Ice or heat: Which is best for back pain?

When you’re struggling with back, neck or joint pain, you’ve probably been told to try ice or heat to relieve pain. Whether that’s an ice pack, a cold (or hot) bath, freeze sprays, heat rubs, or a good old hot water bottle, it’s something that’s synonymous with healing.

But which one is really best?

Let’s find out…

Ice heat
Ice, ice baby

Hot and Cold Treatments: What do they do for back pain?

The general understanding of both ice treatment (aka cryotherapy) or heat treatment (aka thermotherapy) is that they both act upon the structures in our body to relieve pain, but in different ways.

Ice is thought to soothe inflamed structures, reducing swelling and relieving discomfort.

Heat is thought to increase blood flow to the area, warming sore muscles and again, reducing pain.

But is this true?

Ice or heat: A sensitive subject

The things practitioners choose to argue about…
Yes, you wouldn’t believe the debate in the healthcare community about ice or heat… particularly amongst those of us who keep an eye on what the latest research says. The truth is, there is no general consensus anymore in regards to which is best. (This is despite numerous websites claiming that one trumps the other and vice versa.)

So unclear is the debate on this one that the Cochrane Review is currently being updated on the guidance! (The Cochrane Library is a site that pulls together the best available evidence on a subject, reviews it, and provides high-quality, reputable reports for healthcare professionals to help guide our treatment plans.)

Hot or cold: Which one should I use?

Old thinking used to state that ice was of most benefit to acute (new) injuries to help reduce inflammation. Scientific studies increasingly find that inflammation is actually a good thing, and that we shouldn’t be trying to get rid of it, certainly not in the early stages. (This is why you may have seen recent news articles stating that anti-inflammatory drugs may increase our risk of chronic pain.)

Similarly, it was thought that heat would promote blood flow to an area, which in turn promotes healing.

ice heat
Burn, baby burn

Ice or heat: What the latest thinking actually is

The main goal of using either cryotherapy or thermotherapy is actually to reduce pain. It does not appear that one is better than the other, and instead, it’s down to whichever feels best!

I’d be inclined to agree with this thinking.

I’ve had many patients say to me that they tense up against cold packs. Or, that they find it difficult to get in and out of a hot bath when their back is sore! Rather defeats the point of feeling better, doesn’t it?

So, my advice to you: Go with whichever feels best!

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