Heat VS Ice?!

People often ask “Should I use heat or ice on my back pain?”, and the answer may surprise some.  Different injuries require a different treatment approach, and thus heat and ice requirements differ.  In a nut shell, ice is generally applied to acute injuries that occur suddenly and often with a large amount of force, and heat is applied to injuries which occur more slowly over time. 

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Commonly, acute injuries occur quickly and include such things as when you sprain your ankle, injure your shoulder during a football tackle, or lifting something and feel immediate pain.  What is happening in response to this type of injury is an acute or rapid inflammatory response.  Inflammation is a natural response to an injury, and actually does help your body to heal.  What isn’t ideal is the injury that the inflammation causes.  Whilst the inflammatory response is an excellent healer, it can cause damage to surrounding tissues that weren’t originally damaged or affected.  The idea is that the ice should limit the progress/expansion of the inflammation and thus limit the unintended damage to surrounding tissues.  Research suggests that ice is only effective for 6 hours after an injury, although the inflammatory process can continue for 48-72 hours.  Ice should decrease the immediate pain felt, as well as allow some pain free movement (especially seen in ankle sprains). 

Some simple tips when using ice:

  • It is best used immediately after the injury is sustained.

  • Ice/cold should be applied for 20 minute, off for 5 minutes, and repeated for up to 6 hours after injury.

  • Ice should be applied through a damp cloth for maximum effectiveness; this will also prevent ice burn.

  • Ice is only effective for 6 hours after injury.  After that, the research suggests a very limited benefit.

Heat should be used primarily with pain that comes on gradually, or with no obvious causing incident.  If you have pain, ache or discomfort that comes on during the day, after a long day at work, or the day after a new gym workout, applying heat liberally to the areas of pain should decrease the discomfort as well as increase the amount of movement in the area.  Heat packs (whether they are ‘wheat bags’, hot water bottles, hot towels or a chemical heating pad) should not be heated too much, and are usually best applied through a light layer of clothing.  Heat should be applied for around the same time as ice (20 minutes on, 5 minutes off).  Heat is most effective in relieving stiffness, muscles soreness, and muscle spasm.  Gentle movement or stretching after the application of heat can be beneficial.

Simple tips when it comes to heat:

  • Best applied at the end of the day or after an aggravating activity.

  • Often heat works best in conjunction with gentle, non-painful movement and stretches.

  • Heat should be applied to the area of concern for 20 minutes, off for 5 minutes, and repeated at least twice for maximum benefit.


With both it is important not to allow the temperature to reach extreme levels.  If the temperature is too hot or too cold it can burn and damage the skin.  If at any stage the ice or heat becomes painful remove it immediately.  If you have concerns or questions about the use of ice, heat or any other forms of treatment, please contact the clinic and speak to our chiropractor who can answer these questions for you.

This information is designed as a guide only.  You should seek assitance from a health practitioner if symptoms persist.