For very acute injuries like muscle pulls, strains, and rolled ankles, I would say neither ice nor heat right away.
Ice is generally used to reduce inflammation and help with numbing some pain. Heat will increase blood flow and help with some stiffness. Here’s the problem, when you are experiencing a new small injury, the first 5 days is going to have a significant amount of inflammation (this may vary based on the injury).
We actually want that to happen because the inflammation is part of the healing process, increasing the blood flow to the area to assist with repair. If we ice this area right away, we may have some temporary pain relief, but we are slowing down the natural healing process. That’s why when the ice is removed, you may get more pain because the inflammation is restarting again with more haste to heal the area. Heat would create too much blood flow to the area at this given time.
So what do you do?
Start by doing light continuous movements such as walking or riding a bike (especially for lower limb issues). This will help circulate the blood flow from the injury throughout the body without increasing the inflammation. After a few days, icing may be a better option in conjunction to slow down excessive or prolonged inflammation. Heat would only be an option here if things tend to remain very stiff in an area that does not appear inflamed. Pain medications do have a use if necessary. You would use a pain reliever initially if you need to decrease the sensitivity, but inflammation is still going to cause some pain. (Remember, it’s not in our best interest to eliminate this yet). An anti-inflammatory would be useful if things persist.
Long-term/reoccurring injuries (lasting longer than 3 months) will have a low level of inflammation, but you have increased sensitivity to the area over a prolonged period of time that causes you to cross the pain threshold consistently. It’s like someone is just continuously poking the area. In these scenarios, it’s best to find out why the poking is happening and remove that interference first. This is where an anti-inflammatory can buy you a window of opportunity to reduce the effects of the hypothetical poking, giving you a chance to access movements to correct the problem without interference. (This is not a recommendation to start using pain medications or saying it is safe to do so long term. This should always be done under the guidance of a medical professional).
Below are a few examples on how we like to utilize and active recovery strategy to keep things moving.
The soft tissue release has a specific direction in which we apply pressure. Pinpoint pressure requires us to move in directions towards the pain, but not on it. If pain is diffuse, you may need to place pressure in the area.
The rolling on the ground helps reduce tension in the body and provides an opportunity to open up with a more active approach.
To increase circulation in the body while maintaining some levels of fitness, tmpos on a bike can be useful. These are meant to be kept at a 6/10 effort for short durations. In the example below, I am using the bike for 15s on and 45s for 4 sets. Then a rest for 2 min and repeat 2 or 3 more times.
Now you have some ways to recover much better from workouts and sports injuries. These are not the only ways, but it is a good start.
The longer these things go on for, the longer it takes to reverse the problem. That’s why it’s best to seek out the guidance of a professional if things persist for >2 weeks to have a better chance of resolving the issue rather than creating a more complex solution to the problem.
Dr. Peter Dionisopoulos is the owner and founder of Dynamic Performance & Rehab. He has worked with many high-level athletes and military personnel, but his true passion is to help active adults maintain their lifestyle by providing information and potential solutions to their aches and pains so they can continue with the activities they love.