“Should I use heat or ice for my running injury?” Nearly every physical therapy evaluation has entails verbatim or question that’s seerily similar. For some patients they have just avoided it all together, unsure of which to use, while others are simply guessing. Some articles have touted that using ice is detrimental… “old school” or “ice age thinking.” While their pun is fairly solid, the thought process is not. Ice has been used forever… literally. Ice provides ‘vasoconstriction’ of blood vessels, a term that equates to crimping a garden hose to limit blood flow. Limiting blood flow is important under specific conditions, primarily during times of inflammation. Ice also provides pain relief by slowing the pain signals to the brain. Both are reasons enough to use ice under specific circumstances. Decreasing blood flow is important early, particularly when inflammation runs away from you (similar to that guy who’s been using you as a wind shield in your last race). It’s also plays an important role in pain reduction. Talk to any total joint replacement patient—they’re living proof that ice has a time and place.
Icing’s role in running is fairly interesting. Most patients I treat are rarely inflamed. A high percentage of runners are part of the “wait-n-see” population. They (read you) will give it a few weeks (read months) to see if it will “work itself out” or “go away on its own.” The purpose of this article is to not nail down the basics of heat and ice. Simply put, if you’re injury is fresh, hot, and causes you to limp, you likely need ice. Rather, my goal is to educate on the use of heat.
Blood is Good… If It Stays Inside Your Body
All nutrients, enzymes, and chemicals navigate every intricacy of our body through our blood vessles (the circulatory system). Our blood vessels allow for our injuries to heal, grow, and thrive, while also distributing medicine for any of those sore spots. For exercise sake, the circulatory system provides oxygen while removing the byproducts of muscular contraction (lactic acid with hard efforts). Our blood flow revolves around supply and demand. As we exercise blood is diverted from our internal organs (stomach, intestines, kidneys, liver, etc) to working skeletal (legs) and cardiac (heart) muscles. The opposite occurs when we’re not exercising. Blood is diverted away from your working muscles and back to your vital organs.
Not a big deal ordinarily, but when you’re dealing with an injury you’re going to want to keep blood around. Keeping the flood gates open will not only keep you feeling loose, but also bombard your injured tissue with a surplus of oxygen and nutrients required to for healing. Every injury passes through a rebuilding stage—one where you can still run, but often results in “feeling it” or “being aware that it’s there.” Clinically, this is primetime for heat and pushing the healing cycle along.
Think about it. You’re recovering from a tendon, muscle, or joint injury. You sit all day at work, dormant. Blood is being diverted away from the injury as your legs are motionless. Not an ideal situation. Using a simple heat pack may actually trick your body to redistributing blood locally. Heat is a vasodilator, causing your blood vessels to relax, which ultimately allows for more passage of blood. So while you’re hanging out at work you could be dousing your injury with a surplus of blood (read nutrients) that are required to rebuild what ails you.
Clinically, I use this quite often. It’s a great way to nudge yourself down the path to full recovery. Both the use of muscles and heat can cause increased blood flow; however, the latter can do so without loading healing tissue. A simple “on for 20, off for 20” cycle can draw blood to a localized area and keep you healing even when you’re lying low. Your only hang up is applying heat too soon. Here are some general rules for avoiding the use of heat:
As always, you’ll want to consult a clinician who can help you with your decision, but don’t be afraid of heat. Heat can be a catalyst to healing, particularly at times when you least expect it: sitting at work or watching TV.