Back and Neck Pain? Learn If Ice or Heat Is Better For You

Before I go any further, I need to issue a standard disclaimer. Obviously an article like this is not meant to replace the advice you would receive from your chiropractor, doctor or physiotherapist. Be sure to consult with an expert before taking any steps. Common sense prevails!

I got my start as a Paramedic in the Toronto area before deciding to get a Nursing degree at the University of Ottawa. My eyes were set on going to medical school. At some point in my education I had a change of heart and practicing medicine (at least the way we do it North America) no longer made sense to me. Looking back at the skepticism I once had for chiropractic, it’s amazing I eventually chose it as a career. Five more years of school (total of 10 academic years post-secondary) and I was a Chiropractor.

I remember my first back injury like it was yesterday. I was a Paramedic in my early twenties.

I thought I was invincible until that first time my knees buckled from searing back pain. I was out of work, depending on WSIB for income and at times I thought I was never going to get better. It was a long road back to health and I learned a lot.

The question at hand is, «when I have back or neck pain, when do I use heat, when do I use ice and when do I use neither?«

It’s a good question and I get asked this all the time. The answer is not that simple. Sometimes I apply ice, sometimes I use heat and most of the time I just leave it alone and do nothing.

2 Rules of Thumb

  • I apply ice from the outside and generate heat from the inside.
  • Most of the time I let my body heal without the use of heat or ice.

Let me explain. Heat feels good. Really good. But when it is applied in the form of a hot-pack or a bath or the ‘magic’ bean bags, it feels good in the moment but it may actually worsen the situation and prolongs the process of healing. I know… it’s hard to accept, but it’s true.

One of the mechanisms your body uses as part of the healing process is increasing blood flow to the affected area. The theory is that more blood flow allows the delivery of special hormones, chemicals, blood clotting factors, immune system activity etc. This extra blood flow is called ‘inflammation’. Inflammation can be good — yes, good. It is part of the healing process. Having said that, when the inflammation accumulates or is excessive and does not reduce, this process stops being beneficial and starts to become… a pain.

Now consider an injured muscle or joint that has become ‘inflamed’ due to your body’s natural response to the injury. The question now is whether to apply ice, heat or just leave it alone.

Consider Heat: The area is already full of extra blood flow, the hot-pack may feel good, but it will bring even more blood to the area. Bad idea.

Consider Ice: Your body is trying to use blood flow and early stages of inflammation to heal the injured tissue. We know that use of ice will reduce the blood flow and reduce inflammation. Should we interfere with mother-nature and possibly hamstring your body’s attempt at healing? Probably not.

Consider Applying Nothing, Zip, Nada: «But it huuuuurts… I want pain relief!»

Rule of Thumb #2

  • Hot-pack: I never use it despite the fact that it feels good.
  • Ice: I will rarely use ice on my own injuries unless there is significant swelling and the pain is severe enough that I would consider taking a pain-killer to numb the symptoms. Ice enables me to avoid the pain-killer. Even then I tend to back-off and let my body do what it needs to do.

There is always a ‘yeah but’. Sometimes we need to act. So here is when and how I will use ice and heat.

Heat: I never APPLY heat. I USE heat. There is an important difference. No heat packs… ever. Let’s say I injure my neck or back working in the garden. Days go by and I am still having back and neck pain. When pain from an injury like this lasts more than a few days, I know I have done some damage to my spine and likely caused some misalignment. I FEEL most of the pain in the muscles surrounding the spinal joints but if the root cause of the pain truly was in the muscles, I would likely fully recover within just a couple of days. The muscles are bracing the spine and protecting it from further injury. When the joints of the spine get locked-up, part of the solution is to get them moving again. Has this happened to me? Plenty of times. Regaining mobility of the spine is key and I do this by walking. When I injure my spine, the worst thing I can do is to lie still as my spine gets even more locked up. I need to keep moving. So I walk as fast as I can tolerate and GENERATE heat from the inside while simultaneously restoring some mobility to the parts of my spine that are now locked-up (by walking… LOTS of walking). My chiropractor (yes, Chiropractors are chiropractic patients too) will take care of restoring mobility to specific spinal joints. Incidentally, I loathe treadmills. I never use them and I never recommend them. I get outside. Cold out? I dress properly. When I am injured in the winter, I over-dress so I can get good and hot. Treadmills cause more injuries in my opinion.

«There’s no such thing as bad weather — just badly dressed. Now go out and play.»


Ice: Ice almost never feels as good as heat but it sure feels good after I have generated a lot of heat on the inside. Ice will help prevent the inflammation from getting out of control especially when there is visible swelling. So if I have injured my back and I am doing a lot of walking and generating a lot of heat, I will occasionally use an ice pack after the walking session to keep the inflammation and pain under control.

OK, last scenario. I wasn’t working in the garden and the injury is not acute. I just have a tried aching neck/back. Usually a good night’s sleep will do the trick. No ice, certainly no heat (other than heat generated from exercise) — I just leave it alone and let my body heal without interfering. Morning comes and sleep brought some deep healing and regeneration to my muscles and spine and all is well with the world. If the pain/discomfort is affecting my sleep I will use some ice before going to bed, ensuring deep sleep and self-healing.

Seven Steps to Use an Ice-pack.

1. No need to buy a fancy ice pack from the drug store. They are expensive and usually they don’t get all that cold. Usually a bag of frozen peas is the way to go. Buy two bags. Why two? Keep reading.

2. I apply the ice where it hurts (there is one exception)… keep reading.

3. I usually put a thin cloth between the ice pack and my skin. Dry cloth acts like insulation. Damp cloth transfers the cold to your skin nicely. No cloth is a great way to damage your skin (frostbite).

4. I leave it there (the ice pack) for about 10 minutes if it’s my neck and 20 minutes if it’s my back.

5. I will wait at least an hour before I do it again and I will generate heat in that hour via walking as described above. I tend to aggravate my back muscles and spine if I try to stretch right after I ice. Not a smart move.

6. When I go to ice again, my first bag of peas has not had time to fully freeze again so I reach for the second bag of peas!

7. For the love of everything sacred, I will not use the peas for anything other than an ice pack. I label them — so someone doesn’t decide to boil them up and eat them.

The exception to the Step #2: If the pain is shooting down my leg ( look-up sciatica ) then I would put the ice-pack on my lower back instead of on the leg. In this case, the inflammation is coming from my lower spine,   pinching   nerves  and the painful sensation is in the leg.