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Should I ice or use heat?

Should I ice or use heat?

I am often asked which is better, ice or heat. My answer is; Ice is always safe if used properly. Heat may exacerbate your symptoms. Here is the general rule of thumb:


If it is a recent injury, always use ice. I recommend to continue with ice as long as the pain has a burning quality to it. Don’t just assume that after 24-48 hours the “acute” inflammatory phase is done. Icing may be used for weeks.
Make sure that your ice pack is wrapped in a thin towel or over a t-shirt. Don’t put it directly on your skin as ice (especially ice cubes) can damage your skin if left on for more than a few minutes. Ice with wrapped bag or gel pack for 15-20 minutes. Take the ice off and give yourself at least a 20 minute break. After the first 2-3 20min on and 20min off give yourself about 40 minutes between icing. In other words 20min on and 40 min off or 20min per hour.
Occasionally direct ice is used on a focal area of injury. You can freeze some small Dixie cups full of water and tear about ½ inch off of the paper around the top of the cup exposing the ice. (The cup helps you to hold the ice without freezing your fingers. You can use an ice cube wrapped in a paper towel as well). Move the ice in a small circular motion over the affected area. It will feel cold, then burn, then ache, then it will start to feel numb. When it is numb stop. When using direct ice, do not go more than 5 minutes even if it does not feel numb yet.


Heat is great for chronic ache and stiffness. Especially in the mornings, heat can loosen stiff muscles and joints and help get you moving. A hot shower or heating pad for 15-30 minutes works well. A soak in a hot tub for 15-30 minutes can be nice. Do not do this if the injury is recent. I have had patients get into trouble using heat. It can be counter intuitive because heat can feel very good, even in the acute phase of injury, but it opens vasculature and can draw in fluid to an already inflamed and swollen area causing the area to have more pain later on.
Occasionally heat can be used in the sub-acute phase of an injury. If heat is used, place the heat pack on the affected area for 5 minutes followed by ice for 10 minutes. You can alternate using this frequency back and forth multiple times. Always end with ice, preferably 20 minutes for the final icing.

What about topical gels?

Topical gels and creams have compounds such as menthol, camphor, ilex or capsaicin (pepper extract) or a combination of these with some other botanicals. They work by creating a sensation on your skin that tricks the brain into not feeling the pain. They do not actually cool or heat the tissue, it only feels like it. Some contain natural forms of aspirin which in theory can help with inflammation. There is disagreement on how much this actually absorbs to have a therapeutic effect. There are other more exotic creams such as Emu oil among others but again there is disagreement on how effective they actually are.
Topicals are generally safe so if you feel it helps take the edge off of your pain then by all means go for it. You may want to postpone applying them until after using heat or ice. The combination of both can cause some skin irritation. Some people do not tolerate capsaicin on their skin so be careful when using it for the first time. If irritation occurs with any topical discontinue use and wash area with soap and water.

Will exercise help?

The short answer is generally YES. Start with gentle basic range of motion as soon as you feel you can. In the neck, gently turn from side to side, tipping your chin down at the end of each turn (nose turned toward your shoulder). Repeat 5-10 times each side. Try this at regular intervals throughout the day, i.e. hourly. Avoid pulling your neck to the side until you speak to your doctor about your specific problem. For the lower back lay on the floor or your bed face up. Bend your knees with your feet on the floor. Gently roll your knees from side to side but control the movement with your trunk muscles. Keeping your “tummy” muscles tight will often reduce the discomfort. Gently pulling one knee at a time to your chest can help. It this is comfortable try both at the same time. If you have “sciatic” (leg) pain, try lying face down and pressing your upper body up while leaving your hips/pelvis on the floor. Hold this position while propping your upper body up on your elbows. You can gently pull your torso forward with your elbows while relaxing your trunk and back. Lying face up with knees bent while resting your lower legs on a couch or chair can reduce lower back pain. This is a good position to use ice.

– Injury

As you heal, the muscles, tendons and ligaments lay down new connective tissue to mend tears and strains. The new tissue is generally not as flexible as the original tissue and is often laid down in a jumbled mess….you know this as “scar tissue”. It happens inside your body as much as it does on your skin such as with a cut. Gentle mobilization of this tissue causes the body to align the fibers in a more flexible, mobile orientation and develops a stronger bond.
If you are injured there may be a period of time from a couple days to a few weeks that the area should be rested before attempting activity or exercise. There are often specific exercises that can be phased in starting with the most basic movements progressing in difficulty as your condition allows. You should talk with your doctor for specific timing and exercises that will be right for you.

– Chronic pain

In people with chronic long standing back and neck pain there is documented atrophy (shrinking) of stabilizing muscles. This tends to promote further dysfunction and pain. Exercise has been shown to rebuild atrophied muscles, improve stability and reduce pain. In chronic pain patients exercise can often be painful in and of itself but the benefits when done consistently and carefully will outweigh the aggravation. Your doctor will discuss with you and show you exercises that will be appropriate for your specific problem.