If you suffer with neck and back pain, you will just love this.
Ice or Heat For Neck and Low Back Pain?
I can’t tell you how often it comes up on a weekly basis this age old question: “should I put ice or heat on my injury, my aching back, neck, hip, and shoulder (or whatever area is hurting)”???
Ice Vs. Heat:
Who knew that this topic would be so controversial? People are often told by their friends or unlce Ted the opposite of what the doctor may recommend to their patients. Especially when it comes to relieving neck and back pain.
As a very very very general statement, whenever pain is present in the body, inflammation is present as well. That is to say, tissue trauma results in a natural, automatic, body response of increased blood flow to the injured tissue.
Resulting in inflammation = Neck and Back Pain
I say it’s a general statement because chronic neck and back pain can have other factors besides actual inflammation that produces the pain, but that is beyond this topic of this post.
Reasons for Chronic Neck and Back Pain:
Psycho-social factors are the main reasons for chronic neck and back pain, that may or may not have anything to do with the actual pain source.
Things like your environment factors can represent your psycho-social factors. Such as a bad marriage, a lousy paying job, an over-bearing boss, economic hardship, and difficult parent/children.
The way we learned to deal with neck and back pain when we were younger can influence this as well. For example, love and attention may have been scarce in a dysfunctional upbringing, and when you had neck and back pain, this may have been the only time you were shown love.
In this case, when neck and back pain develop again, not that you don’t actually feel pain, but it becomes chronic, because perhaps you are given more attention then before.
Having chronic neck and back pain may mean not going to a job that is despised, and using your “Sick leave”.
A law suit, although a real injury occurred, and you are experiencing true neck and lower back pain, other factors continually emphasize and highlight your pain.
Basically, psycho-social factors are any and all things that perpetuate that neck and back pain that may not actually have anything to do with the musculoskeletal/anatomical pain.
But back to the age old question.
When it comes to musculo-skeletal neck and back pain (pain in the muscles, joints, tendons, ligaments, and bones), which is better to use ice or heat?
Again, when pain is present, so is inflammation… so use ice to reduce swelling. With in the first 0-3 days of the “inflammatory phase of healing”, or the acute phase, ice is absolutely essential.
When heat is used inappropriately in the inflammatory stage, vasodilation, or relaxation of the blood vessels, results in further increased blood flow, to an area that already has increased blood flow.
Think about what happens when you twist an ankle.
It swells up like a balloon, and if you’ve ever done this before (I’ve done it easily 3-5 x/each ankle playing soccer over the years), then you know exactly what it looks like.
The last thing you want to do with this swallon area is heat it.
The goal is to reduce the swelling, and icing is the best way to do it.
The increased blood supply to the injured and swollen area will actually result in increased pain as well.
I remember watching the Olympics in Beijing and seeing the gymnast males icing up their shoulders after each event.
These guys created tremendous torque and stress on their joints, and pro-actively iced thier joints to makes sure their muscles and joints didn’t stiffen up between events.
Almost seems counter intuitive, not putting ice on the area seems like it would actually result in “stiffening of the joint”, not actually helping it by reducing inflammation. But there you have it.
These olympic athletes, being trained by the best trainers in the world, and they are icing (I Can’t tell you how many times I hear my patients tell me that their doctors tell them to heat the area, to reduce neck and back pain).
Now don’t get me wrong, the use of heat may be used later in the healing process during the reparative phase of healing. Many of my older patients that suffer with advanced arthritis, and have increased pain in the morning, will benefit with heat to reduce their neck and back pain.
They report that a warm shower really helps get them going first thing. I think that that is great, and if it helps, keep doing it.
This is arthritic like pain that you are experiencing, so chances are its more of a chronic breakdown, with accompanied inflammation, that is responsible for neck and back pain.
But as long as pain is present, and it is a sharp pain, using ice is usually safer and more effective. Think of what the olympians do.
Daily Activities To Relieve Neck and Back Pain:
An other controversial topic is the amount of activity one should do when they are in the inflammatory phase of an injury.
In general, this stage can last the first 2-4 days, but really if you have ever twisted your ankle before, you know that that ballooned up ankle doesn’t return to normal just because it’s the end of day 4. It usually stays inflammed for a good while yet.
That said, when the injury is new, their is pain and swelling, and its anywhere for the first 7-10 days, many doctors will tell their patients to go on “bed rest”.
Now obviously this is another generalization, and depends on the nature and extent of the injury,
But, I usually think, all things being equal, in a typical soft tissue injury (no broken bones or unstable joints), bed rest is actually the worst thing to tell someone to do. Gentle, increased circulation and movement is typically soothing for contracted and spastic muscles.
However, one must be careful in regards to improper methods of performing sitting, bending, pulling, pushing, and lifting can perpetuate the inflammatory phase, slow down the healing process, and interfere/prevent people from returning to their desired activities of daily living, especially work.
Improperly performing these routine activities is similar to picking at a scab since you’re delaying the healing process.
So, not doing too much, and not doing to little either is the key. Getting in the water is usually the most ideal, but gentle movement, and motion is great.
Exercise:
Specifically with neck and back pain, there are many exercises that you can do.
When deciding on the type of exercises, the position the patient feels best in, or the least irritated in, is usually teh direction to emphasize, or called directional preference, by Robin Mckenzie, a popular physical therapist.
If you feel a reduction in pain when bending forward (known as “flexion-based”), flexion exercises are usually indicated.
Examples of these including raising a single knee to the chest, double knees to the chest, tilting the pelvis backwards, sitting in forward flexion, or hamstring/leg straight out stretches.
When bending backwards results in pain reductions ( referred to as “extension based”) standing and bending backwards, performing a sagging type of pushup (prone press-up) laying backwards on large pilllows or on a gymball are good exercises.
Some of these motions are advanced motions, requiring good balance, and certainty that the injury is stable and non threating.
That said, the dosage or duration must be determined by the individual and it is typically safer to start with 1 or 2 exercises and gradually increase the number as well as repetition and/or hold times.
As an example, knee to chest exercises, can be held for up to 30 secs/leg, or prone push-ups can be held for 10-20 sec, to a comfortable high point.
If a “sharp” or “bad” neck and back pain is noted, the patient is warned to discontinue that exercise and report this further discussion with their chiropractor or therapist. It is normal and often a good sign when stretching a”good” pain is obtained at the end range of the comfortable zone of the exericse.
Approach this area, and breath into the strech, and with that breath, relax consciously the injured or aching area.
Breathing into the pain, experiencing the pain, and with your breath, trying to relax the injured area, is a huge strategy for combating back and neck pain.
Again, this is a comfortable zone, and not a sharp or bad pain being experienced.
At the end of the day, common sense must be used. In my opinion, ice out weighs heat, motion outweighs bed rest, and direction preference for neck and back pain, or the direction that makes the pain a minimum, either forward or backwards, are all simple ways to manage neck and back pain.
Till next time,
Watching your neck and back pain.
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