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Back Pain – When to use ice vs. heat

A question I get asked a lot by clients and people who suffer with back pain is a really simple one: “When do I use ice and when do I use heat?” Rightly or wrongly, 9 out of 10 of my clients tend to favor heat–a nice hot water bottle, a soak in the bath, or one of those lavender scented wheat bags to try and ease their back pain. (I think a lot of people don’t like the idea of putting cold ice on their back, unless it’s really hot outside!) As you can appreciate, every concern and injury is different. Sometimes it’s ice to cool it down, or heat to help relax it. It can be very confusing!

When to use ice

 There’s one time in particular we say to use ice and that’s when something just happened and it’s very painful, likely hot and maybe swollen. This is an “acute” injury—”acute” meaning it just happened. For example, an ankle sprain or pulled muscle. When it comes to your back pain, the time to use ice is if your back has suddenly “gone” and you’re in a lot of pain, or you’ve overdone it and your back becomes very painful towards the end of the day. You see, your body is actually very clever.

Let’s use an ankle sprain as an example. When you sprain your ankle, your body will immediately try and protect itself. This is why you get swelling and it becomes very hot and painful. The swelling is just your body’s natural cushion to protect against the sprain. The pain and heat come from the inflammation. Again this is your body’s way of trying to protect and heal itself. If something’s painful, you’re not going to want to touch it, are you? The exact same thing is happening in your back too. You just can’t see it.

So your ankle, back, or whatever you’ve hurt can start to heal without any more damage. So that’s WHY it happens. But this pain can be worse than the actual injury itself, so cooling it down with ice is a simple method to help ease the intensity of the pain as soon as possible. And by using the cool ice for short periods but often on the injury (20 minutes every hour or so), the cooling and warming of the injury will help the blood keep flowing around the area to help it heal even quicker. Now we’ve got an idea of when it’s the best time is to use ice, so now let’s tackle when to use heat.

Try thinking of it like this

When something is warm, it’s softer, and when something is cold, it’s harder (Think of a chocolate bar. Like most things, when chocolate is warm it’s softer.) It’s exactly the same with our body too. With that in mind, I always explain to my patients that it’s time to apply heat when you feel more stiff, achy and need to get things moving–that’s the perfect time to use heat. So first thing on a morning if your back’s feeling really stiff and tight, a hot shower to loosen the muscles also works wonders. Follow that with some gentle stretches too and you’ll feel a huge difference!

Typically if it’s something that’s been nagging you for some time (chronic), and it’s more stiff and achy rather than painful, then heat is the way to go. The reason it’s stiff and aching is because the muscle joints are so tight. Like anything, you warm it up and it’s more supple. It’s exactly the same with your joints and muscles. Muscles should be able to move. If they’re stiff and tight, you’re more likely to have an injury by over stretching them as they simply can’t stretch as far as you need them too. It’s for this same exact reason footballers and any sports people warm up before doing their sport so they don’t pull a muscle!

Here’s Why

When we’re asleep at night our muscles cool down because they aren’t being used, so our blood is going directly to our brain for our dreams and for our stomach to digest our dinner. So why don’t we warm up first thing in the morning to get us ready for the day? Don’t worry, I’m not talking about 10 laps jogging around the block. Just a warm shower followed by a few minutes of simple stretching.

Not sure what stretches to do? I always recommend the perfect combination of Yoga and Pilates style stretches to keep your back healthy and pain free. The key things to remember: If it’s just happened and is very painful– ice it! If it’s stiff and tight– warm it up! That’s it from me this week. I’ll be back again next week. Until then, have a great week!

The author, Jennifer Penrose, is a Physical Therapist and owner of Penrose Physical Therapy. If you have any questions about back pain, you can call (360) 456-1444 or email


“How does a Naturopathic Physician fit into your healthcare?”

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Check out other back pain articles HERE


Jennifer Penrose

Penrose Physical Therapy

"Leading Experts Helping People Become More Active and Mobile, Reduce Stress and Achieve Longevity… So They Can Enjoy Great Health For Years to Come!"

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