When to Use Ice vs. Heat for Pain

It is one of the most common questions we hear, and one of the easiest to get backwards. You tweak your back, reach into the freezer or the heating pad drawer, and pause. Ice or heat for back pain? Picking the right one will not change your life, but it can make a sore day more comfortable. Here is a simple guide you can keep in your back pocket.

The quick rule

Reach for ice when something is fresh, swollen, or inflamed. Reach for heat when something is stiff, tight, or achy without much swelling. New injury, think cold. Old stiffness, think warm. It is not a hard science, and a lot of comfort comes down to what feels better to you, but the rule covers most situations.

When ice helps

Ice calms things down. In the first day or two after a fresh strain or injury, cold can help reduce swelling and dull pain by slowing things in the area. It is a good pick for a back you just wrenched, a freshly rolled ankle, or any spot feeling hot, puffy, and angry. Use it for about 15 to 20 minutes at a time with a thin layer between the ice and your skin, and give your skin a break before going again.

When heat helps

Heat loosens things up. For muscle tightness, stiffness worse in the morning, or a chronic achy back with no swelling, warmth increases blood flow and helps tense muscles relax. It is also a nice way to prep a stiff area before gentle movement or stretching. Use it for about 15 to 20 minutes, keep it warm rather than scalding, and never sleep on a heating pad.

Common mistakes

A few errors come up constantly. Putting heat on a fresh, swollen injury can make the swelling worse, so wait until the early inflammation settles before switching to warmth. Applying ice or heat directly to bare skin can cause burns, so always use a barrier. Leaving either on far too long does not speed anything up and can damage skin. And relying on ice or heat alone for a problem returning again and again misses the point, because they manage symptoms, not causes.

When to get it looked at

Ice and heat are for everyday aches and minor tweaks. If pain is severe, not improving after a couple of weeks, or comes with numbness, tingling, weakness, or it followed a fall or crash, it is time for an evaluation rather than another round on the heating pad.

Frequently asked questions

Should I use ice or heat for back pain?

Use ice for a fresh, swollen, or inflamed back in the first day or two, and heat for stiffness and muscle tightness without swelling. When in doubt, go with whichever genuinely feels better, and keep sessions to about 15 to 20 minutes with a barrier on the skin.

How long should you ice an injury?

About 15 to 20 minutes at a time, with a thin towel between the ice and your skin, and a break before repeating. Longer is not better and can irritate the skin. Ice is most useful in the first day or two after a fresh injury.

Come see us

If you keep reaching for the ice pack and the same pain keeps coming back, the real fix is figuring out why. The team at Preferred Rehab in Gilbert, AZ can get to the cause and build a plan around it. Call (480) 633-3151 or book online to get started.

Related reading

• Does Chiropractic Care Really Work for Low Back Pain?
• What Happens During Your First Chiropractic Visit?

References

• Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgrad Med. 2015;127(1):57-65.
• Qaseem A, Wilt TJ, McLean RM, Forciea MA. Noninvasive Treatments for Acute, Subacute, and Chronic Low Back Pain: A Clinical Practice Guideline From the American College of Physicians. Ann Intern Med. 2017;166(7):514-530.