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What to use, hot or cold?!?

Heat or Ice?

They BOTH have their place.

Find out what one works better when!

Range of lower back problems that can benefit from heat and cold therapy

Heat and /or cold therapy is beneficial either as a primary or adjunctive therapy, but people often overlook this treatment because it’s simple, inexpensive, and readily available. The following common lower back conditions may benefit from heat or cold therapy:

  • Lower back pain from common conditions, such as herniated or degenerated discs, spinal stenosis (narrowing of the bony canals of the spine causing nerve compression), or spondylolisthesis

  • Direct lower back injury from falls, sprains, sports injuries (twisting injury from swinging a golf club), or collisions

  • Pulled back muscle due to excessive strain or force leading to overstretching of the muscle fibers, such as from lifting weights

Always use heat and cold therapy intermittently, for 15 to 20 minutes, with a 2-hour break in between to avoid skin and nerve damage.

3 guidelines to use heat and cold for different types of back pain

While some people may prefer to use one type of therapy over the other, certain conditions may respond better when a specific therapy is used. Here are common examples of different types of lower back pain and the therapy of choice for each.

1. Use cold first and then apply heat for acute back pain. When your back pain is acute (less than a 4-week duration) and/or occurs due to a direct injury, use cold therapy first.2 Lowering the body temperature will help constrict the blood vessels, reduce swelling, decrease inflammation, and cause a numbing effect. Once the inflammation has subsided, use heat therapy. When you apply heat, it improves the flexibility of soft tissues, movement of muscles, and overall functioning of the back. The local warmth stimulates blood circulation in your lower back, which in turn brings healing nutrients to the injured tissues. It is also advised to continue using heat therapy intermittently for several hours or days in order to improve tissue healing and prevent recurrence of pain.

2. Try continuous, low-level heat for subacute or chronic back pain. If you have subacute or chronic back pain (more than a 4-week duration), apply heat therapy using a medium that provides constant warmth.2 For example,

  • Keep a warming or heated blanket wrapped up around your lower back

  • Use a commercial adhesive wrap that sticks to the lower back and provides several hours of low-level heat

When using continuous low-level heat, make sure to follow the package instructions carefully to prevent skin damage.

These approaches provide closed heat to the lower back, stimulating and encouraging healing.

3. Ice your back immediately after exercise to reduce muscle soreness.

Muscle soreness and back pain can occur from extensive workouts, trying a new type of work out, or even from excessive walking. Soreness from these activities may start on the first day but typically continues to peak until the third day.4 This phenomenon is called delayed onset muscle soreness and can cause significant inflammation and pain in your back.

When you have back pain from exercise or exertion, use cold therapy immediately after the activity to reduce tissue damage, inflammation, and pain. After a 24-hour period, use heat therapy to encourage tissue healing.

Tips to combine heat & cold therapy daily

Here are a few tips to help you incorporate the use of heat and/or cold therapy in your everyday activities:

  • Keep a heat patch near your bed—use it first thing in the morning to warm up your muscles if you wake up with an achy or stiff back

  • Apply a cold patch before bed if you have exercised or exerted your back

  • Use heat therapy before sleeping and after waking up if you have chronic back pain

  • Carry a couple of self-activating heat patches and ice packs in your bag or car to use while driving or at work

You are more likely to benefit from heat and cold therapy when you make these treatments a part of your daily routine.

When to not use heat or cold for your lower back

There are some conditions and situations that should not be treated with heat or cold therapy. For example:

  • These therapies must not be used on open wounds, bleeds, or when there is any fluid oozing out of the painful region.

  • If you have certain chronic conditions such as multiple sclerosis, poor circulation, spinal cord injuries, diabetes mellitus, and/or rheumatoid arthritis, it is advised to avoid heat therapy. Heat in these conditions may cause excessive burns, skin ulceration, and/or increased inflammation.


Please note: this is written by By Marco Funiciello, DO for


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