Nearly everyone has experienced back pain, and unfortunately, some people live with chronic back pain. Back pain can be debilitating, costing lost work hours and even quality of life. Many sources suggest using ice or heat for back pain, but which is better? Here’s how to know whether to use ice or heat for back pain, plus how to properly apply ice and heat to get the greatest pain relief. 

Contents

• Cheat Sheet
• Statistics
• Types of Back Pain Ice and Heat Relieve
• Which is Better?
• How Ice Relieves Back Pain
• How Heat Relieves Back Pain
• How to Use Ice and Heat for Back Pain
• When to Avoid Using Ice and Heat
• Back Pain is Often Caused by Poor Posture

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Ice or Heat for Back Pain: Cheat Sheet

Here’s a quick overview of when and how to use ice and/or heat for back pain.

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Back Pain Statistics

Back pain is a major problem in the United States, evidenced by these statistics. 

• Nearly 65 million Americans report recent back pain, and 16 million – 8% of Americans – have chronic back pain
• Back pain is the 6th costliest ailment in the U.S., racking up more than $12 billion in healthcare and indirect costs annually
• Back pain is the #1 reason for lost work days, causing 83 million lost work days each year
• Lower back pain is the #1 cause of disability worldwide, affecting 619 million people. That figure is expected to reach 843 million by 2050

Types of Back Pain Ice and Heat Relieve

Ice and heat can relieve acute back pain and chronic back pain. Acute pain is often caused by surgery or sports and other injuries, such as strains and pulled muscles. Chronic pain can be related to herniated discs and other conditions. 

“Ice and heat are considered more beneficial for acute pain and the healing process as a whole after injuries or surgeries, as long as they’re not applied directly on wounds or incisions,” says Dr. Brittany Ferri, an occupational therapist at Medical Solutions in Barcelona. “However, some people with chronic pain may still find temporary comfort from these modalities.”

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Ice or Heat for Back Pain: Which is Better?

Both ice and heat can help relieve back pain, so the question isn’t necessarily which is better – it’s which is best to use at the right time. 

For acute pain, use ice for the first 24 to 48 hours to reduce swelling. Then, switch to heat to relieve muscle tension. 

“If your back pain is the result of an injury, it’s typically recommended to use ice within the first 24 to 48 hours since that cuts down on inflammation that may be present in the early stages,” explains Dr. Ferri. “After that time, heat is more often recommended since it eases muscle tension, soreness, and other symptoms that may be present. Both can be effective at pain management for acute injuries, but heat in the early stages can worsen inflammation, if it is present.”

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Treating chronic pain with ice or heat comes down to personal preference, as Dr. Ferri says many individuals with chronic pain find heat and ice to be less effective than other options such as medication, acupuncture, and yoga due to the mechanisms of chronic pain. Still, she says there’s no harm in trying ice and heat. 

“They just may provide more temporary relief than they do for individuals with acute injuries and pain. There is also no harm in alternating ice and heat if you are past the initial states of your injury,” Dr. Ferri says. 

She cautions to give your skin a break to prevent burns, whether you’re applying ice, heat, or both, and recommends applying heat or ice for 15 to 20 minutes at a time with 5-to-10-minute breaks between use. 

How Ice Relieves Back Pain

Studies show that ice therapy – also known as cold therapy – causes physiological effects such as reduced blood flow, inflammation, and muscle spasms, all of which contribute to pain relief. 

“Ice constricts blood vessels and prevents excess blood flow to the area of an injury. This excess blood flow is what we recognize as swelling, which is the body’s natural response to an injury. Some swelling is normal after an injury, but too much can impact range of motion and the healing process in general,” explains Dr. Ferri. “That’s why ice is recommended first after an injury, since this is when swelling occurs the most.”

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How Heat Relieves Back Pain

Studies show that heat therapy increases blood flow and soft tissue flexibility, leading to pain relief. One study found evidence that heat wrap therapy reduces pain and disability, while another found that thermotherapy (heat therapy) patients had significantly less pain compared to cryotherapy (cold therapy) patients and a control group that took the pain relief drug Naproxen. 

“Moist heat is considered more effective since it penetrates deeper layers of tissue for added effect,” says Dr. Ferri. “Standard heating pads and heated grain packs are considered dry heat since they often require microwaving or are electric in nature. Hot water bottles, steamed towels, saunas, hot baths, and the like often have condensation and release steam, which makes them moist heat methods.”

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How to Use Ice and Heat for Back Pain

• For acute injuries, use ice for the first 24 to 48 hours, then switch to heat
• For chronic pain, you can try heat, ice, or alternate the two
• Apply ice or heat for 15 to 20 minutes, then take a break for 5 to 10 minutes before switching or reapplying
• Use moist heat when possible (hot water bottles, steamed towels, saunas, and hot paths), but you can also try dry heat (heating pads, grain packs)
• Any ice source will work, just be sure to use a towel or cloth to protect your skin from direct contact with ice (ice cubes, cold towels, gel packs, frozen vegetable bags)

Use ice and heat for up to three days. If you’re not noticing improvement by that point – or if your pain is severe or causing mechanical issues at any time – you should consult a physician to make sure there’s not a more serious cause for your back pain. 

“When using for back pain, some people turn to ice and heat along with over-the-counter pain medications in the early stages, one to three days after an injury,” says Dr. Ferri. “After that, any major symptoms such as sharp pain, poor range of motion, or difficulty walking warrant a trip to the doctor.”

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When Not to Use Ice or Heat for Back Pain

If your symptoms are severe, always consult a medical professional before self-treating. You should also speak with a physician if you have an underlying medical condition. For example, some people with vascular disease shouldn’t use ice or heat because it could damage their blood vessels. In addition, those with impaired sensation should avoid using ice or heat. 

“Individuals with impaired sensation should not use ice or heat since they cannot notice signs of discomfort or burning from the items being too hot or cold. The same goes for people with deep vein thrombosis, peripheral vascular disease, or other circulatory concerns, since they may feel the effects of it being too hot or too cold more quickly than others and it can cause damage to their blood vessels proximal to the area of application,” says Dr. Ferri. 

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She adds that heat can aggravate dermatitis and that it’s best to avoid heat immediately after exercising or if you have an active infection, since it can accelerate its spread. 

“For the same reason you use ice to lower inflammation – the body’s immune response – in the early stages of an injury, heat will impact the immune system and can prevent the body from sufficiently fighting an infection that is already present,” says Dr. Ferri.

Back Pain is Often Caused by Poor Posture

Ice and heat can alleviate back pain, but you’re only treating the symptoms, not the cause. Poor posture is a leading cause of back pain, and with our tech-centric culture, it’s only getting worse as many more people are developing tech neck, forward head posture, and hunchback as a result of slouching and craning to view our devices. 

Do Posture Correctors Work? Here's What Back Doctors Say

If you want to relieve back pan and eliminate the need for ice and heat, consider improving your posture with: 

• Posture correctors: Gently retract your shoulders and train your body to maintain proper posture on its own over time
• Exercise, stretches, and yoga: Strengthen your postural muscles so you can sit and stand with good posture
• Posture apps: Analyze your posture, automatically detect when you slouch, and set reminders to check your posture, stand up, and move
• Ergonomic workstations: Create a posture-friendly set up when you’re working
• Medical care: Consult a chiropractor or physical therapist to outline a posture improvement plan

Ice and heat can help relieve back pain, but they won’t treat the root cause. Follow the tips outlined in this article to properly use ice and heat for back pain, and consider taking proactive measures to fix the root cause and prevent back pain from occurring in the first place. 

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