Heat vs. Ice for Back Pain? Use What Works

Jul. 12, 2017

Image of Ice cubes and fireWhen you hurt your back, it seems like everyone has advice for how to ease the pain. Very often that advice comes down to one of two things: a heating pad or an ice pack. But how do you know which one to use?

We went to The Spine Center’s senior physical therapist, Dr. Rami Said, for advice.

Dr. Said says that for a brand-new injury, the choice is clear: Start with ice. “If an injury is new and fresh (acute), your body’s reaction is typically going to be inflammation and swelling. You battle inflammation and swelling continuously until it settles down. To address this, ice is always the first choice within the first two weeks.”

But after the initial swelling goes down, Dr. Said says either ice or heat may bring relief. There’s no rule or scientific study to say conclusively that one is better for back pain than the other.

“We have seen that back pain responds to heat and ice differently from patient to patient, and the response is greatly influenced by things like how chronic or frequent a patient has to deal with the problem,” says Dr. Said.

One patient may find that heat helps, another may feel better sticking with ice. Whichever method gives relief is the one you should use.

In fact, for some patients he recommends both. If you wake up in the morning and feel stiff but aren’t in pain, he suggests beginning the day with heat.

“Heat will bring more blood flow to the area, reduce stiffness and discomfort, possibly reducing the pain and aching, so you feel as if you can move a little easier,” he says.

Dr. Said suggests starting your day with a heating pad or a hot shower, then trying to find ways to keep warm throughout the day.

As the day goes on, injured areas tend to swell and become inflamed. By the end of the day, an application of ice will help to reduce the swelling that has built up, along with any pain it is causing.

Whichever you use, heat or ice, Dr. Said cautions that there is no proven benefit to long applications of either. Both heating pads and ice packs do their best work in the first eight to ten minutes.

After that the benefit tapers off. He also says there’s no actual science behind how long to wait between applications of heat or ice, only what helps your pain the most.

“The bottom line is this,” says Dr. Said. “Use whatever feels best to manage your symptoms. If you try one modality and it is ineffective, just switch to the other and reassess.”

Learn more about Dr. Rami Said at his bio page here.

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