Dr. Bell's Blog

Back Pain: Ice vs. Heat...What is Best?


It can be very confusing, when back and neck pain strike, to know whether to use ice or heat.  The use of both cold and heat therapy can both be effective in the care of back and neck pain, but it is important to know when to use each.  There are some black and white specific rules when to use each, with some shades of gray mixed in.  Let's take a look...

What To Do In The First 24-72 Hours

The purpose of ice application is to reduce inflammation.  This happens from vasoconstriction, or narrowing of the blood vessels.  The general rule of thumb for most injuries, including back pain, is to apply ice for the first 1-3 days.  Ice should never be applied directly on the skin, and should not exceed 20 minutes in duration.  Longer applications will not provide any additional benefit, and can lead to frostbite and ultimately increased inflammation.   Application should also not exceed 8-10 times over a 24 hour period. Frozen gel packs are great to use, but so are frozen vegetables.

Heat for Healing

Applying heat to an injury helps increase blood flow to the area, creates vasodilation (enlarged blood vessels), relaxes tight muscles, which ultimately helps promote healing.  Heat should be applied once the initial inflammation has subsided, and should only be applied for 10-15 minutes at a time.  Just like with ice application, never apply it directly on your skin (exception is soaking in a warm bathtub) to avoid burning your skin. Heat therapy comes in many forms including a hot bath, warm towels, hot stones, as well as a heating pad.

Sometimes Both is Best

Alternating cold and heat therapy can be a very effective tool to manage pain and speed up recovery.  This essentially reduces inflammation and loosens muscles simultaneously, and is the foundation that pain relief ointments like Icy Hot are built on.  In most cases starting with ice and following it immediately with heat is what works best.  Apply each for 15 minutes, with no break in between.

In closing, whether you are applying ice, heat, or both, it is best to listen to your body and the feedback you receive while doing it.  How does it feel?  If ice is helping, stick with ice.  If ice is making it more stiff, switch to heat.  Sometimes what we feel will work the best, doesn't always. Trust the feedback you get back from your body, and don't forget to fix the root cause of the problem. Ice and heat help address the symptom, but getting your spine checked and adjusted will help you get to the root of the problem so that you can...

Live Well. Be Well.