Common Question: Heat vs Cold

Should I use heat or ice for my low back pain? I get this question all the time from my patients. Bottom line for low back pain use whatever helps to relieve the pain. But lets go into the principles of both ice and heat as modalities.

The rule of thumb for heat and ice is after an injury the first 24-48 hours is the acute phase and ice is the best to manage inflammation (swelling) and help to control pain. After the first 48 hours the injury moves into sub-acute and then chronic phases and heat is the best modality.

Cryotherapy or treatment of ice helps to decrease inflammation. It is a very easy to apply anti-inflammatory and can help control swelling, pain associated with swelling and decrease pain by numbing the area of pain. Ice is very effective for superficial joints like ankles, knees and shoulders. It can also have benefit to the back, however because the back is a much larger area it is hard for the ice to reach the depths of the tissue needed. Ice should be applied for 10 - 15 minutes with enough layers to protect from frostbite or frost nip. Ice can feel cold, burning and painful before it turns numb. Just make sure to have protective layers between the ice and the skin such as a pillowcase or towel depending on your sensitivity levels.

Heat is a great option to treat muscle tissue. It increases circulation to an area which can help to warm up the area. This is particularly beneficial for muscle tightness, spasm and soreness. Typically people with low back pain feel much better after lying on a hot pad or pack for 10 minutes. Associated with low back pain is muscle spasms and feelings of tightness in the low back, so heat can help to loosen this region up. Heat can be applied for 10-15 minutes at a time or longer depending on how hot the heat source is. Be careful not to burn yourself with the hot pack and use towels or protective layers to minimize risk of burns.

In general, both heat and ice can be beneficial for low back pain. Heat for the muscle tissue and ice to decrease inflammation. Both help to reduce symptoms and decrease pain. So both are helpful. Ultimately it is up to you, use the one that feels good!