What works better for acute muscle injury like neck or back strain — ice or heat? Most doctors say that the initial ~48 hours of an injury, with the swelling and achiness, are best treated with ice. But actual research has been fairly scanty. Now, there’s an interesting new study which helps find some real answers. This was a randomized, controlled trial conducted at an emergency department; patients >18 years old with acute back or neck strains were eligible for inclusion. All patients received 400 mg of ibuprofen orally and then were randomized to 30 minutes of heating pad or cold pack applied to the strained area. Here are the findings:

CONCLUSIONS: The addition of a 30-minute topical application of a heating pad or cold pack to ibuprofen therapy for the treatment of acute neck or back strain results in a mild yet similar improvement in the pain severity. However, it is possible that pain relief is mainly the result of ibuprofen therapy. Choice of heat or cold therapy should be based on patient and practitioner preferences and availability.

DETAILS: There were no differences between the heat and cold groups in the severity of pain before (75 mm [95% CI = 66 to 83] vs. 72 mm [95% CI = 65 to 78]; p = 0.56) or after (66 mm [95% CI = 57 to 75] vs. 64 mm [95% CI = 56 to 73]; p = 0.75) therapy. Pain was rated better or much better in 16/31 (51.6%) and 18/29 (62.1%) patients in the heat and cold groups, respectively (p = 0.27). There were no between-group differences in the desire for and administration of additional analgesia. Twenty-five of 31 (80.6%) patients in the heat group and 22 of 29 (75.9%) patients in the cold group would use the same therapy if injured in the future (p = 0.65).

The Bottom Line?

It’s not a wonderful study as their p-values don’t reach statistical significance, but it may be the best study so far on this issue. My personal recommendation is unchanged; ice for an initial injury, then ice/heat depending on your preference. And don’t forget the anti-inflammatory ibuprofen pills as well — they do wonders for that initial swelling and achiness, and they are much more effective than Tylenol for this type of injury.