Cool it Off or Heat it Up ?

Hi this is dr. John Shim and today I want to talk about a very common and controversial topic, and that's the use of ice versus heat for back pain. We all know that for acute injuries such as sprained ankles or twisted knees using ice is the preferred method it decreases inflammation decreases the pain and in contrast in these acute horrible sprains and strains and even breaks if you use heat you actually increase the inflammation may actually cause more pain and discomfort. Well does that apply to your back? Well, it turns out it's relatively controversial but in my opinion if you think you really pulled or stretch the muscle or tendon or ligament of your back and it's really very very painful I do think ice is a benefit to you. Ice has that property of cooling the skin therefore cooling some of the nerves. Ice also has that property of decreasing the inflammation so it could be beneficial for you, but there are some cautions to must take when we use ice. Never put ice directly on the skin because it could potentially cause frostbite. Always use something like a towel barrier and do not apply it on the skin for more than 10 or 20 minutes at a time. You can't repeat it as often as you like after you give some recovery time to your skin. When you use ice make sure you rest during that period of icing. I can't tell you how many times I see people walking around with ice packs or doing work with ice packs still pushing stretching pulling on their muscles. In a way you're kind of defeating the purpose of using the ice because the ice are there to decrease the inflammation swelling. If you keep pulling and tugging you're actually flaring up the situation. Get some rest during the period of using ice. Ice packs can be gel packs frozen towels or even a package of frozen peas. Folks with certain medical conditions such as Raynaud's disease, loss of sensation to the area, or paralysis should avoid ice therapy. Studies have shown ice can be beneficial but more studies need to be done. Now I want to switch gears and talk about the use of heat. It turns out heat therapy can be beneficial for chronic back pain and stiffness but not for acute injury. Remember that as I talked before in acute injuries you can actually increase the swelling and inflammation. In chronic conditions chronic stiffness heat can help dilate the blood vessels and deliver more nutrients to the sore and stiff area. Heat helps stretch the softer tissues including the muscles, ligaments, tendons and it eases stiffness. Forms of heat include a hot water bottle use of a sauna or a warm bath. For those with loss of sensation or paralysis you have to use caution because it can be too hot or you won't feel how hot that area would be. Remember not to apply a hot water bottle for more than 20 minutes at a time and use some common sense and don't stay in a Sode up for more than 15 to 20 minutes. Always check your water temperatures both with the water bottle and before getting into the bathtub. Studies have shown some limited benefit to heat therapy and more studies need to be done to prove its benefit. An alternative treatment is to rotate cold and heat therapy every 15 to 20 minutes for chronic conditions but remember the general principle, avoid heat for acute injuries use heat for chronic stiffness and chronic arthritis type conditions. This is Dr. Shim talking about the use of heat versus cold and treating back pain. Thank you for listening.

One of the biggest questions we get after an injury is “should I put heat or ice on this?” It seems so simple, but it is one of the most controversial questions in injury medicine.

Let’s talk….

There have been many studies done on the efficacy of heat or ice on joint, muscle or soft tissue injuries and there is actually very little solid evidence to steer you toward  one or the other. Basically we have to go on experience and past results, and a little bit of common sense.


For acute injuries such as contusions, torn muscles, and fractures, use ice.  It decreases the inflammation and reduces the pain signals.

Wrap an ice pack, a pack a frozen peas or corn, or even frozen towels so the ice is not directly on the skin.

Only use ice packs for 10-20 minutes at a time to prevent frostbite.

Rest during a period of icing and if you are icing an extremity, elevate it.

Avoid ice if you have Reynaud’s disease, loss of sensation to the area, or paralysis.


For chronic injuries such as low back pain and stiffness, use heat.  It helps dilate the blood vessels, delivering more nutrients to the sore and stiff area.  It also stretches the softer tissues, including muscles, ligaments and tendons, easing stiffness.

Heat can be a hot water bottle, a microwave pack, a warm bath, or a sauna.

Heat packs should also be wrapped to prevent any burning of the skin and should not be kept on longer than 20 minutes.

Though heat can be a comfort, it should not be used on postoperative incisions or for acute injuries. Lengthy stays in a sauna or hot tub can cause weakness and dizziness. This could cause a fall that would result in more injuries.

The biggest thing to take from this is to not use heat on acute injuries or exacerbations. It will only increase any swelling, and along with that, the pain.


  • Schwitzguebel AJ, Muff G, Naets E, Karatzios C, Saubade M, Gremeaux V. [The acute management of muscle injuries in 2018]. Rev Med Suisse. 2018 Jul 11;14(613):1332-1339. PubMed PMID: 29998635

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