As a Doctor of Chiropractic I get asked this question a lot. What should I put on my aching muscles, Heat or Ice packs?
Firstly I should mention that, if your back is aching because you fell off the top of a 14 foot ladder, you have a knife stuck in your back, you’ve been shot, or you have severe pain with any of the following new symptoms, numbness in your legs or groin, bladder and bowel weakness , feel unwell, have a previous history of cancer, you are in severe pain and cant get any relief in any position or by resting, or any other symptoms you suspect are not from the muscles and joints in your back, then seek medical attention. NHS Direct is a good start if you are unsure.
There is research to support both Ice packs and heat packs. However 17 years of treating injuries from acute ankle sprains to chronic zygopophyseal joints, has taught me they both are useful, depending on the timing and injury. Remember there are always exceptions and common sense should apply!
90% of the Time I recommend ICE packs. Most recent injuries, sprains, strains and pulled muscles are painful due to inflamed tissues. If you can press on the area and it hurts, inflammation is very likely. You cant always see the swelling. Inflammation releases chemicals that burn the tissues, increases the local temperature, the heat makes all the burning chemicals work even better. The chemicals send pain signals to the brain that sensitize the nerves to signal more pain with less stimulus. This draws fluid to the area that cause more swelling and dilates the blood vessels drawing more blood to the area which carries all the products for even more inflammation. Ever heard of a viscous cycle?
Ice to the rescue. Cryotherapy is the fancy name for using ice packs. Ice will reduce the temperature, making the chemicals of inflammation less active. Ice shrinks the swelling. Ice constricts the blood flow so there isn’t more chemicals coming to fuel the fire. Ice numbs the nerves giving you some pain relief. Ice helps control the inflammation. A natural anti-inflammatory!
The best way to use Ice is wrapping a bag of frozen peas, or crushed ice, or these soft pliable gel packs(available from most pharmacies), in a tea towel. Make sure the frozen peas, the ice or the gel pack is flexible and not in one frozen clump. Place it over the area that hurts when you press, make sure there is some cloth between the pack and your skin. The ice pack will be cold achy and burning at first but should fade away to a “numbish” relief. This usually takes 10 to 20 minutes. Don’t leave the pack on longer than 20 minutes. Take the pack off and put it back in the freezer. You can re-apply the ice pack after 30 minutes. Do check for frost bite or any reaction to your skin that doesn’t settle in a few minutes. If after a few minutes the ice just makes it feel worse and worse, apply common sense and stop using it. Most conditions usually need 3 to 4 re-applications of the ice pack and it may a take a few days of using the ice to completely settle the inflammation. You don’t need to lay on the ice pack, often tucking the ice pack into clothing is the easiest way, especially for the lower back and neck. The ice may make the muscles stiffen but you can usually avoid this by staying mobile while using the ice packs or by getting up half way thru the session and moving gently in the pain free range for a repitions.
You can view my video about proper ice pack use here
People with skin conditions over the injured area, or those with sensory problems (eg Diabetes, neuropathy) should seek further advice prior to using ICE or Heat.
Heat is tricky. Heat is the opposite of Ice. Heat can help the muscles to relax but it can and usually does aggravate inflammation. If you suspect it is just a pulled achy tired muscle then you can try using heat packs. But be warned. Heat always tends to feel good while it’s on. It dilates the blood vessels bringing more soothing warmth to the area, as well as blood and fuel for the fire(inflammation). If there is inflammation present, (and if its fresh there usually is) you may be lucky and feel it while the heat pack is on and common sense would tell you to take it off and not use it again. However, it usually just feels good while it’s on, but an hour later you are worse due to the blood bringing in more swelling, inflammation and the heat activating those inflammatory chemicals. If you don’t know any better, you put the heat on again because it felt so good the first time, and you get relief again, but an hour later you are reaching for the heat pack. Viscous cycle? You are now contemplating putting that hot water bottle on while in bed to help you sleep. Unfortunately you wake very sore, stiff and yes, more inflamed. We swell more at night, our circulation slows, we don’t move around as much and we are usually more inflamed. Please don’t get trapped by the heat pack! If you try heat packs,(maybe because you are nesh and scared of cold), use the Wheatie bags or hot water bottles and make sure it isn’t going to burn your skin. The gel packs are best as ice packs only and I wouldn’t recommend using them for heat. These packs can crack and hot lava like gel on the skin burns! With heat packs they can stay on 30 minutes. Stay vigilant over the next hour and watch for any signs the heat has aggravated any inflammation. You can check by seeing if the pain worsens and if you are now more tender to touch then before. If so, stop using it and consider using the ice packs. Heat packs work very well when it’s just tight muscles and there is no inflammation. One or two applications of the heat pack should have you feeling much better, so if you are on the 4th application of heat and are no better, consider ice.