When Do I Use Ice? …And When Do I Use Heat?

Easily one of the most common questions I get asked daily, and it’s something that confuses many people… “Should I use heat or ice for my back pain?”

Rightly or wrongly, most people favor heat – a nice hot water bottle, soak in the bath, or one of those lavender scented wheat bags to try and ease their back pain. I think of the key reasons is the simple fact that we live in Wisconsin, where winter can last months!

Every health concern and injury is different…

So 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, a sprained ankle or pulled muscle.

When it comes to your back pain, the time to use ice is if your back has suddenly ‘gone out’ 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 or activity.

You see, your body is very clever. Let’s use an ankle sprain as example. 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 move or 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 is happening. But this pain can often be worse than the 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 little and often on the injury (20 minutes every hour so), the cooling and warming of the injury will help the blood keep flowing around the area to help it heal even quicker.

Okay, so now that we’ve got a good idea on when to use ice… how about when do we use heat?

Try thinking of it like this… When something is warm it’s softer, and when something is cold, its harder (think of those chocolate easter eggs you can’t help but sneak into!) it is exactly the same with our body too.

With that in mind I always explain to my clients 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 in the morning if your back is feeling really tight, a hot shower to loosen the muscles often works wonders. Follow that with some gentle stretches and you’ll feel a huge difference! Typically, if it something that’s been nagging you for some time (think chronic) it’s best to use heat as the muscle and joints are tight, which is what is making it ache and stiff.

It’s for that same reason football players and any other athletes warm up before their sport – so they don’t pull these muscles. 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 your neighborhood. Just a warm shower followed up by a few minutes of simple stretching. Not sure what stretches to do? A physical therapist can help! Give us a call at the office (920) 230-2747 to set up a time to talk one on one – either in person or over the phone, completely FREE!

So key things to remember – if it just happened and is very painful – ice it, if it is stiff and tight – warm it up!

For more tips like this on how to ease back pain, click here where you can download our free guide with easy ways to heal back pain HERE.

About the Author

Eric Koehler

Eric Koehler - PT, DPT, OCS, FAAOMPT, Certified Dry Needling


Dr. Eric Koehler has been working as a Physical Therapist for over 25 years in the Oshkosh, Wisconsin and Fox Valley area. He has a Doctor of Physical Therapy degree and has completed his Fellowship in Orthopedic Manual Therapy in 2017. This level of clinic training is only attained by 1% of all Physical Therapists. Eric's mission is to provide non-surgical, non-drug approaches to help individuals overcome pain and weakness to help them get back to enjoying their life.