ICE Vs Heat: The Ultimate Guide

One of the commonest questions patients ask us is when to use ice and when to use heat. Everybody seems to have an opinion about this. In fact, you can ask two of your friends and theywill probably give you three opinions! Using ice or heat can be very beneficial indeed, especially when used for back pain, slipped discs, muscle spasms and/or sciatica, something we see a lot of at our clinic. So, when and how should you use ice or heat? Please allow me to explain:


Firstly, in our clinic we use the Visual Analogue Scale (VAS Scale) for our patients to rate their pain. The principle is very simple: Patients are asked to rate their pain and give it a number between 0 and 10, with 0 being no pain at all and 10 the worst pain imaginable (for women10 equals giving birth, for men 10 equals hitting their big toe!). Pain rated between 0 and 5 onthe VAS scale is often a chronic, niggling and constant pain. Pain rated between 5 and 10 is often a sudden, acute sharp pain.


An acute injury, being a slipped disc, sciatica, sudden back pain or a sports injury is usually accompanied with swelling and inflammation. In these circumstances Ice would be recommended for the first 48 to 72 hours after the injury. Ice helps to reduce the swelling by constricting the blood vessels. Additionally, ice soothes acute pain by causing numbness in living tissue. It is highly recommended that you do not apply the ice directly to the skin (to avoid frost bite). We normally recommend applying the ice for 10 minutes per hour over the affected area.


Heat is generally more helpful with chronic injuries that have occurred over time, like re-occurring injuries or tightness. These conditions would respond better to heat, since heat tends to dilate (open up) blood vessels thereby increasing blood flow. Similarly to ice, it is best to apply heat in cycles, so 20 – 30 minutes on each hour. If the skin becomes painful or inflamed then please stop applying heat. You will find a few quick examples of what you should use with certain types of injuries in the full version of this article on our website when dealing with an acute back pain caused by lifting, a pain caused by wear and tear and a sports injury.


Let’s take a look at a few examples of when you might use ice or heat.


Question: Let’s say you are working in the garden, felling the tree that your wife has asked you to fell for 6 months now. You are almost done, and are getting ready for the last big swing withthe axe as suddenly, you feel this sharp shooting pain in your lower back. What do you use?


Answer: Ice. Chances are that you have slipped a disc doing this and the sharp pain indicates that there is swelling and inflammation. You want to lie on your back and apply the ice on the area where it hurts. Then, as soon as you can half move again, ring our clinic.


Question: you are walking the dog, it is a typical British December day with rain, wind and it is cold. You are starting to feel that niggle in your lower back again. What do you use?


Answer: Heat. This is probably an old injury playing up. Something you did not have properly checked when you did the injury 10 years ago. You might want to have that checked you know!


Question: You are preparing Christmas diner. And just as you are bending down to put the turkey in the oven, you feel this sudden pain in your back. What do you use?


Answer: Ice. You probably have had a niggle in the lower back for some time, and decided to ignore it because it was not really holding you back. And then, just at the most inconvenient time, it decides to play up. Typical. Use ice and get it checked.