Heat or Ice on an Injury - is there a right or wrong way?

I get asked all the time what is the proper treatment for pain and injury and it all depends on several things:
- How old is the injury?
- Is there bruising and/or swelling?
- Is is soft tissue or bone?

There is a rule of thumb that says that immediately after an injury to apply Rest, Ice, Compression, Elevation (RICE).  Doing this will usually help the healing and prevent additional swelling, except in the case of a broken bone.  Apply the ice, but get to a doctor and make sure a bone isn't broken!

If an injury is older than 24 hours, my personal opinion is that you have several choices but it depends on what type of injury it is.

Bruising - Applying ice to a bruised area will only cause blood to continue pooling in that area, but heat can cause swelling and more bruising.  My recommendation is to do an ice massage.  Freeze water in a Dixie cup and rub the area for at least 20 minutes.  It will be cold and red.  This does two things; it brings new blood into the area with more oxygen and nutrients for the tissues and it helps the old blood flow out and take away inflammation.

Swelling without bruising is usually helped better by ice compresses, but if movement is restricted, I would use the ice massage because just ice will cause tissue to contract and tighten.

Pain without bruising or swelling - I tend to believe that we all react differently to cold and heat.  I prefer heat because I don't like to be cold, but that might not be the case for you.  If you prefer cold, use cold.  If you don't know, try one or the other and see how your body responds.  Soaking in a hot tub with 2 cups of Epsom salts will help or using a heating pad.

If you have a bone bruise, it is going to take a long time to heal regardless of what you use, so just be patient.  Soft tissue heals faster, especially if you begin treatment as soon as you are hurt.

Icy Hot and treatments like it are, in my opinion, worthless.  There are ingredients, like menthol or wintergreen, that cause a mild chemical reaction on the skin and make tissues feel hot or cold.  It isn't actually reaching beyond the surface of the skin.  It is a placebo effect.

Aspirin helps with pain and swelling.  Ibuprofen (Advil, Motrin, etc) is a muscle relaxer and anti-inflammatory.  This means that it actually helping the healing process and reducing pain.  I am also a fan of natural treatments like Traumeel, Arnica oil, etc.  These have natural ingredients that are absorbed by the body and help with pain and swelling.  I have used Traumeel on a client with a bad ankle sprain and it took the bruising out and reduced the swelling.  Both will reduce pain.

The best thing you can do with any injury is start with ice and then listen to your body and reduce your activity or movement until you feel better.  If you have any questions, ask your doctor or friendly massage therapist :)

What works best for you when you get hurt?