To Ice or Not to Ice your injury? – Sacha Bhandal

To Ice or Not to Ice your injury? The feeling you get when you use heat on your body is usually one of relief and bliss. Ice on the other hand is one where majority of the people usually cringe when it is applied to your skin, unless it is a hot and humid day outside. Although, everybody has different preferences and some might prefer the feeling of ice on their body regardless of the situation.

If you use common sense, ice has always been recommended when a body part is in a state of inflammation, especially during the acute stage. Heat is recommended to relax muscle spasms and general stiffness of muscles and joints. This has been taught and educated for so long, however, what if there is a possibility that this is not the best recommendation and that we have it all wrong? Just keep your mind open instead of being defensive.

The question that we need to ask is what does the evidence state in terms of Heat versus Ice?

A 2012 study in the British Journal of Sports Medicine found no clinical studies of the effectiveness of ice after acute muscle strains. According to a 2013 study that was published in the Journal of Strength and Conditioning Research it found ice to delay recovery from eccentric exercise induced muscle damage. Other studies have found icing to be counterproductive in the long run. Dr. Gabe Mirkin, who is the assistant professor at the University of Maryland, was the one who coined the term “RICE”(Rest, Ice, Compression and Elevation) in his Sports Medicine book published in 1978. Even he has changed his mind and admits and nobody rests injuries anymore and there is no data that shows ice does anything but block pain. He even stated that there is data that shows ice delays healing.

However, despite this, if you watch specific athletes in professional sports during and after their games they still continue to put ice packs on their knees and shoulders. There is no evidence to support its use, except that it may numb the pain temporarily. It is unfortunate that athletes are still being educated to use ice based on old information when in fact there is no good evidence to support its use.

When an individual has injured themselves such as spraining their ankle, the number one thing to focus on is improving function right away. Its all about getting the person to perform gentle resistance exercises using an elastic/theraband, or performing traction to the ankle using the band as early as possible. You can try this for other body parts too. Some trainers and exercise physiologists are saying no to “RICE”. One notable exercise physiologist who runs a training facility in Toronto recommends Movement, Elevation,Traction and Heat. He uses the acronym “METH”.

There are studies that show the benefits of heat when directly compared to using ice for injuries. For example in the Journal of Physiological Science, an injured rat Soleus (Calf) muscle was investigated by using ice and heat. It was found that heat was a beneficial treatment for successful muscle regeneration at least by reducing fibrosis in the muscle. Another study that looked at the influence of heat on muscle regeneration after a crush injury on the leg of rats also found that when heat was applied right after the injury it promoted muscle regeneration and inhibited collagen deposition.

What happens when heat is applied to the body? We know that heat promotes increased blood production as blood vessels dilate to the injured area. The increase in blood flow does bring chemicals, proteins and white blood cells to the injury. This does create a process called inflammation, which helps to initiate the healing process. These cells do help promote healing to the tissue that is injured.

What does ice do? Well ice constricts blood vessels and pushes these cells out of the area of injury. We do need these inflammatory cells to help repair the injury, whether its muscle, ligament, nerve or a tendon injury. Could this be why the evidence shows that healing is delayed with the use of ice? Its highly likely from my opinion.

I never use ice for any of my clients after their injuries even if the body part is swollen. I use movement, traction and heat to their body part. They have all recovered well and in a timely manner. I feel we need to move forward and adopt a more proactive approach to what the evidence is stating. Know what the evidence states but I also do agree that you should also listen to your body and do what feels right. Remember, “change is the only constant thing in life.” Don’t be resistant to change and don’t let your ego prevent you from hearing and adopting what could be better in the long term.
Until next time.


1) Bizzine, Mario. Ice and Modern Sports Physiotherapy:still cook. Br J Sports Med 2012 46:219.

2)  Oakley, Elizabeth T, Pardeiro, Rafael B, Powell, Joseph W, Millar Audrey L. The effects of Multioke Applications of ice to the Hamstrings on Biochemical measures, Signs and Symptoms Associated with Exercise Induced Muscle Damage. Journal of Strength & Conditioning Research, 2013 Oct;27(10):2743-2751.

3) Hutchins, Aaron. Why ice doesn’t help an injury. May 20, 2014.

4)Shibaguchi T, Sugiura T, Fujitsu T, Nomura T, Yoshihara T, Naito H, Yoshi. Effects of icing or heat stress on the induction of fibrosis and/or regeneration of injured rat soleus muscle.
J Physiol Sci 2016. Jul;66(4):345-57.

5)Takeuchi K, Hatade T, Wakamiya S, Fujita N, Arakawa T, Miki A. Heat stress promotes skeletal muscle regneration after crush injury in rats. Acta Histchem. 2014 Mar;116(2):327-34.

6) Loten C. Stokes B, Worsley D, Seymour JE, Jiang S, Isbister GK. A randomized controlled trial of hot water (45 degrees C) immersion versus ice packs for pain relief in bluebottle stings. Med J Aust 2006 Apr 3; 184(7): 329-33.


What is so “hot” about Inflammation? – Sacha Bhandal

Inflammation is a term that you hear being used quite often these days. What exactly is inflammation? I hear this a lot in my line of work. Inflammation is a process that is indeed important to the human body. When the body senses an injury, the immune system sends white blood cells to the injured area to surround and protect it. These white blood cells are important in the healing process. This process works the same way if you have a cut, burn, pneumonia or a tooth infection. There are 2 types of inflammation. One is acute, which happens during a traumatic event like a cut to your skin or if you fall and bang your elbow. It leads to redness, heat and swelling around the injured area.

Chronic inflammation involves a similar process, however, the inflammation lasts longer and the immune system sends too many white blood cells and other inflammatory cells to the problem area and it begins attacking nearby healthy tissue and organs.

One form of chronic inflammation is when you are slightly overweight. I know this is a topic that can be sensitive for many, but I am just reporting what the evidence states and how your body works.   Being slightly overweight will cause you to naturally have more visceral fat around your organs and the abdomen area. The body sees this as a problem area and will send white cells to this visceral fat and you end up in a state of inflammation. This leads to a state of ongoing inflammation in your body. The longer you stay inflamed the more that these inflammatory cells may float around into your blood stream causing the entire body to be in a state of inflammation. This is why maintaining an ideal weight for your body type is important.

How do you check your inflammation levels? There is a blood test that tests a liver chemical called C-reactive protein. This will determine the level of inflammation that you are in. You may want to speak to your doctor about this.

There are many dietary changes that one should make to treat inflammation. One may want to change their lifestyle and become more active. Exercising can lead to an increased production of endorphin’s and decreased cortisol levels, which may fight the inflammation. Also, if you maintain an ideal body weight, it will cause you to have less visceral fat and this will reduce the inflammation in your body. We also know that there are natural foods that can assist with inflammation, ones that I personally have used.

The one that a lot of people do not know about is Tart Cherry Juice. This is something I have used in the past during workouts to help prevent muscle damage, soreness and inflammation. A great deal of elite athletes have used this as well. The New York Rangers (NHL) have been on the leading edge of using natural sources to combat inflammation and muscle pain. They have used Tart Cherry Juice by drinking it regularly before and after workouts and games. A clinical study published in the British Journal of Sports Medicine in June 2006, found a significant decrease in symptoms of post exercise muscle damage in college males following the consumption of a Tart Cherry Drink. Strength loss, pain and recovery time were all reduced versus a placebo. I recommend Tart Cherry Juice to some of my clients.

Government and university research have revealed that consumption of 45 tart cherries a day can lower inflammatory markers in the blood stream. This is a lot of cherries to eat so consuming the juice is ideal.

Many people do suffer from difficulty sleeping. Something that I discovered, while taking Tart Cherry Juice is that cherries do contain Melatonin, This hormone is naturally produced by the Pineal gland and helps regulate the body’s internal clock. There is research that demonstrates that tart cherry juice is beneficial in improving sleep duration and quality in healthy men and women. Maybe drinking this juice before bed could help you to fall asleep. Also, you may try to consume a handful of cherries at night, which could assist with your sleep quality. Its worth trying.

A few other substances to help combat inflammation are Curcumin and lemon water. Curcumin, which is the main ingredient in Tumeric has been known to be a great natural anti-inflammatory. Curcumin on its own is something that the body has a challenging time absorbing so using black peppers can assist with maximum absorption.

The one thing that works well without having to spend a lot of money is drinking lemon water. I usually start my day off with a cup of warm lemon water. Starting off your day with lemon water or even drinking it throughout the day will maintain your body in a state of alkaline and this will assist with reducing inflammation in your body.

There is one condition that I see and treat often in private practice. It is a condition called Tennis Elbow. A lot of health care professionals call it Lateral Epicondylitis, however, this is not correct. Evidence reveals that tennis elbow is not truly an inflammatory condition. Surgeries and autopsies do not reveal inflammation in the muscles involved but yet it still continues to be called Lateral Epicondylitis by the medical community. The correct term that is used for this condition is Lateral Epicondylalgia. This simply means muscle pain in the group of muscles that control the forearm. Since the evidence does not support inflammation with this condition, then why are anti-inflammatories still commonly used? It clearly doesn’t make sense especially if it is not an inflammatory condition. Instead, its best to try some sort of therapy that works on rehabilitating the muscles, whether its through manual therapy, acupuncture, cupping or stretching exercises. You may want to speak to a physiotherapist about this.

Inflammation can be controlled and treated through natural means as discussed above. Modifying ones diet by eliminating sugar and maintaining an ideal body weight are very helpful in treating inflammation. Foods, such as Tart Cherry Juice, Curcumin, lemon water are just a few of the other items that can help. Remember, its a combination of changes that help the most. Reducing inflammation does not work overnight. It is a process that takes time and you have to modify your lifestyle if you want to take control. Until next time stay happy, keep having fun and be kind to yourself.


1) Playing with the Fire of Inflammation Harvard Health Publications- Harvard Medical School- August 2016.
2) New York Rangers Using Tart Cherries to Combat Muscle Soreness in Training Regimen. BJOM, Jan 2007.
3) Howatson G, Bell PG, Tallent J, Middleton B. McHugh MP, Ellis J. Effect of tart Cherry Juice on Melatonin levels and enhanced sleep quality. Eur J Nutr. 2012 Dec(51)8:909-16.
4) Waugh Esther, Lateral Epicondylalgia or Epicondylitis: Whats in a Name? JOPST, 2005(35)4: 200-202.

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