Cold First, Heat Later 4

By: Arnold J. Weil, M.D.

It doesn’t matter what sport you are playing or the type of injury that you sustain, one of the most common questions that we’re asked at our practice is whether to apply heat or ice to the injury. It’s not always a straightforward answer, and the method that you choose can greatly affect the speed of your recovery.

Understanding the dynamics of an injury can simplify the decision.  After a trauma to the neck, back or extremity, the injured area can become inflamed and swelling may occur. Swelling inhibits the healing process and can cause pain and limited mobility.  Preventing or reducing swelling, therefore, helps speed the healing process and enhances tissue repair.

Ice packs are the standard form of cold treatment (also called cryotherapy), and are used for applying penetrating cold into the deep tissues.  The initial response of the skin to cryotherapy is an anesthetic sensation, which is why we get “goosebumps” and, later, numbness in the treated area. This type of cold modality constricts the blood vessels, reduces blood flow and prevents swelling and lessens pain. The cooling effect of an ice pack lasts longer and is much more effective than other superficial methods of treatment such as ice massage.  For those body parts that have less surface area, such as small joints or the neck, so-called “gel packs” are often used to achieve greater penetration for the cold modality. Ice should be applied immediately after an injury for five (5) to fifteen (15) minutes. The amount of time spent icing the body part depends upon the location and seriousness of the injury. These applications should be utilized throughout the waking hours at regular intervals. Areas of low body fat, like the knee or ankle, do not tolerate cold as well or as long as fatty areas, like the back or thigh, so allow a reasonable time in between treatments.

Indications for cold treatment include the following:

•    Acute inflammation or swelling
•    Acute muscle spasm
•    Pain

After the initial 48 to 72 hours, most injuries have responded well to ice treatments and the swelling will begin to subside. This is the time when heat can be applied to the area to further increase blood flow and promote healing. Heat stimulates and increases blood flow to the injured area.  In addition to promoting healing after the initial cold care, heat also relaxes muscles and eases pain. Indications for the use of heat include the following:

•    Joint Stiffness
•    Chronic muscle spasm
•    Chronic inflammation

Superficial and moist heat is used at intervals of 15 – 20 minutes throughout the day. Caution must be used to avoid prolonged exposure, as even moderate heat can cause burns.

Dr. Weil is the Founder and CEO of Non-Surgical Orthopaedics, P.C., a medical facility that provides the latest non-invasive treatment for low back and neck pain.  The practice has three locations throughout metro Atlanta.  Please visit Dr. Weil’s website at

Arnold J. Weil, MD
Non-Surgical Orthopaedics, PC
335 Roselane Street
Marietta, GA  30060
phone 770-421-1420
fax 770-421-8055

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4 thoughts on “Cold First, Heat Later

  • Miriam

    I have an herniated disc on my low back, at the sacrum column area. I’ve injured myself about 22 years ago, I was 30 years old then, while doing a bouncing stretch, but I overdid it and it was pretty violent. At first I was treated with an antiinflammatory injection and kinesiology, which worked fine, but every 10 years or so, and more often lately, I have a reoccurrence of the inflammation and pain. I took an M.R.I. last year, in October, and my physician, in Argentina, said that I need surgery. However, I live in Canada, in Toronto, and I am still waiting, since November 27th., for the neurosurgeon to call me for a consultation. Fortunately, after a more intensive treatment with Arthrotec 75 during one month, in December, I feel much better but the pain still persists and I cannot lift heavy objects or stay on my feet for a long period of time, which is interfering with my work and my chances of getting new work.

    What would you recommend for me to do?

    Thanks very much for your help.


  • Admin

    Hi Miriam,

    There are a variety of other non-surgical options, including physical therapy and different spinal injection procedures that have been shown to be extremely effective in reducing pain and ultimately avoiding surgery.

  • Herniated Neck Disk

    I have been dealing with neck pain for a few years now. I have had epidural shots and been treated with pain medication. My herniated disks are in the upper neck of my spine. Those shots didn’t last very long unfortunately…only like a week or so.

  • admin

    Herniated Neck Disk: Every situation is different, but depending on the actual pathology in the neck on the MRI, there may be different types of injections that could address the actual problem causing the pain