Back pain is one of the most common global pain conditions, affecting 80% of people in their lifetime. It costs the U.S. an estimated $50 billion in direct medical expenses, and another $50 billion in indirect costs (e.g., lost wages and productivity). Bottom line: recovering from back pain quickly, safely, and inexpensively is crucial. There are a variety of ways to treat both acute and chronic back pain, but none fits the bill quite as well ice and heat therapy. But different types of pain require different solutions. Do you use ice or heat for back pain? Here’s how to decide.

Ice or heat for back pain? It depends 

Determining whether to use ice or heat for back pain is all about the type of pain you are experiencing.

Cryotherapy, also called ice or cold therapy, can be as sophisticated as a special ice pack or as simple as a frozen water bottle. Even placing a cool cloth on the painful area functions as a type of cold therapy.

Heat therapy, technically referred to thermotherapy, uses tools like hot baths, electric heating pads, or pads that can be warmed in a microwave to apply heat to an area. In many ways, massage can be a form of heat therapy, having some of the same effects (discussed more below).

The quick answer for ice vs heat for back pain is that ice is appropriate for inflammation, and heat is the go-to when muscles are sore, tense, or strained. We’ll discuss this further below.

That said, there is no substitute for talking to your doctor and getting a proper diagnosis of the cause of your pain. Knowing more about the roots of an injury or condition is the best way to design appropriate, effective treatment. Using heat or ice at the right time could further exacerbate your condition.

Benefits of ice or heat for back pain

Ice therapy for back pain and heat therapy for back pain have both been around for as long as people have suffered strains, sprains, and trauma to the back and neck. But are they effective?

The answer is not so simple.

Inflammation is the body’s natural, protective response to injury, but too much inflammation can do more harm than good. As with other types of inflammatory injuries, ice therapy for back pain does ease swelling. This can, in turn, reduce the pain of an acute injury.

With heat therapy for back pain, the soothing comfort of a heating pad on a sore back can go a long way to ease muscle tension. And there is evidence that heat provides a relaxing psychological benefit as well (think about sliding into a hot bath after a long day).

In other words, ice or heat therapy for back pain provides important physical benefits in that they either reduce inflammation or offer crucial emotional benefits by soothing soreness and creating a more relaxed state.

Depending on the type of injury, there is some evidence that either cryotherapy or thermotherapy can help ease back pain when combined with other treatments. Earlier reviews of studies found that heat therapy was most effective for lower back pain.

Ice or heat therapy for back pain is easy, affordable, and a good first-line approach for minor back injuries. There are generally no side effects, and this treatment is available to anyone who needs it.

When to use ice therapy for back pain 

As mentioned above, ice therapy for back pain is recommended for injuries that relate to inflammation.

When the body suffers a sprain or tear, blood vessels swell in response to create space for immune cells to rush towards the injury. This inflammation also immobilizes the area to protect it from further injury (also activating the pain response). If protective inflammation goes too far, there is the risk of damage to the tissues surrounding the injury.

Ice therapy for back pain helps constrict the blood vessels, reducing inflammation. In addition, ice numbs the nerve endings responsible for pain transmission, which relieves some of your pain. Another benefit is that the body is forced to rest while ice is applied, removing the possibility for further injury.

Ice therapy is best during the acute phase of injury when the area is inflamed. Mild sprains, strains, and tears to connective tissues are most responsive to this therapy.

Can cold make back pain worse? 

While the general rule may be that ice is good for inflammatory back and neck pain, there are some cases in which ice is not a good idea. If your back pain is intermittent, this could be a sign of muscle spasm. Muscle spasms don’t respond well to ice. In fact, icing can actually cause muscles to contract even further causing more of the pain you are trying to heal!

Another example of this is the trigger point response to ice. Trigger points are areas of the body that are particularly sensitive to pain. In some cases, ice can increase the sensitivity of these areas, again leading to more pain.

A good rule of thumb is to avoid ice therapy for back pain from muscle contractions or cramping (as opposed to inflammation or strain). Every situation is different, though, so always double check with your doctor or pain specialist.

How to use ice therapy for your back pain 

Your doctor will prescribe a specific regimen of ice therapy for back pain, but here are some general guidelines.

  • Apply ice within the first few hours of injury
  • For cold packs, follow a 20-minutes-on, 20-minutes-off schedule
  • Unless performing an ice massage, do not let ice contact the skin directly (more below)
  • For cold water therapy, keep water temperature cold but not freezing

Some doctors recommend different icing schedules, such as icing ten minutes every hour for the first three days, then three times a day. Taper off to icing after vigorous activity. Again, communication with your doctor is key. Your injury is just as unique as you are, so your circumstances may dictate different treatment.

Ice therapy tools for back pain

Ice therapy tools can be as simple as sliding a bag of peas from the freezer, but they can also be so much more. Some options include:

  • Wrap-around braces: These work well for upper back and neck pain, cinching around the shoulders for easy treatment
  • Ice packs: Whether homemade, barely frozen water-filled plastic bags or cloth-covered packs from the drugstore, these are common tools for ice therapy
  • Ice massage: DIY an ice massage or purchase cryo-cups that keeps ice off the skin

Your physical therapist will also have specialized tools in their office for ice therapy. Whichever you choose is a matter of preference, budget, and recommendation from your doctor.

When to use heat therapy for back pain 

Heat therapy for back pain can be just the thing you need when you go too far, too fast at the weekend softball game. But how does it help ease this type of pain?

Applying heat to a sore area helps to dilate blood vessels and improve circulation to the area. This speeds up the removal of lactic acid build up (which can cause cramping and muscle spasms) while it eases tight muscles. Heat therapy for back pain also just feels good, a psychological bonus that has pain-relieving benefits, too.

Heat therapy for back pain is best for the following cases:

  • Overexertion injuries
  • Muscle cramps
  • Back spasms
  • Widespread pain (e.g., from fibromyalgia)
  • Chronic stiffness

As always, check with your doctor to see if heat therapy for back pain might work for you.

Can heat make back pain worse? 

Heat therapy for back pain in contraindicated in a few scenarios. Remember that heat has the effect of warming and loosening the injured area: the exact opposite thing you want if the injury is already hot and inflamed. Avoid heat therapy in inflammation injuries. Heat should also not be applied directly after an injury, as it can increase the inflammation response.

Pregnant women should not apply heat directly to the belly, but a heating pad is generally safe, soothing relief from back pain when applied directly to the back only.

Other times to avoid heat include if you are experiencing numbness in the injured area or if there is an open wound with the injury. Again, talk to your doctor to make sure.

How to use heat therapy for your back pain 

As with ice therapy for back pain, there are some precautions to note when using heat to ease sore, stiff backs.

  • Apply heat in the same 20-minutes-on, 20-minutes off schedule as with ice therapy
  • Start a heating pad on the lowest setting
  • Take care to not rest all of your weight on electric heating pads to avoid burns
  • Do not use heat therapy on broken, irritated, or inflamed skin

Many heating pads come with an automatic off switch. This is helpful to ensure that you do not fall asleep while the pad is on. If soreness persists after several days of heat therapy, talk to your doctor. You may have an underlying issue that is causing pain, or another type of therapy might be more appropriate.

Types of heat therapy

There are a variety of ways to explore heat therapy for back pain. One of the most effective types of heat therapy is a hot bath. Moist heat seems to be more effective at relieving pain. Because the temperature of a hot bath is difficult to maintain, other heat therapy tools might work better over a period of time.

The following are some ways to apply heat to a back injury:

  • Electric heating pad: Easy, effective, and available at every drugstore
  • Special clothes: The Revive tank is a compression garment that can be used for ice or heat for back pain
  • Rice packs: Rice packs can be heated in the microwave (and re-heated as needed)
  • Gel packs: Chemical gel packs produce heat for a period of time and are convenient on the go

There are also patches with heating compounds and other all-day heat packs available. Your doctor can suggest the best options for your injury and your lifestyle.

Beyond ice or heat for back pain: Contrasting therapy

There are times when ice and heat for back pain are the most effective therapy. Applying cold to an area causes blood vessels to constrict. Once cold is removed and heat is applied, the blood vessels expand, rushing nutrient-filled blood rushing to the area.

This action can be very helpful in treating back pain associated with two specific conditions: osteoarthritis and delayed onset muscle soreness.

Osteoarthritis is a wear-and-tear condition that occurs as we age. It can cause debilitating chronic back pain. Contrasting therapy soothes inflamed joints while providing ease and comfort to the affected muscle groups.

Delayed onset muscle soreness (DOM) can occur between 12 and 24 hours after a muscle injury. It is caused by tiny tears in the muscle fibers, tears that can cause inflammation and pain. Contrasting therapy can help control inflammation and pain while opening up the blood vessels to help heal these microscopic tears.

Get help with your back pain 

When you’re in pain, a fast effective response is important. If you know whether to use ice or heat for back pain, you have a good first-aid tool at your disposal. Knowing what to do next can be more complicated, but this therapy can provide comfort while you decide on next steps (e.g., calling your doctor or finding a pain specialist).

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