Should I Apply Ice or Heat?

Such a seemingly simple question.  In my opinion, it is an easy one to answer, but I have heard so many different variations that I thought it would help to clarify the issue.

The majority of my patients tell me that their other health care practitioners recommend applying heat for relief of their low back or neck pain. This has always confused me since it seems obvious that, in most cases, ice is the better choice for addressing the root cause of most musculoskeletal issues.

From a purely logical standpoint, it makes sense to apply cold to a heat problem and heat to a cold problem. If it is too hot outside, we don’t go inside and turn the heat on.  At its root, inflammation comes from the Latin for “setting something on fire”.  It makes sense to me that we would want to cool down this condition instead of adding more heat to it.

Why Ice Is Probably Better for Treating Inflammation

So, any time I feel like inflammation is active and present, I recommend applying ice.  In my experience, the most effective way to ice is to:

  • apply it for 20-30 minutes at a time
  • wait an hour for the tissues to naturally re-warm
  • repeat the icing

I recommend continuing this cycle of “ice for 30 minutes on and 1 hour off” as much as the level of inflammation requires.  This varies based on the person and their condition.  The easier way to tell this to people is “Ice for 30 minutes every 2 hours”.  Not any clinically better, just easier to remember.

I think the main confusion between ice and heat application occurs because of the way clinicians look at their patient’s root issues.  If I am a physical therapist and I am working to strengthen and balance muscle function, I may correctly tell a patient to heat as a way to relax tight muscles. 

However, as a chiropractor focused on the joint inflammation that is underneath the tight muscles, I may correctly tell the same patient to ice to reduce the joint inflammation. Without this explanation, the result is a confused patient. 

Of course, this can easily turn into a chicken and egg discussion. I suppose a physical therapist could argue that the muscle bracing and asymmetric use of the region is the root cause of the joint inflammation.  A chiropractor could argue that the muscle bracing and resultant asymmetric muscle use is created by the body’s response to the inflamed joints.  Either way, there is inflammation present in the area and icing it seems like a better option.

What to Expect When Treating Inflammation with Ice

When icing, it is important to know that you will generally have 4 reactions.

  • The obvious first one is that ice is COLD.
  • After that, the area will start to ache. Many people feel this ache and stop icing because of it. The ache is a natural response to the constricted blood vessels and irritation of the free nerve endings in the area.
  • After the ache, people generally report a burning or painful sensation which eventually becomes numbness. This necessary sequence typically takes 5 minutes.
  • Hanging in there until the area becomes numb and leaving the ice on for another 15-25 minutes will help you get the full benefit of icing.

If you’re dealing with back or neck pain, check out these articles as well:

4 Stretches to Help Relieve Low Back Pain

3 Stretches to Help Relieve Neck and Upper Back Pain