Hey, this is Dr. Steve Gangemi. In this video, I’m going to talk a little bit more about injuries and what to do when you get injured. One of the first things people think about when they get injured is, “Well, what do I do next?” And typically the go-to treatment is ice. People love to use ice. They know it dampens their pain. We’ve all been taught that it reduces inflammation, swelling, and we don’t want an area to be swollen after we have an injury. We want to get that swelling down and get that area healing up as quickly as possible. But actually I’m here to tell you that that’s a completely wrong and invalid idea.
Ice is definitely great to reduce pain and even block pain to a certain degree, and for the most part, it actually might be better than taking a painkiller or an anti-inflammatory in most circumstances. But you don’t want to be icing an area that you’ve just injured for the sole reason that inflammation is a natural and necessary step in the repair and rebuilding process of an injury. If you reduce the natural inflammatory response, you’re actually going to further delay your healing and maybe even end up with a chronic injury that you could have healed up much faster if you just did some other therapies.
The one thing that ice will do is slowly remove the lymph flow away from the area, which is the way your body carries waste out of the injured area. Basically you have this area of inflammation, there’s a bunch of waste products being built up there as the tissue is trying to repair itself, and those waste products need to be removed from that injured area, as well as blood flow being brought back into the area. This system of removing waste from the injured area and bringing fresh blood and nutrients to the area that is injured to help heal it up will be slowed down and sometimes even stopped if you ice the area too much and too long. So think twice before you ice.
Now, the other thing people like to do too is heat an area, and then the question is always, “When do you heat? When do you ice?” Some people will say heat as much as somebody else will say ice. Ice is typically recommended, again, for an acute injury, although, based off the reasons I just explained, you typically don’t want to do this unless you’re really just trying to dampen the pain. There’s always going to be exceptions, but for the most part, you don’t want to ice.
Heat, on the other hand, can be beneficial for a chronic injury. That’s one that you’ve had a few days, if not obviously weeks, months, or sometimes years for people. They tend to heat an area that helps to bring fresh blood into an area, helps to get the area moving and sort of loosen up the tendons and ligaments, that connective tissue that might have stiffened up from the injury and the muscle imbalances in the area.
Active recovery tends to be better than heating an area. That means moving an area that is injured as effectively and as much as you possibly can, obviously without causing too much pain, so you’re further delaying the injury or causing yourself just unwanted pain. But heat can be beneficial to a certain extent, for a longer-term injury, as well as creating heat by using friction in the area and basically working the muscle around an area, such as with trigger point therapies or other various modalities that some practitioners use.
Sometimes, people will use heat and ice together, 10 minutes on, 10 minutes off, and that’s called contrast therapy, with the notion that it’ll help to pump blood in and out the area and get the injury healing up faster. But again, that’s a very unproven type of therapy and the effects of the ice, the detrimental effects of the ice, tend to outweigh the benefits heat at that time. You definitely don’t want to be heating an acute injury, one that just happened to you. Let the natural inflammatory process take its place so you do repair and rebuild the injury properly, hopefully, a lot faster than you would have otherwise.
Elevation is actually a good thing to do. If you’ve injured an ankle or you injured your wrist landing wrong, something like that, you can definitely put it above your head or put it above your heart if you’re lying on your back. Put your ankle under a pillow, elevate it a little bit, and you can help to naturally get some of the inflammation out of there to heal up that injury.
Obviously the confusing thing is a lot of people have chronic injuries. They have a bad knee or they’ll say “This is my good leg.” “This is my good arm.” “This is my good shoulder,” and they’re always sort of nursing that chronic injury and nobody’s helping them get it recovered. Then they go to a professional, and they tell them, “Well, you shouldn’t be icing that, you should be heating it.” “You shouldn’t be heating it, you should be icing it,” or, “You Should be doing both,” or, “You should be doing this.”
But the fact is a lot of these therapies that so many have recommended for so long have never even worked. We’ve just used them for so long because it seems like it’s the right thing to do and we have this notion that inflammation is a bad thing. The message here is think twice before you ice and don’t assume that the inflammation is bad. Actually you want to embrace the inflammation to a certain degree and understand that if you don’t have some normal and necessary inflammation in an area that you just injured, you will not properly repair and recover from that injury.