Heat vs. Ice for Back Pain Relief: What Works Best?

Back pain is a common problem. The World Health Organization (WHO) estimates that over 600 million people worldwide are affected by low back pain. It is a leading cause of absence from work and disability. Heat and cold therapy can help to manage chronic and acute low back pain at home in addition to other treatments, exercise and physical therapy. Please continue reading to learn more about using ice or heat for back pain.

Common Causes of Back Pain

Muscle or ligament strains caused by sudden awkward movements or heavy lifting.
Bulging or ruptured vertebral disks in the spine.
Spinal stenosis (narrowing around the spinal cord).
Osteoarthritis of the lower back.
Osteoporosis (weak bones).
Ankylosing spondylitis (an inflammatory condition that makes the spine less flexible).

Risk Factors for Back Pain

Back pain can affect people of all ages, genders, races, and occupations, but some people are at a higher risk.

Older age (back pain typically affects people above the age of 30).
Being overweight or obese (due to extra pressure on the back muscles).
Lack of exercise (due to weak muscles).
Poor posture (due to muscle strains).
Health conditions such as arthritis that affect the spine.
Improper lifting techniques during work or exercise.
Stress, anxiety, and depression (due to muscle tension).
Smoking (due to decreased blood flow to the spine and smoker’s cough).

Chronic Versus Acute Back Pain

Acute low back pain is pain that lasts less than 3-6 months and is directly related to an injury. After it goes away, you can return to a normal lifestyle. Chronic low back pain lasts for more than 6 months and continues to be present even after the acute injury that caused it has healed. In general, chronic back pain is harder to treat than acute pain. However, both acute and chronic back pain respond to treatments, including heat and cold therapy.

Types of Back Pain

Back pain can originate from muscles, nerves, bones, or a combination of these structures. For example:

Nerve pain due to herniated disks or pinched nerves.
Muscle pain due to strains, poor posture, or injuries.
Bone pain due to arthritis, osteoporosis, or fractures.

The Basics of Heat and Ice Therapy

How Heat Therapy Works to Relieve Back Pain

Applying heat widens the blood vessels and helps facilitate healing. The increased blood flow brings oxygen and nutrients to the injured tissues, promoting healing. Heat can also help to reduce other symptoms like stiffness and muscle spasms that accompany back pain.

Ice Therapy in Pain Management

Ice acts as an analgesic (pain reliever) and works to numb pain. Cold therapy causes blood vessels in the area to narrow, thereby reducing bruising, swelling, and inflammation.

When to Use Heat for Back Pain

Types of Back Pain Best Relieved by Heat Therapies

Back pain due to muscle spasms or muscle tension
Osteoarthritis pain
Nerve pain due to a pinched nerve or herniated disk
Older injuries that are more than 6 weeks old

Practical Tips and Precautions: Moist Heat or Dry Heat?

You can use moist heat (from hot packs, baths, and showers) or dry heat (from heating pads, hot water bottles, adhesive heat wraps, and self-activating heat patches) to relieve back pain.

Generally speaking, moist heat penetrates deeper and works better than dry heat. However, a heat source such as a heating pad is convenient to use and allows you to adjust the heat level.

Start with the lowest setting on an electric heating pad and increase the heat level as needed.
Do not use a heating pad or hot water bottle for more than 10-15 minutes at a time.
Avoid staying in a hot shower for more than 10 minutes or in hot baths for more than half an hour.
Don’t use water that is too hot. It can cause burns and make your skin feel dehydrated.
Wrap heated gel packs in a thin towel rather than placing them directly on your skin.
Do not use heat on open wounds or damaged skin.
Exercise caution when you apply heat if you have health conditions such as diabetes mellitus, multiple sclerosis, or circulation problems. These conditions can impair heat perception and prevent pain signals. You may not feel the heat and end up with burns.

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When to Use Ice for Back Pain

Cases Where Ice Therapy is More Effective

First 1-2 days after an injury to treat the initial inflammation caused by muscle strains
Post-exercise back pain and muscle soreness
Acute injuries that are less than 6 weeks old

Practical Tips and Safe Practices for Cold Therapy

You can apply ice using cold packs (ice cubes in a baggie or frozen vegetables) or purchase frozen gel packs. A home-made cold patch is also easy to make. Soak a towel in cold water, squeeze the wet towel until it is damp, place it in a plastic bag, and freeze it for 20-30 minutes.

Do not place ice packs directly on your skin — this can cause skin damage. It’s best to wrap the frozen object in a thin towel.
Do not apply an ice pack for more than 20-30 minutes at a time — this can cause an ice burn.

Alternating Heat and Ice Therapy for Back Pain

When to Use Alternating Heat and Cold Therapy

Muscle pain caused by overuse
Exercise-related back pain (use heat therapy before exercise and cold therapy after exercise)
Chronic pain due to arthritis

How the Body Responds to Contrasting Therapies

Alternating between heat therapy and cold therapy can be very effective for certain types of back pain. The heat therapy can boost blood flow to the area and deliver nutrients to promote healing. The cold therapy numbs pain and reduces inflammation.

Guidelines for Alternating Therapy to Maximize Relief

Apply a cold pack for 15-20 minutes. Follow this up a few hours later by using a heat patch for 10-15 minutes. Do this several times throughout the day for maximum relief from back pain.

Beyond Ice or Heat: Other Methods to Ease Back Pain

Stretching and Physical Activity

Gentle stretching exercises can ease back pain and prevent further discomfort. Regular physical activity can strengthen your back muscles. Always check with a healthcare professional before starting a new exercise program.

Chiropractic Care, Massage, and Physical Therapy

Some people benefit from chiropractic care that can relieve low back pain through manual manipulation and spinal adjustments. Massage therapy can alleviate back pain and decrease stiffness. Massage is particularly effective for lower back pain caused by muscle soreness and muscle spasms. Physical therapy can help to manage back pain through posture correction and exercises for strengthening and flexibility. Find out “What Does a Physical Therapist Do?”

Lifestyle Modifications for Preventing and Managing Back Pain

Eat a healthy, well-balanced diet to reduce inflammation, which can contribute to chronic low back pain.
Manage stress to reduce muscle tightness and spasms. Deep breathing exercises, yoga, meditation, and cognitive behavioral therapy (CBT) are all excellent stress management techniques.
Get regular exercise to keep your back muscles strong. Don’t forget to warm up before your workout and cool down after exercising. Learn proper techniques for running, weight lifting, etc., from a trainer.
Ensure you’re getting enough of good quality sleep. The body needs sleep to heal from injuries and repair tissue damage.
Pay attention to your posture. Sit in an ergonomic office chair that maximizes back support.

When to Seek Professional Medical Advice for Back Pain

In most cases, back pain improves gradually in a few weeks with lifestyle modifications, home remedies, and self-care. However, you should call your healthcare provider if:

Your back pain is severe and does not improve with home treatments.
It is accompanied by swelling, bruising, or a severely limited range of motion.
The pain lasts more than a few weeks.
Back pain has spread to other parts of your body, such as your buttocks or legs.
There is numbness, tingling, or weakness in your legs.
Back pain is accompanied by unexplained weight loss.