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Should I use ICE or HEAT for injury?


Dr. Alfie Arcidiacono, from Chirosports Northern Beaches at Narrabeen says one of the most common areas of confusion for most injured people is whether to use ice or heat? To help most people appreciate the best choice it is important to understand actually what is inflammation. Once you understand the purpose of information and how to manage it correctly you will benefit from much greater relief and a faster recovery.

Inflammation is a normal response to damaged tissues. Damage to small capillaries causes excessive bleeding in the area and blood vessel dilation to recuit an army of white blood cells to initiatie the protection of the injured tissue, then repair and longer term corrective remodelling to normal.

WIth excess bleeding from the trauma beyond the minimum to immobilise tissue, means unnecessary swelling may distend an already painful structure, and longer to clean up the excess. Hence, we need a moderate degree of swelling to protect the injured area, but we don't want to much.

The million dollar question is when do I choose ice or heat?


You may have seen plenty of sports people on the side-lines reach for an ice pack after acute injury for a peripheral joint, but too often when it comes to our spine which is made up of multiple joints we tend to think heat is the answer? For an acute injury ice is most often the answer in the first 24 to 48 hours unless otherwise advised. The problem with heat is it dilates blood vessels delivering excessive blood to injured areas.

Cold works by reducing inflammation. Cold will tend to cause blood vessels to constrict, which is the desired effect when treating inflamed tissue. Now you will appreciate the logical thing to do after an acute injury, like a twist or a wrench of the back. The benefit of cold is that it also produces numbness, so it will have a pain-relieving effect as well.


You can use a pack of frozen peas wrapped in a towel, or crush ice in a plastic bag, or hot water bottle with ice or iced water.


Use cold repeatedly in the first 24 to 48 hours after an acute injury. As a rule of thumb seven to ten minutes is the ideal time to apply cold and this can be repeated several times over about an hour.

Take care about using ice for more than 7-10 minutes. Always inspect the skin and make sure it does not get excessively white. If the back starts to hurt more, then remove the cold pack. Older people or those that may have lost skin sensitivity must take great caution as believe it or not failure to ‘feel’ the ice and extended use may cause an ‘ice burn’ causing further damage. Always seek professional advice if you are not sure. Repeat 3 times per day.


Be careful about applying ice or heat packs or water bottles directly to the skin which can cause damage. Use a towel between a pack and the skin and test sensitivity, especially in the elderly. This advice provided does not replace professional advice as each injury and person is unique, and this is only a general guide. Seek chiropractic advice from your Chirosports professional for instructions specific to your injury.