Back Talk: Which is best, icing or heating?

By Dr. Layne Towery
March 11, 2014 at midnight
Updated March 10, 2014 at 10:11 p.m.

Every time I have a pain, my doctor says to put heat on it. It rarely helps. I also fell asleep with a heating pad on my back and got a third-degree burn. How long is too long for ice or heat? When should I use ice and what type of ice pack do you recommend?

Hot and cold therapy both have the ability to decrease pain and muscle spasms. They have the opposite effect on tissue metabolism, blood flow, inflammation, edema and connective tissue extensibility.

Ice or cool therapy as the choice of modality will decrease the above effects, while heat or warm therapy will increase them.

There are three phases of healing. The first is the inflammatory phase, next is the regeneration or repair phase and finally the remodeling phase.

Ice is always the first thing you should use when you have an acute muscle or joint pain. Ice will help reduce swelling and inflammation. It will also accommodate redness from the increased local temperature, which usually lasts three to five days.

Next is the repair phase. Now is when you can start alternating heat and ice. Adding warm therapy to the injury at this time will increase circulation and cellular metabolism, which will result in an influx of oxygen and nutrients to promote healing of the damaged tissue. This phase lasts about six weeks.

During the last or remodeling phase, restoring flexibility and increasing range of motion is very important. Heat can be used at this time. Because tissue becomes more extensible after it has been warmed up, range of motion exercises can easily be performed at this time.

Ice should be used for 30 minutes at a time. Your skin will initially have a burning feeling for a short time and then get numb after about 15 minutes. We use an ice pack that has a Velcro strap so you can still be mobile while you're icing the injured area.

I am not a big fan of heating pads, but if you use one, I would get one with a timer. Remember, never fall asleep while using a heating pad.

Layne Towery is a Victoria chiropractor and acupuncturist and can be reached at or 361-570-6284.



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