Should You Use Ice or Heat to Treat Back Pain?

Ice or heat? Heat or ice? That's probably the most common question asked about treating back pain. The best way to answer it, I have found, is to explain exactly what ice and heat do and why they help relieve pain. Once you understand the mechanism behind these treatments, you'll be more likely to use them when your own back pain flares up.

The Pain-Spasm Cycle

Let's  say you have sciatica. Your  muscle goes into spasm. Your body reacts to this "injury" by sending more white blood cells to the injury site to fight the problem. That means fewer red blood cells go there, which means the injured area is getting less oxygen and nutrients, and waste products aren't being carried away.

It may also put the muscle into a pain-spasm cycle. The injury triggers nerves to send signals to the brain, which interprets it as pain. This pain tells the brain to send a signal back to the injured area, which contracts the muscles to close off blood supply to prevent swelling. But this lack of blood supply actually leads to more pain, more swelling and more spasms.

  The initial spasm causes pain and swelling, which leads to more injury and further spasms. More pain, more spasms, more pain, more spasms—a vicious cycle. Without treatment, this cycle can last for years. The only way to begin healing the muscle is to break this cycle. That's where ice and heat come into play.

Which is Best

If both heat and ice do the same thing, which is better to treat back pain? There are really no hard and fast rules, but I typically have my patients do the following:

1. When an injury first occurs, use ice first. This is true whether the injury is acute (caused by some trauma like lifting something heavy or sitting too long) . It's also important to use ice fast. You need to get ice to the injury within 5 minutes to get the best effect. If you're not at home and don't have ice handy, buy a bag of ice. Begin treatment immediately. Apply ice for the first 48-72 hours. Use it for 20 minutes, then take it off for 20. Repeat as often as you can.

2. After 48-72 hours, when you feel the swelling has gown down and the pain-spasm cycle is broken, you can begin stretching the injured muscle with the appropriate exercises. At this point, choosing ice or heat is really up to you. Most people like heat before they exercise and ice after. Either way, you're getting red blood cells to the area to promote healthy healing.

3. For a really advanced treatment plan, I recommend a contrast bath. Try 20 minutes of heat followed immediately by 20 minutes of ice. Repeat three times. The contrast really shocks the body and gets it out of the pain-spasm cycle.

What to use and how to apply

Let's start with ice. The best application of ice I have found is to use a Zip-loc bag with crushed ice in a bit of water, Remove all of the air from the bag and then zip it closed. It is best to also put a wet paper towel on your skin over the affected area, then apply the ice bag.
 

To further improve the effectiveness of ice, first rest the area, then use a wrap over the ice pack to improve the contact with the skin and to compress the area to minimize the swelling. If the area can be elevated, please try to elevate it to allow the area to drain at the same time.

Now with heat. There are heating lamps, heating pads, hot tubs, hot showers, pain creams with cayenne pepper and even ultrasound, which is a form of heat..
I know what you are going to ask which works the best. Personally, I love the hot tub. Unfortunately I do not own one and going to a community hot tub is like taking a dip in a cesspool.

 

As technology advances and becomes cheaper for the masses, far-infrared heat is by far at the top of my list now. Far-infrared heat transforms safe light energy into safe heat energy, at a frequency that penetrates the body up to three inches with an even distribution and prolonged thermal effects.

Remember that heat and ice are not the solution to long-term pain relief. They are the paths to the solution. The goal of both ice and heat is to break the pain-spasm cycle and allow you to do the stretching exercises that build muscle strength and flexibility. That's what brings prolonged pain relief. And that's the ultimate goal.

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