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  • Q&A with Australian Health Practitioners

    Is it better to apply heat or a cold ice pack for back and neck pain?

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    Back & Neck Pain Pain
    I have heard people using both methods… some use a heated pad while others use a cold ice pack. Which is better?
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    Dr John Smartt

    Osteopath

    John Smartt is an osteopath who practices in the centre of Sydney. View Profile

    There isn't a straightforward answer to this. Heat will tend to relax the muscles, but, if the injury is very close to the surface, it will also tend to increase the blood flow, and therefore increase the inflammation, which is likely to increase the pain. Cold will tend to take the pain away short term, and will help to reduce inflammation, but it will also tend to make muscles tighten, which may make the problem worse. 
    So both heat and cold are two-edged swords; it really depends on the particular problem.

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    Dr David Salisbury

    Osteopath

    Dr David Salisbury is an osteopath situated in Lakes Entrance, Victoria. He completed his osteopathic studies at RMIT University, and now works at Complete Freedom … View Profile

    I agree with John. I think that the realxing effects of heat work well for long term back or neck pain, whereas an icepack can help if you have injured yourself in the last 48 hours. Sometimes I recommend a combination of the two - eg. 5 minutes heat, 5 minutes cold, 5 minutes heat etc. So you can get the benefits of both.

    Dr David Salisbury - Osteopath - www.bdhh.com.au

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    Vitali Kanevsky

    Physiotherapist

    Modern, comfortable, clean and well equipped practice in Rose Bay, Sydney providing high standards of professional care, dedicated to returning you to pain-free activity.Physiotherapists are … View Profile

    Unless you've specifically torn the muscles around the neck or back, or bruised it with visible swelling I would always suggest heat. As above this will relax the muscles and has been shown to very effective with pain relief.

    Most neck and back pain relates to the deeper structures around the spine and the temperature effects of ice would not penetrate that deep - the surrounding blood filled muscles dissipate the cold. Muscle spasm around the neck or back it usually secondary to the deeper source of pain and is best managed with heat.

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    Dr Ryan Hislop

    Chiropractor

    Ryan Hislop is the Clinical Director at the Orange Chiropractic Health and Wellness Centre. As an experienced and evidence-based diagnostician, Ryan works largely by medical … View Profile

    This area is definitely debatable, so sometimes it is helpful to seek an experts opinion for each individual case. There is even new research suggesting that using ice for an extended period of time causes an increase in blood vessle dilation in deeper tissue which actually acts as heat.

    It may help to look at what each modality does.

    Ice constricts blood flow to muscles. As the muscle cools, the amount of blood in the muscle diminishes as the constriction process pushes it out.As the muscle warms and the blood vessels expand, new blood comes rushing in and cleans the debris left behind from the injury and stimulates the healing process. The more often the cycle is allowed to transition, the faster one’s body can recover from an acute muscle injury (injury having severe onset and a short course).  Note that the increasing the icing time has a negative effect on the body.

    Heat on the other hand increase blood vessle dilation and increases blood flow in the area. This has a relaxing effect on the muscles and soft tissues. In some instances where the is already increased blood flow to an area such as during localised inflammation/bruising/swelling, this modality may be detrimental as there may be an increase in the amount of swelling and bruising, slowing healing times.

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    Dr Jonathan Evans

    Osteopath

    Registered Osteopath Focusing onInjury Recovery, Scoliois, Shoulder & Neck ProblemsPre & Post Pregnancy TreatmentPaediatric Osteopathy For Babies & Children View Profile

    I would agree with the other posts that there isn't a straightforward answer, I won't repeat advice that's already been given, but I would add that some chronic conditions, such as MS react badly to the use of ice. My general rule is the further the injury is from the spine the more effective ice is,  i.e. great for anke & knee sprains, but not that effective for back & neck.

    Here's a link to an article on the use of heat & ice that also discusses RICE (Rest, Ice, Compression, Elevation) http://www.ionosteo.com/ionblog/bid/202424/Is-Rest-Ice-the-Best-Treatment-for-a-Joint-or-Muscle-Injury

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