Should You Ice or Heat An Injury?

“You should put some ice on that.” <– We’ve all heard it, right? Inflammation has become sort of a bad word in the health world, which is no surprise if you think about how many conditions are related to chronic inflammation – dementia, skin issues, lung issues, heart issues, digestive issues, and depression for example.

So we eat foods that “fight inflammation” and ice injuries to keep inflammation down. But what if inflammation is sometimes our friend? When I injured my rotator cuff while paddle boarding recently, I received a lot of advice on how to treat it. Not all of it made sense to me, so I decided to dig into the research. I also asked my co-author for this article, Dr. Lori Rose, for her thoughts, which we’ll be sharing below.

As always, please keep in mind that this article is for informational purposes only and is based on the opinions of Dr. Rose and myself. It is not intended to be a substitute for professional medical advice, diagnosis, or treatment – a full disclaimer can be found here. Okay, let’s jump in!

How inflammation supports injury healing

In the case of acute injuries (assuming no infection), the swelling and pain we experience actually supports the healing process. Localized inflammation makes blood vessels more leaky, which allows white blood cell to easily travel into the damaged area and support healing. (source)

If we take anti-inflammatories and use ice, we slow down the healing process by reducing the access our white blood cells have to the area. Furthermore, by icing we reduce blood flow, which is what the body uses to bring nutrients needed to create new tissue as well as carry away the waste from the damaged area. When blood flow is reduced, the “trash” that the white blood cells are trying to remove from the area get stuck there, joints get stagnant, scar tissue forms, and the healing process is impaired. (source)

If you’re thinking, “Hey, this sounds a lot like what pediatricians are saying about fevers now – that they’re a natural defense mechanism and reducing them may prolongs illness.” Yep, it is!

While it’s always a good idea to get checked out if an injury is serious or an infection is present, natural responses such as fever and swelling serve a purpose. The main benefit of reducing inflammation and blood flow is that it reduces pain. And while that’s important, there are other options for soothing discomfort that don’t suppress inflammation and blood flow. So if we aren’t icing and reducing inflammation, what exactly should we be doing?

MEAT instead of RICE

Nope, we’re not talking about the paleo diet. If you look up how to handle an acute injury, you will quickly see the acronym RICE: rest, ice, compress, elevate. However, these recommendations are based on alleviating pain and swelling, not supporting the healing process.

RICE is very effective at these goals, but in focusing on pain and swelling reduction we actually slow the natural repair response. In fact, here is the creator of RICE taking back his advice based upon years and years of evidence showing that RICE is not only ineffective but actually damaging in some cases. Slowly but surely modern methods of addressing acute injuries are “catching up” to the methods used by our ancestors, using another acronym: MEAT.

What is MEAT?

MEAT stands for movement, exercise, analgesics (not anti-inflammatories), and treatments (as in other treatments like physical therapy and/or massage). Combining this with hot, blood moving herbs (like cayenne salve or a ginger compress) that increase circulation to the area can support the flow of blood, which as mentioned earlier brings healing nutrients to the area and takes away the damaged “trash.”

Practitioners “in the know” may use ice, but they use it very differently: they alternate between cold and hot, cold and hot, cold and hot, to bring blood to the area, then send it away repeatedly to support the carrying of nutrients to the site and the carrying of wastes away. After seeking help from a local massage therapist and my chiropractor, I finally saw a physical therapist about my shoulder and this is what he recommended. Because arnica is so helpful for bumps, bruises and sore muscles, also made up a batch of arnica cream to help ease my discomfort.