Hot or Cold – What should you use for your pain? And, should we rest back pain or exercise mildly?

Written by Stephen Sacks – Medically reviewed by Stephen Sacks – Last updated March 3, 2015

It used to be that I was so sure when people would ask me this most simple question.

Within 72 hours, use a cold pack to speed healing, decrease inflammation and swelling and bring blood and nutrition to the area.
Before 3 weeks are up, alternate hot and cold packs.
Once chronic, use hot packs.

But when someone says that they used hot by mistake instead of ice, they never seem to have made anything worse.

Now, recent research has thrown this up in the air.

According to The American Journal of Sports Medicine, June 2013, a summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains. Although it seems the cooling effect delayed swelling, it did not hasten recovery from the muscle damage. In fact, ice might even make things worse and cause more damage.


Additionally, one of the biggest pieces of research into back pain was conducted by the US military years ago. (Tried as I did, I couldn’t find the original paper). Half of the hundreds of recruits with back pain were prescribed rest and the other half, mild exercise. The ones that fared better were the ones who rested. The final advice given: keep moving!

So, with all this confusion, what should we do? I often wonder how some practitioners can advise patients to wait a week/ 9 days/3 weeks etc. before returning to specific exercise. How do they know excatly how long it will take? Where can I but their crystal balls? Maybe it would be better to go straight into exercise, albeit slowly?

I suggest that we know our bodies better than our therapists – though we MUST heed advice! I suggest that we do not want to hurt ourselves and that we are reasonable. We seem to know instinctively what we need.
There is no evidence to suggest any modality, so sometimes it might just be best to use what you feel makes you comfortable – you are probably going to be right and unlikely to do any damage. Move if you feel it helps, rest if it doesn’t. Ice or hot – whatever you feel is best.

However, please bear in mind that hot packs or hot water bottles do not include chemical skin irritants in a tube that make you feel like it is hot but really do little – except irriate the skin!