better served by trying ice first, which may do more to numb the pain. Start with either option, and don’t hesitate to switch to the other if it does not feel effective.
If you are trying to reduce pain shortly before exercising, it may be better to start with heat. Using ice may make you feel a little stiffer and uncomfortable, which might lead to the need for a longer warm-up before you start exercising.
Putting these things together, my general recommendation for managing long-term pain is to use heat if you are feeling stiff and before activity, then using ice for sharper pains and after activity.
Current evidence suggests using ice for a few days after an acute injury, combined with tolerable movement and exercise, to help get you back to the activities you enjoy doing. For older injuries, you can choose either ice or heat, as both are equally effective. Whether you are dealing with an acute injury or a more chronic one, our team of physical therapists at Maven are here to get you back on your feet as soon as possible.
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