A quick history – overview where did the idea of using ice or heat on an injury even start?
– 1978 the acronym RICE was formed to help us remember to Rest, Ice, Compress, and Elevate.
– 1998 this was adjusted to PRICE, protection, meaning to protect the injured area from undergoing more inflammation by injuring too soon again.
– 2012 POLICE was released as Protection, Optimal Loading, Ice, Compression, and Elevation. To the naked eye it’s obvious that ice brings down inflammation, but it was also beginning to be understood that using the injured structure in the proper way (proper loading) would aid in the recovery of injury and limit compensation patterns that often occur when an injury is not treated.
Thus far it appears ice reduces swelling… but why does the inflammation process exist in the body?
Picture 1 is my sprained wrist (I fell off my bike a few summers back, note to self, unclip your feet when you get to a stop light!). My wrist was very swollen after fall, almost double in size. The inflammation process started after the fall due to too much pressure put on the wrist that resulted in bruised tissues and broken blood vessels. The wrist became swollen within a few hours of injury as the beginning steps towards healing. That’s correct, inflammation is an immune response to clean up the damaged tissues in the body by releasing macrophages that breakdown dead cells and release Insulin-Growth Factor-1. IGF-1 promotes growth and diffusion in satellite cells (muscle stem cells), which on activation can re-enter the cell cycle to become myoblasts which turn into muscle cells. IGF-1 can influence cell behaviour and type 1 collagen expression which helps form ligaments and tendons.
How incredible is the body! It moves into immediate action using inflammation as an autonomic response when there is injury that needs to be cleaned out and rebuilt. As the founder of Osteopathy Dr. AT Still once said “The body has an innate ability to self-heal and self-regulate”.
Picture 2 shows how a blood vessel vasodilates (expands) due to chemical signals, these chemical signals can occur from injury that send signals to the body to begin the cascading events of inflammation. Picture 2 also demonstrates a constricted (smaller diameter) blood vessel, this is also due to chemical signals in the body, that can be caused by an external energy such as ice. In general, ice will constrict blood flow to the area, whereas heat can increase blood flow by increasing the diameter of blood vessels.
If you have severe inflammation due to a break or a fracture, it’s extremely important you head straight for your medical doctor so they can assess the impact of injury and send for imaging to confirm the type of injury. Often, ice is highly recommended in such cases to help control pain and initially reduce the cascading inflammatory event that brings swelling and pain, due to irritation to the nerves in the areas.
Ice is not recommended past the initial time of injury, it’s important to allow the body’s natural healing process to occur to repair and function. After we know you do not have a break or fracture it’s important to get in to see your Manual Osteopath to open up the drainage pathways in the body to make sure the old blood and dead tissues can be removed to allow new blood to flow freely to the area to reduce recovery time and improve overall loading patterns through the body. I will help you figure out what the optimal loading time is for the specific injury in question, whether you should use ice or heat. Our initial focus in treatment is to make sure the drainage channels are open; the lymphatics are free of restriction to make way for new blood to promote healing.
Whatever you decide to use, ice or heat, remember that it will often only be only to make you more comfortable. Limit your use for only 10 minutes at a time to limit changing the chemical composition in the tissues with prolonged use of either cool or warmth.
On episode 53 of Osteocast we discuss the use of ice versus heat and how Osteopaths view injury and the necessary healing time. You can listen to the podcast on apple, spotify and anchor: https://linktr.ee/OsteoCast
I’d love to hear your thoughts on this topic, info@smtosteopath.com.
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