• Gel packs, ice packs, heat pads, wheat bags . . . all sounds a bit Dr Seuss!
  • Cold pack or hot pack which is best?
  • Public confusion with Physical therapy.

For most people we see in the office, there is a lot of confusion around whether to use heat therapy or cold therapy for an injured back or neck. Sadly even many professionals offer conflicting advice on the subject. So can how can one expect Mr or Mrs You to have confidence in first aid treatment for back pain, neck pain, or other injuries.

Ice pack

All ice packs should be wrapped in a damp towel- a tea towel is ideal. ( Try finding an image of an ice pack in a tea towel ;-) )

Let’s look at a logical approach to the issue.

When an injury occurs there are 4 phases of healing that the body moves through to repair the damage. They are clotting, inflammation, proliferation and remodelling.  Each phase must occur to create effective long term resolution. From a first aid(home) perspective the first two phases are the most important. The initial phase of bleeding and clotting is relatively rapid so it’s the next phase that we can help the body most with.

The use of ice assists the body to move through the process of inflammation faster with a minimum of tissue damage created by the outpouring of fluids from cells and blood vessels. That means the body moves to the proliferation and re-modelling phases faster and you are back on the road sooner.

The use of heat packs or a heating pad for a recent injury is a pretty solid no-no. After all, when was then last time you saw a professional athlete sitting on the sideline putting heat into a body part? The big trap is that heat feels good but can have rather negative consequences in terms of increased blood flow and swelling.  Conversely, who really ever feels like putting on an ice pack after a winter sports game?

Is There a Place for Heat?

That’s not to say that heat is an absolute no. Initially we find that it will increase fluid out-pouring blood flow and swelling. The side effect of this is increased tissue damage and increased pressure effects on tissues in enclosed compartments. This swelling then has to reduce again before we can get forward motion of the healing phases and longer recovery is needed for the increased tissue damage.

However, later in the healing process we may want to increase blood flow to an area to hasten the flow of oxygen and nutrients and stimulate faster repair. This is when alternate applications of heat and ice can stimulate good fluid flow with limited swelling.

When there is muscle stiffness, soreness or abdominal pains without any risk of inflammation, then a heat bag can be a wonderful relief and feel fantastic. In fact that’s the whole idea behind spa pools and heated stone massages.

So there’s a right time for a heat pad and a right time for a cool pack. I’d leave it for 2-3 weeks after an injury before introducing heat and definitely get ice into it early.

Just go back to the basics- first do no harm, then look at the logical.

To download instructions for the application of ice/cold therapy click on this link.

PS . . . the original research done to measure the safe time limits for ice application was done on rabbits ears. Now, call me old fashioned, but the average human body part is a bit thicker than a rabbit’s ear. That means the old 20 minute maximum rule might not apply to thick body parts such as the low back.

Stop Press!!!!

The latest research info suggests that ice is really best for pain reduction and that’s about it! The research suggests it may have little impact on inflammation (not my personal experience over the last 30 years) and if used later on may result in poorer healing or tissue damage. Again the more research papers I read the more debate there is on the topic. It’s in these cases that I return to what I have seen in practice over many years-nothing beats a hands on result.

Dr. Andrew Iggo is in private practice in Sydney, Australia. Working from state of the art premises in Fairlight, his focus is on providing not only relief from pain, but correction of function and the provision of wellness care for families and individuals. With a young family of his own comes a natural inclination toward the care of kids and Mums-to-be. A strong sports and dance background also give him a unique perspective on performance enhancement and injury recovery. We are sure you’ll be in great hands.