Ice pack or heat for back injuries?

Ice pack or heat for back injuries?

I often get asked this question by patients, and for many years my answer was to try both and see how it feels, and then go with the one that works best for you. Increasingly however, I don’t recommend icing injuries, and here’s why.

For many decades, the standard medical advice for treating minor injuries has been to apply ice to the injury site. This is done with a view to decreasing inflammation and swelling. The NHS still recommends rest, ice, compression and elevation (‘RICE’) for minor injuries.

So what does ‘the science’ actually say about this subject? It turns out that there is very little solid scientific evidence to support using ice for injuries. A 2012 study looking at using ice to treat ankle sprains showed no clear evidence of any effectiveness and a large 2008 study looking at using ice for all soft tissue injuries, showed insufficient evidence of any clinical benefit.

In fact, there is even evidence that applying ice to injury sites can interfere with the body’s natural healing processes. Ironically, the doctor that originally coined the term ‘RICE’ in a book in 1978, no longer recommends using ice. He now maintains that ice actually delays recovery by reducing blood flow and stopping cells responsible for healing entering the injury site. In particular, cells called macrophages need to get to the injury site and release a growth factor called IGF-1 to regenerate damaged tissue. 

Interestingly, it turns out that applying ice isn’t the only thing that people are doing which might interfere with injury healing. There is now evidence that taking any anti-inflammatory medicines (e.g. ibuprofen or aspirin) after an injury may interfere with healing. Even the NHS recommends waiting 2 days before taking any. 

So what can you do??

Rest, compression and elevation may still be useful, and you can consider trying paracetamol for any pain associated with your injury. However, there’s good news and bad news about paracetamol. The good news is that there’s no evidence that paracetamol interferes with healing at the injury site. The bad news is that whilst it works for arthritis pain and headaches, there’s no strong evidence that paracetamol is that effective for back pain! (N.B If you do take paracetamol, you should be very careful to adhere to the dosage guidance on the packet).

A role for osteopathy?

When patients come to me shortly after an injury they are usually still very sore, and don’t want to be moved around too much. In these situations I tend to focus on maximising the blood flow to the injury site by relaxing nearby muscles and joints. I often also use a combination of medical acupuncture and red light therapy, which I’ve personally found helps with both pain and recovery. I also like to discuss different supplements that might assist with healing which could include magnesium, collagen, vitamin C and arnica. 

If you are looking for an Osteopath in East Grinstead, please get in touch with:

Cliff Russell, Registered Osteopath

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Cliff Russell - Registered Osteopath - East Grinstead