Does heat relax muscles

Ice Packs vs. Warm Compresses For Pain


  • Brings more blood to the area where it is applied.

  • Reduces joint stiffness and muscle spasm, which makes it useful when muscles are tight.

  • Should NOT be used for the first 48 hours after an injury.

Types of warm packs or pads

Warm towel

  1. Dampen a towel with warm (not scalding) water.

  2. Put on the affected area to ease muscle spasm.

Heating pad

Be sure to protect any type of heating pad device from coming in direct contact with the skin. Precautions should be taken to avoid burns, especially if you have nerve damage, such as from diabetes or other health problems.

When muscles work, chemical byproducts are made that need to be eliminated. When exercise is very intense, there may not be enough blood flow to eliminate all the chemicals. It is the buildup of chemicals (for example, lactic acid) that cause muscle ache. Because the blood supply helps eliminate these chemicals, use heat to help sore muscles after exercise.


  • Eases pain by numbing the affected area.

  • Reduces swelling and inflammation.

  • Reduces bleeding.

Types of cold packs

Ice towel

  1. Dampen a towel with cold water.

  2. Fold it and place it in a plastic, sealable bag.

  3. Place the bag in the freezer for 15 minutes.

  4. Remove from freezer and place it on the affected area.

Ice pack or cold compress

  1. Put ice in a plastic, sealable bag.

  2. Fill partially with water.

  3. Seal the bag, squeezing the air out of it.

  4. Wrap the bag in a damp towel and put it on the affected area.

When an injury or inflammation, such as tendonitis or bursitis occurs, tissues are damaged. Cold numbs the affected area, which can reduce pain and tenderness. Cold can also reduce swelling and inflammation.

What’s Best for Sore Muscles: Heat or Ice?

Working out does the body good, but it’s not all sunshine and rainbows once those supersets are through. Muscle soreness annoys most athletes, which could be a (literal) pain in the buttDelayed onset muscle soreness : treatment strategies and performance factors. Cheung, K., Hume, P, Maxwell, L. School of Community Health and Sports Studies, Auckland University of Technology, Auckland, New Zealand. Sports Medicine, 2003;33(2):145-64.. But when it comes to optimal recovery, is post-workout heat or ice best?

Hot or Not — The Need-to-Know

In one report, researchers looked at 17 studies involving nearly 400 people. The brave souls who endured an ice bath for at least five minutes after exercise reduced muscle soreness by 20 percent compared to those who simply restedCold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Bleakley, C., McDonough, S., Gardner, E., et al. Health and Rehabilitation Sciences, University of Ulster, Antrim, UK. Cochrane Database of Systematic Review, 2012 Feb 15;2:CD008262.. Don’t jibe with a tub full of ice? Cold packs have their own success story, reducing blood flow in the muscles (a sign of inflammation) by 50 percent after 10 minutes of ice-timeCold therapy of athletic injuries. Thorsson, O. Kliniskt fysiologiska laboratoriet, Universitessjukhuset MAS, Malmö. Lakartidningen, 2001 Mar 28;98(13):1512-3.. Muscle soreness is the common coldof the exercise world: It’s a nuisance, but we’ll most likely all have to deal with it at some point in time. And while it may be, well, a little nippy, some experts have found that cryotherapy (cold therapy), is an effective way to help prevent sore muscles. (It’s important to remember that this only helps alleviate pain and doesn’t actually repair muscles faster.) Heat, on the other hand, may not fire up recovery. One study found that applying heat to muscles after exercise failed to prevent delayed onset muscle soreness (DOMS)Effects of deep heat as a preventative mechanism on delayed onset muscle soreness. Brock Symons, T., Clasey, J.L., Gater, D.R., et al. Department of Kinesiology and Health Promotion, University of Kentucky, Lexington, KY. The Journal of Strength & Conditioning Research, 2004 Feb;18(1):155-61.. Some experts are quick to note that high-quality studies on heat are limited, though. One small study did find that heat wrap therapy reduced lower back pain, whereas older research warns that applying heat incorrectly may prolong the recovery process from certain sports injuriesContinuous low-level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Mayer, J.M., Mooney, V., Matheson, L.N., et al. U.S. Spine & Sport Foundation, San Diego, CA. Archives of Physical Medicine and Rehabilitation, 2006 Oct;87(10):1310-7.Athletic injuries: Heat vs. cold. Kalenak, A., Medlar, C.D., Fleagle, S.B., et al. American Family Physician. 1975 Nov;12(5):131-4.. Ouch.

Sub-Zero to Hero — Your Action Plan

For some, ice might be the one-stop shop for pain reliefTreatments for chronic pain in persons with spinal cord injury: A survey study. Cardenas, D.D., Jensen, M.P. University of Washington, Department of Rehabilitation Medicine, Seattle, WA. Journal of Spinal Chord Medicine, 2006;29(2):109-17.. The cold impact is shown to numb pain while narrowing blood vessels, which helps limit the amount of swelling. Heat actually has the opposite effect: It increases blood flow, which may enhance inflammation. But if applied after any swelling has gone down, heat may help with the muscle recovery and relaxationEffect of heating on vascular reactivity in rat mesenteric arteries. Massett, M.P., Lewis, S.J., Bates, J.N., et al. Department of Exercise Science, The University of Iowa, Iowa City, Iowa. The Journal of Applied Physiology, 1998 Aug;85(2):701-8.. Just be sure to limit electric heat pack use to 15 to 20 minutes tops, with a few layers between the pack and skin to prevent burns. Cryotherapy could be a walk on thin ice, too, though. Some experts caution that cold therapy research is also limited and low quality. But the typical recommendation is to ice in cycles of “10 minutes on, 10 minutes off” to avoid any potential dangers. Applying ice for more than 20 minutes at once could damage muscle tissues, increase heart rate, and may even lead to shock. Of course, there are other soothing solutions to help keep those muscles feelin’ fresh. Anti-inflammatory medication could help reduce swelling (definitely check with the doc first). And stretching, eating well, staying hydrating, and even treating the body to a massage may also do the trick to speed along recovery, no extreme temps necessaryPost exercise ice water immersion: Is it a form of active recovery? Lateef, F. Department of Emergency Medicine, Singapore General Hospital, Singapore. Journal of Emergencies, Trauma, and Shock, 2010 Jul-Sep; 3(3): 302.. This article has been read and approved by Greatist ExpertsRobynn Europe and Jordan Syatt. Photo by Ben Draper

Ice, heat or a little of both? How do you recover from a hard workout?

Conventional wisdom favors icing after a hard workout to reduce inflammation and begin the recovery process. Many athletes, including pros, swear by the idea. But the science behind cryotherapy might be a little shaky, and some experts recommend warmth as a more natural way to begin healing overworked muscles.

I asked the opinions of two local people who confront this issue every day. Robert Gillanders is a physical therapist in the District and a spokesman for the American Physical Therapy Association. Steve Hays is the track and cross-country coach for Whitman High School in Bethesda, and a 2:52:19 marathoner.

Your athlete or client has just completed his hardest workout of the week. What is your advice about recovering quickly and effectively?

Gillanders: I generally recommend movement, compression and elevation. This could come through a structured cool-down after the workout that includes active stretching. It could come through wrapping a painful or swollen area with compression garments. It could come by elevating the involved areas.

If I were forced to choose heat or cold, I would say warm. A warm tub, say body temperature, can provide an environment to get some hydrostatic pressure, an in-place stretch and active movement. It is not great for elevation, but you can get that later by putting legs or other heavily worked areas higher than your heart.

Recovery is key to preparing the body for the next workout. This includes restoring the calories expended and rehydrating, as well as ensuring adequate sleep before the next workout. A hard workout will create inflammation because it is the body’s way of starting the healing process for the micro-injured area. Jumping in an ice bath will stop inflammation but also postpone the healing process.

Hays: I normally tell my athletes to use both ice and heat — two cycles of 10 minutes of ice, alternated with two cycles of 10 minutes of heat. Ice slows blood flow and heat has the opposite effect, increasing blood flow. The increase in blood flow helps to flush out the byproducts created by the workout, and the ice helps to reduce inflammation.

During a hard workout, blood rushes to your muscles, carrying oxygen and the needed energy to complete the workout. After a hard workout, muscles are inflamed and you have countless micro-tears in your muscles. You want to flush out all the waste that is the byproduct of this process.

The cooling part of this process doesn’t need to be an ice bath; 65 to 75 degrees is fine. The cold water reduces the blood flow to the muscles and reduces the inflammation while still allowing for waste products to be flushed. Athletes experience less post-workout soreness after a cool bath.

Have you tried other methods? What led you to the practice you recommend today?

Gillanders: In physical therapy, the use of ice has been long-standing. Post-injury, the standard has been RICE: rest, ice, compression and elevation. What caused me to change was that the relevant research really did not support RICE, especially rest and ice.

We know movement is good. No longer do we recommend bed rest for back pain, or staying in bed after surgery. In fact, we recommend the opposite. Whether it is post-whiplash or post-knee replacement, we know that appropriate movement is good. It brings nutrition to the joints, which maintains range of motion and health in the area.

Ice also is discouraged mainly because it stops the body’s natural path toward healing. The body has three stages of healing: (1) inflammation (2) repair and (3) remodel. Without inflammation, we do not proceed to the other stages of healing. So the use of ice to control inflammation makes no sense. Why stop the first stage of healing?

The same thing goes for taking non-steroidal anti-inflammatory drugs such as ibuprofen. Because they block the inflammatory cycle, they can limit the body’s natural process of healing itself.

Hays: I have not tried other methods. Though I have not seen much data on the effectiveness of ice baths, my own anecdotal evidence suggests that they are effective. One year at running camp in Colorado, we finished a run around Turquoise Lake near Leadville (elevation 10,152 feet). It was about a 14-mile run, fairly hilly and in the middle of July. When we finished we went down to the snow-fed lake (the water temperature must have been below 60) and soaked our legs. The next day I experienced very little soreness. Since then, I often soak after long runs, and always soak after completing a marathon. I find that I am able to return to my training faster and ramp up my miles again.

Are there exceptions? What about someone who has a minor, nagging injury, for example?

Gillanders: There are always exceptions. People are going to have pain, and ice makes them feel better. Ice can be good for muscles in spasm, or even as a security blanket, if someone has done it all his life.

Pain is usually a sign from the body that something is amiss. You can exercise through slight pain, say zero to three on a scale of 10, as long as it is stable. Pain above those levels usually results in compensations that lead to other problems.

If someone is taking care of himself, with regular stretching and appropriate strengthening, a hard workout is no big thing. In the clinic, I usually see people injured when their bodies are not prepared for the stress of training, Take care of the body and it will take care of itself. Humans did quite well for thousands of years without ice or heat, just the natural healing process, which included lots of movement.

Hays: The body’s natural response to an acute injury is inflammation, to protect the injured area. So to reduce the pain and swelling, I would recommend ice during the the first 24 hours. After that, though, it’s time to find the cause of the injury and see a sports therapist. I wouldn’t recommend trying to run through an acute sports injury by just icing after each run. You need to find the cause of the injury.

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Can you replace your normal workout with a shorter, more intense one?

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Benefits of Heat Therapy for Lower Back Pain

While the overall qualities of warmth and heat have long been associated with comfort and relaxation, heat therapy goes a step further and can provide both pain relief and healing benefits for many types of lower back pain.

In addition, heat therapy for lower back pain – in the form of heating pads, heat wraps, hot baths, warm gel packs, etc. – is both inexpensive and easy to do.


It’s possible to make a moist heat pack with common household items.
Watch: Video: How to Make a Moist Heat Pack

This article provides an examination of how heat therapy interacts with the body to alleviate pain as well as options on how to apply heat therapy to help alleviate many types of lower back pain.

See Back Muscles and Low Back Pain


How Heat Therapy Works

Many episodes of lower back muscle strain result from strains and over-exertions, creating tension in the muscles and soft tissues around the lower spine. As a result, this restricts proper circulation and sends pain signals to the brain.

See Pulled Back Muscle Treatment

Muscle spasm in the lower back can create sensations that may range from mild discomfort to excruciating lower back pain. Heat therapy can help relieve pain from the muscle spasm and related tightness in the lower back.

In This Article:

  • Benefits of Heat Therapy for Lower Back Pain
  • How to Apply Heat Therapy
  • Treatment for Back Pain Flare-Ups Video
  • Video: How to Make a Moist Heat Pack

Heat therapy application can help provide lower back pain relief through several mechanisms:


Heat therapy dilates blood vessels (vasodilation), which increases blood flow. This improves blood circulation in the painful or stiff area.

  • Heat therapy dilates the blood vessels of the muscles surrounding the lumbar spine. This process increases the flow of oxygen and nutrients to the muscles, helping to heal the damaged tissue.
  • Heat stimulates the sensory receptors in the skin, which means that applying heat to the lower back will decrease transmissions of pain signals to the brain and partially relieve the discomfort.
  • Heat application facilitates stretching the soft tissues around the spine, including muscles, connective tissue, and adhesions. Consequently, with heat therapy, there will be a decrease in stiffness as well as injury, with an increase in flexibility and overall feeling of comfort. Flexibility is very important for a healthy back.

There are several other significant benefits of heat therapy that make it so appealing. Compared to most therapies, heat therapy is quite inexpensive (and in many circumstances it’s free – such as taking a hot bath). Heat therapy is also easy to do – it can be done at home while relaxing, and portable heat wraps also make it an option while at work or in the car.


For many people, heat therapy works best when combined with other treatment modalities, such as physical therapy and exercise. Relative to most medical treatments available, heat therapy is appealing to many people because it is a non-invasive and non-pharmaceutical form of lower back pain relief.

See Exercise and Back Pain

Although it seems like a simple concept, one question that we are commonly asked is when to use ice versus heat therapy to treat pain. In this post, we will discuss how each one works on a physiologic level, and when to use each one. Both heat and cold therapy are an inexpensive and easy-to-use treatment for the management of acute, chronic, and postoperative pain. These therapies are also great to use after vigorous exercise to stimulate healing. One main point to keep in mind is that ice reduces inflammation, while heat stimulates blood flow. Knowing that simple fact can help if there’s ever a question about when to use which one.

Cold Therapy

Cold therapy such as ice baths or ice packs are commonly used for the treatment of acute, injury provoked pain. As previously mentioned, cold therapy reduces inflammation. When the body is undergoing an inflammatory response, many chemicals are secreted and directed to the injured area. These chemicals are used to stimulate healing. While the end result is the body repairing itself, inflammatory responses can be somewhat painful. Due to the abundance of chemicals released, other symptoms such as redness, swelling, and pain are often experienced as well. Cold is a great option because it not only reduces inflammatory symptoms, it can be an analgesic as well. Topical application of cold or ice will decrease the temperature of the skin, muscles, and even inside our joint capsules. Cold also slows the conduction velocity of peripheral nerves, which can mask or override our sensation of pain. One way that cold can actually treat pain instead of just numbing or masking it is by its effect on swelling and edema. Cold causes vasoconstriction, which slows the bloodflow to the area, reducing the amount of fluid buildup and the symptoms that go along with that.

Heat Therapy

Unlike cold therapy, heat therapy stimulates blood flow. This is helpful in the treatment of pain due to chronic, overuse type injuries or disease processes. Pain from sore or tight muscles is often associated with a buildup of lactic acid. Applying heat to these areas helps to stimulate the flow of oxygen-rich blood which can decrease the amount of lactic acid in the muscles, thereby decreasing pain and improving range of motion. Heat may also lead to pain relief by way of muscle relaxation. When using heat at therapeutic levels, collagen tissue relaxes and elongates, easing tension built up in the muscles. Using heat in conjunction with a stretching or home exercise program or along with a formal physical therapy program will provide the greatest results.

Similarities between Heat and Cold Therapy

Something that heat and ice both have in common is that they both reduce muscle spasms and alleviate pain. Both applications also have an effect on free nerve endings within our tissues. The effects that both heat and ice have on the peripheral nerves may increase the pain threshold among patients.

When to Use What?

Using ice is critical for use after procedures such as total joint replacements, joint manipulations under anesthesia, fusions, tendon repair, etc. For example, after a total knee replacement, there is bleeding into the joint that occurs post operatively. Because of the joint capsule, this bleeding stays contained in the joint, and isn’t actively visible. Using ice to slow some of this bleeding is so important for a few reasons. Bleeding into a joint post operatively can cause a hematoma. Hematomas in post op total knees can increase the risk of infection, can decrease range of motion, and cause pain which leads to immobility. These are all risks for having post op complications or requiring further surgery to wash out the hematoma. Icing 20 minutes on and 20 minutes off for the first 48-72 hours after a total joint replacement, or other orthopedic surgery is extremely important. Ice is also great to use in the period immediately following trauma such as sprains, strains, contusions to decrease bleeding and edema (swelling).

Heat is great to use for more chronic-type pain. A lot of patients find it helpful to loosen arthritic, stiff joints, and also to relax muscles and decrease spasm.

Please take a look at the chart below and make sure to always follow the safety precautions when using heat or ice therapy!

ARTHRITIS MOIST HEAT – Relaxes stiff joints and tight muscles
GOUT FLARE-UPS ICE – Calms flare-ups and numbs pain
HEADACHES ICE – Numbs throbbing pain

HEAT – Relaxes neck muscle spasms

STRAINS (MUSCLE INJURY) ICE – Eases inflammation/numbs pain – good to use in acute period

HEAT – Eases stiffness – better to use after acute injury phase is over to decrease bleeding into the muscle

SPRAINS (LIGAMENTOUS INJURY) ICE – Eases inflammation/numbs pain – good to use in acute period

HEAT – Eases stiffness – better to use after acute injury phase is over to decrease bleeding into the muscle

TENDONITIS (ACUTE INFLAMMATION) ICE – Eases inflammation/numbs pain
TENDONOSIS (CHRONIC INJURY) HEAT – Relieves stiffness after inflammation resolves


  • Treat for no longer than 20 minutes at a time
  • During ice treatment, check skin every 5 minutes to make sure the skin is not red or blistered, indicating freeze damage
  • Do not place ice or heat directly on the skin, use a thin towel in between
  • Do not lie on a heating pad or fall asleep using one to prevent burns
  • Do not use heat or ice if you have no feeling in that part of the body
  • Never use heat if you have swelling or bruising

Muscle Spasms

Muscle spasms, one of the most common causes of back pain and neck pain, often may be resolved with conservative, non-surgical treatment; however, there are a few signs to be aware of that should prompt a call to the doctor.

You’ve just hefted that bag of dog food into the trunk. Or maybe just turned your head to make sure all’s clear before pulling out of the parking lot. Or perhaps just taken a good, long stretch after spending the last 9 hours cramped in coach on an overseas flight. Now waves of uncontrollable muscular pain are gripping your back so tightly you can hardly stand up. Because the muscles that surround and support the spine are among the most powerful and often-used in the body, muscle spasms can be one of the most common – and painful – causes of back pain.

What Is A Muscle Spasm?

One of the body’s natural, protective response mechanisms, a muscle spasm is an involuntary, sustained contraction of the muscle fibers in response to injury or inflammation, either in the muscles themselves or the nerves that serve them. In the back, muscle spasms also may signal injury or damage to an underlying spinal structure such as the vertebrae, discs or ligaments that connect the vertebrae.

Back spasms may occur for a variety of reasons: a sudden or extended trauma to the spine or the muscles and tissue that support it such as a strain or sprain, or some other type of mechanical disorder that may be causing spinal nerve compression or irritation.

What Are The Symptoms Of Muscle Spasm?

The primary symptoms of a muscle spasm typically include acute back pain or neck pain, depending on the location of the underlying injury or condition, accompanied by a sensation of severe muscle tightening, which may occur in “cycles” that last from a few seconds to several minutes.

The pain and stiffness actually serve a two-fold purpose: to signal that something’s wrong and to protect the affected tissues and structures from further injury by limiting motion. Symptoms tend to appear suddenly following physical activity, and usually ease up following a period of rest.

How Are Muscle Spasms Treated?

At Home
In many instances, muscle spasms can be resolved within several days or weeks following a conservative course of treatment, provided there are no serious underlying medical or spinal conditions. Contact your doctor immediately if you are experiencing:

  • Changes in bowel and/or bladder function, resulting in incontinence or difficulty controlling bowel movements.
  • Muscle weakness in your arms or legs; a feeling of instability when you walk or a progressive decrease in the distance that you can walk.
  • Pain and numbness that travels down your arms and/or legs, especially when it is worse with sneezing, coughing, or sitting down.
  • Pain that worsens when you’re lying down or that keeps you awake at night.
  • Pain accompanied by fever, weight loss or other signs of illness.

If none of the above are present, there are some things you can do on your own to both loosen and soothe your painful muscles and reduce the inflammation that’s causing the problem.

Bed Rest Isn’t Best. Going about your normal, everyday activities – but perhaps at a slower pace, and definitely avoiding what may have caused your pain in the first place – is a good way to start the healing process. A little “couch time” won’t hurt, but light activity speeds recovery, so avoiding lying down for long periods of time.

Cold Compresses. For the first 72 hours immediately following the onset of your muscle spasms, wrap an ice pack, cold gel pad (or a bag of frozen vegetables) in a thin cloth to avoid frostbite, and apply to the affected area for up to 20 minutes several times a day. Ice slows inflammation and swelling, numbs tissue and slows nerve impulses to the injured area. Take care, however, not to ice the area too long – cold therapy sessions longer than 20 minutes could potentially cause muscles to tighten even more or tissues to become more inflamed.

Heat Therapy. After the first three days, you can start using heat to loosen muscle tightness and increase blood flow. Waiting at least 72 hours after your spasms start allows the initial swelling and inflammation to go down, and moist heat is generally preferred to dry because it reduces the potential for dehydration. Good heat sources include a moist heating pad or heat pack, or a warm bath, Jacuzzi or shower.

Anti-Inflammatory Pain Relievers. Non-steroidal anti-inflammatory drugs, such as aspirin, ibuprofen, acetaminophen or naproxen sodium, can ease pain, swelling and stiffness. There are a number of over-the-counter and prescription options. Your physician or pharmacist can help you determine which is best for you.

External Bracing. Short-term use of a soft brace or corset can help ease muscle spasms by keeping the inflamed tissues or spinal structures immobilized. Worn properly, a brace can relieve pain and provide warmth, comfort and support (consult with your doctor or pharmacist for proper positioning and fit). But, don’t rely on this type of external support too long – allowing it to perform your muscles’ job will eventually weaken them, making re-injury easier.

If Conservative Care Doesn’t Help…

If your muscle spasms haven’t subsided and the pain and other discomfort associated with them hasn’t improved noticeably after 72 hours of self-care, contact your health care provider, as there may be an underlying medical/spinal condition that needs to be addressed. Therapies that he or she also may recommend for relief of your pain and discomfort include:

Massage Therapy. Massage therapy is the practice of applying pressure or vibration to the soft tissues of the body such as the muscles, connective tissues, tendons, ligaments and joints. Using deep-tissue pressure and/or more superficial stroking motions, it may be used on all or part of the body to loosen and relax the muscles, manage pain, improve circulation and relieve stress and tension.

Physical Therapy. During physical therapy, different treatments such as applications of heat and cold, ultrasound, hydrotherapy and massage are often incorporated to help alleviate muscle pain and stiffness. Ultrasound involves passing a wand over the painful area, transmitting high- or low-frequency sound waves deep into the muscles, warming them and increasing blood circulation. Therapeutic exercise and stretching also may be prescribed to build strength and increase range of motion, as well as teach correct posture and relaxation techniques. Learn more about physical therapy.

Acupuncture. Acupuncture involves placing very thin stainless steel needles into the skin in certain locations that are thought to correspond to certain organs and anatomic structures deep within the body, including the spine. While the theory behind how acupuncture works has not been validated by modern research, one school of thought is that the needles stimulate pain-suppressing neurotransmitters, reducing inflammation, increasing circulation, reducing muscle tension and ultimately providing pain relief. Learn more about acupuncture.

Chiropractic Care. Chiropractic care seeks to prevent and treat back pain and other health problems through the correction of misalignments, or subluxations, in the spine through manual spinal adjustment, the key component of chiropractic care. Other chiropractic therapies include muscle stimulation, TENS (transcutaneous electric nerve stimulation), ultrasound and/or ice and heat therapy. Chiropractic care also may incorporate therapeutic exercise, stretching and massage therapy. Learn more about chiropractic care.

Preventing Re-injury

To prevent re-injury of your back or neck – and hopefully avoid any recurrence of painful muscle spasms – it’s important to build and maintain the strength and flexibility of the muscles, tendons and ligaments that support your back and spine. This can be done through:

  • Regular, low impact cardiovascular exercises that don’t jar your back and are easy on the joints, such as bicycling, walking or swimming. If exercising outdoors is not option, consider using a treadmill, elliptical trainer or stationary bicycle. These can be found at almost any exercise studio, or you can buy a home version at your local sporting goods store.
  • Core strengthening exercises. By conditioning your abdominal and back muscles, you can develop a “natural corset” to support your spine.
  • Gentle stretching to improve and maintain flexibility. Stretching also helps maintain good blood flow to the muscles.

For back-strengthening programs at the beginner, intermediate and advanced levels, check out these exercises for the back and spine.

Please Note! If you’re experiencing active muscle spasms, please consult with your doctor before engaging in any type of exercise or stretching program, even if you’re already active. When muscles, nerves and other tissues are inflamed and in contraction, or are in the initial stages of recovery, it’s important not to exceed the range of motion they’re prepared to handle because this may cause further injury and/or prolong the healing process.

Back to Diagnosis

Effects of Cold Therapy on Pain and Breathing Exercises Among Median Sternotomy Patients

The most painful activities during the days following cardiac surgery are coughing and deep breathing exercises. Cold therapy is an effective nonpharmacological method that decreases the pain during coughing and mobilization. In this study, the effects of cold therapy on pain and breathing exercises among patients with median sternotomy following cardiac surgery were investigated in a randomized crossover clinical trial. Data were collected from patients with median sternotomy (N = 34) in the first two postoperative days. Because of the crossover design of the study, each patient was taken as a simultaneous control. Gel pack application was used as the cold therapy. Patients underwent four episodes of deep breathing and coughing exercises using an incentive spirometer (volumetric). Patients were evaluated according to the visual analogue scale for pain intensity before and after deep breathing and coughing exercise sessions. The pain score was 3.44 ± 2.45 at baseline for deep breathing and coughing exercises on the first day. The reported postoperative pain in the gel-pack group was not significantly different before and after the deep breathing and coughing exercises, but it significantly increased in the no-gel-pack group (p < .001). Although the interaction between the treatment and time was significant (partial eta-squared: .09), the gel-pack group had a lower change in average pain levels. This interaction was not significant in terms of spirometric values. In conclusion, cold therapy had a positive effect on pain management in the early period of post–cardiac surgery but was not effective for the pain associated with breathing exercises.

When Either Heat Or Cold Will Do

Soothe aches and pains caused by conditions like osteoarthritis, rheumatoid arthritis, back pain, fibromyalgia, and neck pain with either heat or cold. Each can give you relief from these symptoms:

  • Muscle aches, spasms, and pains
  • Lower and upper back pain
  • Stiff, swollen, or tender joints
  • Neck stiffness
  • Finger, hand, or wrist pain
  • Knee pain

For short-term pain relief of any of these conditions, apply a hot or cold compress using any of these items:

  • An electric heating pad
  • A gel pack that can be microwaved or frozen
  • A bag of ice or frozen vegetables
  • A washcloth or small towel soaked in hot or cold water (wring it out, fold it, and apply to the sore area)

Whether you use heat or cold, be sure to wrap the pack in a thin towel to help protect your skin.

Apply to the painful area for 15-20 minutes several times each day.

Whether you use heat or cold, you may notice your skin looks a little pinker after applying the compress. That’s normal, but let your skin return to its normal color and temperature before applying fresh ice or heat.

Call your doctor if you notice any of the following signs after removing the compress. These symptoms mean the temperature was too extreme and may have caused skin damage:

  • Skin that’s purplish-red, dark red, or a spotty red and white color
  • Hives
  • Swelling
  • Blisters

Chronic Pain: Management and Treatment

How is chronic pain treated?

Although no single cure is available for chronic pain, there are many ways to treat and manage it. The first step should be to treat any underlying conditions that may cause pain. These treatment methods will vary according to the specific disease or medical condition. The treatment also will depend on the type of chronic pain involved. It is recommended that a team of healthcare professionals work with the patient to develop a comprehensive plan for treating and managing pain, instead of relying solely on medications. The focus should be on development of self-management skills, along with lifestyle changes and efforts to improve physical and mental health. The plan should include psychological and behavioral therapy.

Drug treatments for chronic pain

  • Analgesics (pain relievers): The use of pain relievers is the most common method for treating chronic pain. These drugs do not work in all cases, however.
    • Non-narcotic pain relievers: Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, naproxen, or COX-2 inhibitors may be useful when the pain is mild or moderate. There are many other types of NSAIDs. NSAIDS work by blocking pain near the pain site. Acetaminophen is a non-NSAID pain reliever that works by blocking pain in the brain.
    • Opioids, opioid-like agents, or combinations of opioids and non-narcotic analgesics: Any of these may be prescribed to reduce pain. Opioids work in the brain, central nervous system, and other areas of the body to block the sensation of pain. Because of the way they work, they have many negative side effects. Opioids are most useful with acute pain such as pain after surgery or trauma and are usually reserved for cases of chronic pain when other pain relievers are not effective and when the negative side effects are manageable.
  • Topical products: Over-the-counter creams and ointments containing capsaicin (a substance generating heat) may be applied directly to the skin three to four times per day. Lidocaine (a local anesthetic) creams or patches also can treat chronic pain.
  • Antidepressants: Many chronic pain patients may benefit from taking anti-depressant drugs. This is because the same chemicals linked to depression also play a role in chronic pain. Types of antidepressants prescribed include tricylic antidepressants, selective serotonin reuptake inhibitors (SSRIs), and others.
  • Anticonvulsants (anti-epileptics): These drugs may be used to treat various neuropathic pain conditions. Such conditions include nerve injuries and diabetic nerve pain.
  • Sedatives/anti-anxiety agents: These may be prescribed for short-term treatment of sleep problems including insomnia (sleeplessness).
  • Muscle relaxants.
  • Corticosteroids.
  • Antirheumatics/immunological agents.
  • Botulinum toxins.

Non-drug treatments for chronic pain

  • Exercise: Light to moderate exercise may help improve blood and oxygen flow to muscles and reduce stress. It may be especially helpful for people with low back pain, arthritis, psychogenic pain, and many others.
  • Heat and/or cold application: Applying heat and/or cold regularly to a sore area via a safe mechanism (such as hot or cold packs that have temperature limits built in to prevent burning or freezing skin) can be very effective for treating many types of pain.
  • Acupuncture: Acupuncture done by a trained therapist can provide relief for all types of chronic pain.
  • Massage: Massage therapy has been shown to be effective for muscle and mechanical pain and may be useful for other kinds of chronic pain as well.
  • Spinal cord stimulation: Electrodes are placed inside the epidural part of the spinal cord. The patient can send electrical pulses to the spinal cord using an implanted electrical pulse generator. The electrical impulses interrupt the pain signal to the brain providing relief.
  • Deep brain stimulation: This technique is only used to treat chronic pain in cases that do not respond to more conservative treatment. It requires surgical stimulation of areas of the brain, usually the motor cortex or thalamus.

Psychological and behavioral treatments for chronic pain

  • General mental health and behavioral counseling: Mental health professionals such as psychotherapists, psychologists, and social workers can work with patients. Goals are for the patients to improve coping skills and develop strategies to reduce stress, anxiety, depression, and sleep problems.
  • Cognitive behavioral therapy (CBT): This form of treatment focuses on gaining coping skills, such as how to identify and change negative thoughts and learning relaxation techniques. These, in turn, will help the person gain more control over his or her emotions and moods as well as more control over feelings of pain.
  • Fear-avoidance training: People with chronic pain may avoid movement and activity and not get enough activity due to their fear of re-injury or pain. Treatment includes education, instruction on active pain management techniques, and routine exposure to activities that the patient may have avoided in the past.

Mind-body treatments for chronic pain

  • Relaxation techniques: These include breathing exercises and other relaxation method.
  • Mindfulness training.
  • Meditation.
  • Biofeedback: Patients can learn this technique to control the body’s functions, including heart rate and muscle tension.
  • Music: Listening to different types of music has been shown to change brain waves and can be very effective in treating pain.
  • Art therapy.
  • Pet therapy.
  • Reiki: A technique in which the therapist can channel energy into the patient by means of touch in order to activate the natural healing processes to help with pain.
  • Guided imagery: This self-care technique is highly effective in significantly reducing anxiety and pain.
  • Aromatherapy: Different aromas can be used to reduce pain and anxiety.
  • Healing Touch: A healing energy therapy that uses a practitioner’s hands to intentionally influence energy fields to promote healing through reduction of pain, anxiety, and fatigue and to improve overall emotional health. Has been used for abdominal pain as well as pain from cancer, sickle cell disease, and heart surgery.
  • Hypnosis.

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When to Use Ice and When to Use Heat for Aches and Pains

No matter what your fitness level, everyone deals with aches and pains from time to time. From the rec-league warriors and high school athletes to fitness newbies, being active can come with aches, pains and sometimes injuries.

When you find yourself in pain, or groaning a little more than normal when you stand up, it can be a tough to know whether to use ice or to apply heat to get some relief. Here’s some advice on what to do the next time you find yourself feeling a twinge.


When tissue is damaged (like sprains, strains or freshly pulled muscles) it causes inflammation, creating swelling, which is your body’s way of preventing you from further injuring yourself.

Applying cold is helpful when you want to reduce swelling, inflammation and pain. It can also reduce painful muscle spasms. Be sure to immediately ice a new injury to keep swelling in check and reduce the pain of pressure on the injury.


Use an ice pack, a frozen towel, or, even a bag of frozen vegetables – peas and corn work great. Keep the ice on up to 20 minutes at a time, using a towel to avoid direct contact between the ice pack and your skin. Let the area get numb, wait and hour and then you can reapply the cold pack, if necessary. Ice should only be used up to three days following injury. After that, you might want to check-in with your doctor.

Ice application to an acute injury is generally safe. To avoid the risks, limit your usage to 20 minutes at a time and avoid using “super cold” products. Don’t let yourself fall prey to frostbite due to prolonged application to fingers, toes, ears, nose. And avoid nerve injury, particularly the ulnar nerve on the inside of your elbow and the peroneal nerve on the outside of your knee.


Heat helps soothe sore muscles that cause back pain or neck pain. It works best for injuries that are at least few days old. Heat opens blood vessels, which can assist the healing process and alleviate some of your pain. Additionally, some arthritis pain from stiff joints can benefit from heat as blood flow increases. Heat can also help loosen muscles when tension headaches strike.

Use a heating pad or a warm towel to help relieve muscle aches and tension. Be sure not to cause yourself more pain and avoid burns by using a towel between the heating pad and your skin. As with ice, only apply heat for about 20 minutes at a time.

Keeping these helpful tips in your back pocket will help you get off the bench and back on your fitness track before you know it.

Q. What determines whether one should use heat or ice to treat muscle and joint pain, especially after exercise?

A. Cold therapy, or cryotherapy, is usually recommended in the immediate aftermath of an acute injury, like a severe bruise or sprain, not mere soreness. The familiar RICE sequence — rest, ice, compression and elevation — helps reduce the pain and inflammation of such an injury. It loses efficacy after a day or so, however, and then gentle warming can help.

For the lingering muscle pain that emerges some time after vigorous exercise, called delayed onset muscle soreness, heat and cold have been used with success in individual cases, but scientific studies comparing the efficacy of treatments have been sparse and inconclusive.

A new comparison, published this year in The Journal of Strength and Conditioning Research, looked at muscle damage and pain in 100 people of comparable fitness. Half received either cold or heat treatment after 15 minutes of leg squats and half received no treatment. The researchers concluded that both heat and cold appeared to be effective in reducing muscle damage, but cold used immediately after exercise or 24 hours later was superior in reducing pain. [email protected]

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