There is an enormous amount of confusion about the use of heat or ice in different kinds of pain.  The confusion is made worse by all of the marketing guff on the brightly coloured packets at the local pharmacy.  It is a shame it has been made so complicated.  It’s really quite simple for most people in most situations.

Therapeutic heat and ice are simple, easy, inexpensive and helpful self treatment aids for most people and in many common problems.  Neither is a magic bullet but they can help.

When I’m talking about heat, I mean stick on heat patches (the sort that stick to your CLOTHES – not the ones that stick to your skin).

When I’m talking about ice, I mean frozen water (cubes, frozen plastic bottle full of water).  The little freezer gel packs don’t get nearly cold enough to have the effects we are looking for.

Don’t use heat or ice directly on your skin and be sure to check that you don’t have a health condition which could make heat or ice unsafe.

Ice is for acute/new injuries near the surface

When you have a sudden onset of new pain and it is red/hot/swollen then ice is appropriate.  Examples of when icing is good: a freshly pulled muscle or a sprained ankle.   You can use ice on chronic overuse injuries like tennis elbow, plantar fasciitis and others as well.

The inflammation is a healthy and normal process, but it’s painful. Icing doesn’t help so much with the inflammation – there is evidence it doesn’t directly impact recovery at all – but it is a great help for slowing down the particular process that causes pain.  There is a good rule of thumb: wrap the ice in something (a thin cloth), apply the ice until the area feels numb, then take it off. Wait till the area warms up again – and repeat. A lot.

Heat is for muscle pain/aching and stiffness, chronic kinds of pain, and stress related pain.

Heat helps soften and take the edge off, both physically and mentally. Chronic kinds of pain (pain that comes back) can involve a lot of anxiety and ‘sensitised nerves’ which create pain where there may be no longer a problem in the tissues.  Warmth can really help with this, physically and mentally.

Over 99% of the time, my patients are advised to use heat for their back and neck pain because most of the causes of pain in the neck and back are not caused by things which are helped by ice (namely an acute injury). What often feels like an ‘injured’ back is usually not ‘injured’ if it’s been going on a long time.

Ice and heat can cause short term issues if you use them at the wrong time.  Ice can make stiff tense muscles feel much worse.  Heat can aggravate acute inflammation.

Now that’s the evidence. Both ice and heat have a roughly equal and mild effect on pain.

However – The evidence also shows that in many cases, if a patient uses what they have a strong preference for it will work better for them than the alternative.  So if you hate the idea of applying heat to yourself  – then try ice. You can always change your mind if it makes your pain worse.