An ice bag or very cold pack may numb the pain in your back, but does this also promote healing? Heat won’t numb the pain, but won’t it increase blood flow to your hurting muscles?

So the big question is: Heat or cold for back pain treatment?

Keep in mind that in most cases, back pain will resolve all by itself, says Kaixuan Liu, MD, PhD, nationally distinguished leader in endoscopic spine surgery; and chief surgeon at Atlantic Spinal Care in Edison, N.J.

This good fortune may occur only two weeks after the initial onset of pain. Both cold and heat can be applied — but not in a random way.

To determine whether you should use heat or cold to treat low back pain, Dr. Liu says it’s important to learn what’s causing the situation.

Sudden-onset of pain in the lower back can be caused by improperly lifting something heavy or by some kind of forceful trauma.

“With a mechanical injury, you might feel anything from dull aching to a shooting or stabbing pain,” says Dr. Liu.

“You might also experience stiffness or loss of flexibility that prevents you from standing or sitting normally.” Discomfort that’s acute is short-lived, but it may recur as well.

If the issue goes on for over 90 days, this is then “chronic” low back pain. It can be caused by improper lifting but also degenerative ailments.

Heat vs. Cold to Treat Low Back Pain

“It’s all about inflammation,” says Dr. Liu. An acute injury causes inflammation–which results in more blood going to the site of the injury, plus immune cells coming to the rescue.

“In the case of acute muscle or joint injury, or surgery,” says Dr. Liu, “it creates swelling that is the beginning of a healing process.” This beneficial response, though, can cause a lot of pain.

For acute inflammation, use ice, recommends Dr. Liu. “The cold shrinks small blood vessels in the area, which keeps blood and other fluids from flooding to the injury site, decreasing swelling.”

It also slows down nerve impulses at the site. This will intercept transmission of pain signals, numbing the area “like a local anesthetic.” Cold also helps reduce damage to tissue that the acute inflammation can trigger.

A heat application promotes blood circulation, and this will lessen pain. However, heat pads are not a smart choice for acute inflammation because the heat can worsen the swelling and even cause more pain.

If there is no inflammation of a chronic nature, you should use heat for your lower back pain to open up blood vessels.

This will promote healing via the increased nutrients and oxygen to the site and will stimulate the nerves — which means interrupted pain signals.

Throwing Out Your Back with the Wrong Movement

You’re moving furniture or some similar activity when suddenly, your back “goes out.” Dr. Liu says you should apply ice, as this is an acute injury. Apply for 15 to 20 minutes three to four times a day for one to two weeks.

After a few weeks switch to heat–for 15 to 20 minutes three to four times daily. It’s important to let at least two hours pass between either form of therapy sessions.

And by the way, the heat source should not be so hot that it’s uncomfortable or cause any kind of burning to the skin. In fact, for either heat or ice, the source should not be directly against your bare skin, but rather, separated by some kind of fabric.

“There’s a popular myth out there that heat and cold are interchangeable in treating back pain,” says Dr. Liu.

“It’s true that they both relieve pain, but mechanisms that produce the pain relief are completely different. That means each has its time and place.”

Dr. Liu specializes in disc herniations, spinal stenosis, spondylolisthesis, and mitigating failed neck and back surgery, among many other conditions that affect the neck, mid and lower back.
Lorra Garrick is a former personal trainer certified by the American Council on Exercise. At Bally Total Fitness she trained clients of all ages for fat loss, muscle building, fitness and improved health. 

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Top image: Freepik.com shayne_ch13