Which to use? Heat vs. Ice

By Dr. Jeff Phelps
Orthopedic Spine Surgeon
Spine Works Institute

One of the most common question we receive from patients who have back or leg pain is which is better, heat or ice? I think the most appropriate answer is to ask yourself which works better for you.

Oftentimes we will have patients state that heat seems to work a little bit better and sometimes patients come in and say ice seems to work a little bit better at relieving their pain. The majority though between the two seems that heat does a little bit better job.

The reason that heat seems to alleviate the pain to a greater extent lies in the fact that heat generally causes muscle relaxation. Conversely, whenever you ice a muscle or joint it generally causes a little bit of increased stiffness due to decreased blood flow. Most of the injuries that we see are generally strains and pulls of the muscles or ligaments of the spine. Because of these muscle or soft tissue injuries heat seems to do a little bit better in terms of alleviating the pain and spasms associated with the muscle sprains.

How can you apply heat to an injured back? Of course using a heating pad is a tried and true method. It is important to not lay on the pad for extended periods of time as they can cause burns. Another option is to take a towel, soak it in water and microwave the towel for a number of seconds. It is extremely important though not to over microwave the towel as you can get the towel extremely hot at it is very easy to burn yourself.

Gentle stretching while you heat a body part generally helps the heat penetrate slightly deeper and helps to relax that muscle.

For my patients who generally prefer ice a great trick to do is to take a disposable plastic or styrofoam cup, fill it with water and place it in the freezer. Once the water has hardened you can tap the ice out of the plastic cup and wrap a towel around the thick part of the ice cube you have made in the cup. You can then use that cone of ice to massage a shoulder or back or knee or thigh and it helps the cold penetrate deeply into the muscle.

Heat and ice can be extremely helpful in terms of treating muscle sprains including those of the neck and back. It is largely a personal preference but I think that heat wins out.

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