What is best for my injury? Ice or Heat?

As physiotherapists we often get asked whether ice or heat is better for an injury. A common theory is that ice should be used in the acute 24-48 hour phase and heat thereafter. I believe this theory to be a good guideline in the instance of sporting type injuries such as ligament sprains. However, when it comes to neck and lower back pain, heat is usually the option I would recommend. From my clinical experience, I find more patients not only respond better to heat for neck and lower back pain, but also feel a reduction in nerve sensitivity with heat compared to ice.

Using ice is great for calming injuries that involve superficial structures like ligaments and tendons, and those that tend to be swollen, red, warm, and inflamed. Some examples where ice is highly recommended include: a sprained ankle or wrist, an acute hamstring muscle strain, Iliotibial (IT) band friction syndrome, and plantar fasciitis. These are injuries where ice usually works best (at least for the initial acute phase).

In contrast, heat works really well to relax muscle spasms and trigger points, while calming the nervous system and allowing blood circulation to increase mobility. Typically, I would recommend heat for conditions such as: osteoarthritis, headaches, neck and back pain. Some will suggest ice for neck and lower back pain, however ice can lead to stiffening of joints and tightening of muscles (think about when you are out on a cold winter day – your body tends to feel more restricted), actually resulting in more discomfort and pain. Heat is particularly good for neck and back pain because it helps settle down and relax the nerves surrounding the spinal area, thus is far more comforting.

The bottom line?
As a guideline, I would typically recommend heat for neck and back pain and ice for pain involving the extremities. However, we know this is not always the case for every injury or every person and which one to use truly depends on what you are trying to achieve (ie. reduce pain, increase range of motion, relax muscles, etc.). Listen to your body and see what feels right – try one and if it doesn’t feel helpful then switch. Everybody is different and will respond a bit differently, so it is all about what is most comforting to YOU and what is helping YOU! If in doubt, don’t be afraid to ask one of your Enhance Physios, or call in to the clinic – we would be more than happy to help over the phone too!