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Heat or Ice?

One of the most popular searches for information on how to treat neck or back pain is whether to apply heat or ice to the injury. There are other articles written on the topic but I thought we would attempt to condense the information and make it easier to digest and apply our own spin on trying to relay an otherwise misunderstood topic.

So, let’s first look at what Heat and Cold do

They are both tools that can be used to help along the road to recovery from a back or neck injury. Let me be clear, they are not cures, these tools simply help and work alongside other treatments and good practices such as healthy eating, stretching and exercise to get your back or neck back in good working order.

Heat, when applied to an injury helps improve the blood flow to that area. It does this because when it heats up an area the body automatically increases blood flow to that area to help cool it down. The body wants to naturally stay at around 97°F to 98°F, if you apply heat to an area and cause it to be say 105°F, the body reacts accordingly.

So how does increasing blood flow help? Well your body knows you have an injury and instinctively sends more white blood cells to the area. This means that there are fewer red blood cells in the blood flowing to the area. This causes a problem in that the area becomes under oxygenated, receives less nutrients and does not do as good of a job in terms of keeping the injured area clean by getting rid of the local waste through red blood cells.

So now by applying heat, the body sends more blood to the affected area thus increasing the red blood cells helping to oxygenate the blood, provide the much needed nutrients and help clean up the affected area by carrying off local waste etc.

Cold on the other hand has the opposite effect as heat in that it causes the temperature of the affected area to drop below the regular temperature the body likes to keep itself at, but it has the same impact on what the body does and that is that the body now sends an increase of blood to warm the area up!

So applying heat and cold effectively do the same thing! Increase blood flow resulting in increased oxygenation, more nutrients and a higher rate of waste disposal for the affected area.

Another positive impact heat and cold have is that they both help reduce the pain caused by local nerves that may be damaged. The cold numbs the nerves while the heat relaxes them.

So which is better?

Well we know that both do a good job of increasing blood flow but it is recommended to apply ice first and to try and follow three simple rules which are:

  1. The 20/20 rule – 20 minutes on and 20 minutes off. Allow the affected area a chance to recover from the cold application and then re-apply. 20 minutes on and then 20 minutes off should do the trick. Try and go through this cycle 3 times if possible.
  2. Act Fast – The sooner you can get ice on the injury after it happens, the better. Getting ice on your injury immediately will eliminate or at least reduce the chance of severe swelling which leads to the increase in the white blood cells. Recovery from the injury will be faster and less painful if you can follow this step.
  3. Stick to the cold – For the first 2 or 3 days you should stick to using cold over heat until you feel you have the swelling minimized and under control. After that feel free to mix in some heat as you wish but still try to limit the application of heat or cold to 20 minutes at a time.

What’s next?

Once you have the swelling from your injury under control and you feel comfortable enough, you can begin some stretching and exercises. It is a good idea to use some heat prior to stretching and exercising at this time to help loosen up the area and increase the blood flow. This will help you get more out of your session and by applying some ice after wards you will help speed up the recovery time.

Exercise and stretching are two of the best things you can do to maintain a healthy and happy spine. Integrate them in to your daily routine even if you do not have a bad neck or back. Trust me, your spine will thank you for it by being more resilient and less prone to injury.


The advice and information given in this article is general advice and information. The spine is a complicated part of our anatomy and you should always consult with a doctor before beginning any new exercise regiment or applying any treatments when possible.

Keep healthy and stay happy!

Dr. Marcello Sammarone, MD ●