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Ice or heat for pain? Which is best post riding?

Pain – especially from sports is really annoying. You try to keep fit, and what happens? You end up with an injury. The question is, what should you do? Ice or heat for pain?  We’ll take at look and see what is likely to get you back on the bike, road, or Zwift faster

Ice or heat for pain?

One thing I have found with using Zwift is that if part of your bike set up isn’t quite right, then the repetitive motion, without the additional movement you’d normally be exposed to the outside can result in quite a bit of discomfort.

Last week I did 55km with a seat which was a little too high after swapping through a series of saddles for a test – (planning to post next week)

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To cut a long story short, my knee ended up looking like this:

That, that is called a knee effusion, and shouldn’t really be there. We all have a little bit of fluid inside our knees, synovial fluid, which is there to reduce friction inside the knee. However there should normally be very little there, less than 3.5ml, so if you can see the fluid clinically, you’ve done something to your knee!

Lots of things can cause a knee effusion, injury, arthritis, damage to the meniscus or cartilage, or as is more likely in my case, excess stress on ligaments from my poor seat height – aka a repetitive stress injury.

Essentially the body is trying to reduce unexpected friction, by producing more synovial fluid. However, this stretches the joint capsule and is really quite uncomfortable.

So given my favourite topic is obviously me, my swollen knee came up in conversation, and I was actually given conflicting advise by two different medics “Oh nasty, you’ll want some ice on that” vs  “Sucks to be you, but a heat pad should take the edge off”.

Now just to address that slight variation in the above advice, if you ask a gynaecologist how to do brain surgery, I wouldn’t bet on your IQ going up… the same is true with any speciality, if it’s not that particular doctors field, treat friendly advice with caution. A classic example is the question of “Should you give ibuprofen when people have fractures?” the jury is formally out as to whether NSAIDs slow the healing of the bone, but it’s good to have an informed opinion, and many people will opt for alternatives with severe bony injuries

Anyway, I digress. The point being there is a bit of confusion in some quarters when to use heat on an injury, and when to use cold. So let’s look and see if we can speed your recovery next time something hurts after a ride!

When to ice and when to heat?

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In a nut, shell heat should be applied to muscular issues.

Ice applied to acute injuries.

On the surface that seems relatively straight forwards. But should ice or heat be applied to a pulled calf? That’s an injury, but it’s also a muscle. See the confusion?

Both ice and heat are used to soothe the pain. That is the main focus here. The ice is not going to have any meaningful effect on the inflammation.

A better way to look at things is that heat is going to be more effective if you can’t say to yourself “Yes this is what I did, and the pain came on suddenly.”

A good example there is back pain. Frequently people will go to bed and wake up with back pain, or the pain will develop over the course of a day without an obvious single issue. In which case we are going to want to heat it, and soothe that pain. This will hopefully allow the person to keep moving and release the spasmed muscle

On the other side, a calf strain or worse in a muscle tear, you are going to want to put ice on that ASAP. Muscle strains and sprained frequently improve over a few days after the injury, after the acute period is passed, if you are feeling stiff then you can try and apply a little heat, as this may help the muscle relax, easing the stiffness.

What is heat for?

Heat is essentially for relaxation and comfort. Think how you feel after a long hot bath, everything is a bit “looser”. So if you are feeling stiff and painful,  WITH NO OBVIOUS ACUTE INJURY heat can help.

When to use ice?

Ice is good, but that doesn’t mean it’s fun. Ice is to reduce pain associated with inflammation. If you have just received a sporting injury, or have pushed a little too far, made your muscles sore from micro tears etc., the ice is your friend. Basically, anything new, “acute” or swollen and you want to be icing it. Frankly, I don’t think there is a better image to promote this than Jessica Ennis-Hill icing herself after training. Trying to reduce the pain from the normal damage training will have done to her muscles

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Avoiding problems

What you have to think is, “What is my intention?” In which case is might be worthwhile looking at things like this:

Ice reduces pain

Heat reduces stiffness but will WORSEN INFLAMMATION. 

If you take nothing away from this, remember this, heat will make anything acute, inflamed or swollen WORSE, and if I had applied the heat to my knee, that would have made things much more swollen.

Similarly icing a stiff back, is likely to make things unpleasant, although not particularly worse!

So hopefully that gives a bit of guidance to “Ice or heat for pain?

If you find that the same injury keeps happening, then it might be worthwhile checking with a sports professional, or your GP there isn’t something underlying going on.

In the case of my knee, I’ve had bike fits to improve the issues with my RIGHT knee. However, the response from merely a saddle change makes me wonder if something is going on – So I’m doing exactly that, and MRI to make sure everything inside my knee is ok!

Which naturally I’ll be putting on here if I find anything!

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James Gill

Author of TitaniumGeek, which started after smashing off my RIGHT elbow. Feel free to drop me a line about sports tech, medicine, or frankly anything that you want to chat about!!