Hot or cold?

When to use heat or ice?

I have asked and been given advice by many professionals over the years as to when to use heat or cold/ice for back problems. The answers seem to be non-specific and I have found there hasn’t been a consistent theme. Generally the advice seems to be, if the injury has just happened (acute) use ice and if its ongoing (chronic) after a number of days use heat. This is fine for an ankle or toe but not greatly helpful for the whole back! Sometimes when I have used heat (hot baths/showers etc.) any leg pain or arm pain that I have been experiencing has been made distinctly worse or conversely my back has felt quite a bit better! I have also found that cold when used indiscriminately can cramp the muscles with all the problems that then arise from that. Confusion has reigned!

Ice Ledge

(Photo credit: Bob.Fornal)

The conundrum I feel I am left with is that with ongoing chronic back or neck pain there are quite possibly a number of things happening throughout the length of the spine which require differing responses at the same time!

I understand that heat can help muscles to relax – we all ‘warm up’ before exercising so muscles can be more easily stretched without injury. I also understand that cold can cool the heat of inflammation that arises from the inflammatory process (On the internet there is much information as to when to use each technique along with a more scientific explanation if you require it). Therefore I would like to propose a way of using both concurrently in a targeted way to help treat ongoing back pain. I believe this process has the potential to reduce the need for pain relief and anti-inflammatories (NSAID’s) with all the benefits associated with that. Where an injury has just occurred I would suggest however using the cold therapy described below for the first couple of days and then going on to using heat and cold as you feel able. Check with your doctor if you have any concerns as always.

First of all, check your back by using the tennis or other type of ball as described in the post, ‘Sports accessory!’  Feel for any tension and sore spots, places that can feel like a bruise when you press on them. They may also feel warm or look slightly red.


(Photo credit: Enokson)

Then soak in a warm bath for around 15 minutes or more. Showers can also be used if you don’t have a bath or you physically feel uncomfortable in the bath, however baths will likely be more effective.

Straight after the bath check your back again with the ball. Some of the tension of tight muscles should have melted away to hopefully leave just a few sore spots which are possibly places of more long term inflammation. Targeting these spots only, go on to use either an ice pack in a towel which conforms to the body or a cooling gel (I use Biofreeze gel or roll on but I am sure there are others around). The cooling gel is applied directly to the skin and is useful if your back is touchy and you don’t want to twist around and hold ice packs against it! The aim is to try to cool down the inflamed area only. if you are using an ice pack, only apply it for 10 – 15 mins  in a towel to prevent further damage to the tissues.

Try this routine for a week, once a day in the evening and see how your back reacts by checking with the ball each day. Again, its all about small, gentle steps – start to get to know your own back and how it reacts. You will learn a lot about your back in the process! Do not over do the pressure of the tennis ball however, as you can make things more sore – if this happens continue with the hot and cold treatments but use your fingers where you can reach rather than the ball to feel for the soreness as you will now have a better idea of where it will be.

The aim of this treatment is to reduce pain that can result from tight muscles and inflammation. This pain can be felt in the arm, legs, shoulders etc. as well as the neck and back.  Any added benefits of you understanding your back more and tailoring your own exercise/daily routine/treatments must be all for the good!

Finally, if your back is currently very reactive and can go into spasm easily consider using an electric blanket at night when autumn and winter sets in. Turn it on a few minutes before going to bed to take the chill off the sheets and then turn it off before going to sleep. This will stop any warmth you have in your muscles from being used to warm the bed!

(Sarah does not have a medical background so it is emphasised that her blog is the result of her experiences and listening to others only. Before doing any of the suggestions contained in her blog, check with your doctor if you have any concerns on how they may affect you)


2 thoughts on “Hot or cold?

  1. Pingback: Hot or Cold? | Surviving Back Pain

  2. Dr. David M. Vitko

    I have been practicing Chiropractic for nearly 30 years. Early on in my practice I used heat packs on my patients when they came in and suggested the same at home. I did this for several years. I noticed a lot of patients had muscle spasms when getting up after the adjustment. So I revisited my physiology books. Heat feels good because it is a strong stimulus to the nervous system. Our body loves heat! Unfortunately, on the local level, it also dialates (expands) blood vessels. This allows fluids to leak out of the circulatory system and into the local (injured) tissues, leading to tissue swelling and congestion. The body has a hard time “clearing out” these extra fluids due to the increased congestion.
    Long story short, for the past 25 years I have suggested ice, or when ice is unacceptable for people, “cool damp compresses” for 30 minutes at a time on lower back and 15-20 minutes on the neck. This has made a tremendous improvement in recovery time for back pain, and prevented many acute injuries from turning chronic. I cannot begin to tell you how many chronic cases I have seen from other doctors who have treated patients for many months with no relief. When these patients started using ice, we quickly saw results. It really is a logical approach. And forget the old stand-by of ice for the first 24 hours and heat there-after. I have found that where there is pain, there should be ice applications up to several times a day until the pain is gone. At least one hour should be left between applications for the body to return to normal temperature. (Diabetics should use cool compresses instead of ice as their circulation may be compromised.) Hope this helps! It has worked for me and my patients. I live by it myself when I manage to “put my back out” on occasion.


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