Ice vs. Heat Therapy for Back Pain: Pros and Cons of Each

• Ice therapy and heat therapy can help you heal from back pain, depending on your condition and the source of the pain.
• Cold therapy is best for acute pain and injuries, whereas heat therapy is best for chronic pain, dull pain, and stiffness.
• Contrast therapy applies heat and cold intermittently and can be beneficial in treating chronic back pain and stiffness.
• People with certain medical conditions should not use these therapies, so be sure to take your whole health into consideration before trying one.

Back pain is one of the most frequently reported conditions in the United States, with some 65 million Americans reporting a recent episode of back pain and 16 million Americans (8 percent of adults) reporting chronic or persistent back pain. As a result, it’s one of the leading causes of missed work and prevents a large group of the population from getting their recommended daily amount of exercise each day.

Unfortunately, with the exception of costly and invasive surgeries, there’s no cure for chronic back pain or acute episodes (except for, in the case of the latter, time and rest). However, there are a number of great things you can do to keep the pain at bay temporarily so that you can get back to doing the things you love to do each and every day. In addition to low-level laser therapy (LLLT), using hot and cold therapies is among the best things you can do to quell your back pain.

In this guide, we cover how to use heat and cold to find relief, with information on the pros and cons of each and how to use one or both as part of a comprehensive treatment plan that really works. Most likely, you have or will someday experience pain that calls for both types of treatment. While ice and heat can promote relief from pain, when misused they can also worsen your condition, so extreme care must always be exercised when using these treatments.

Cold therapy reduces blood flow and constricts blood vessels (vasoconstriction), which helps to reduce swelling and numb the pain. It’s best for treating acute pain, such as that caused by injuries, and it should be applied in the first stages of healing (within 72 hours).

• Best for acute pain from injuries
• Works for sharp, sudden pain
• Helps reduce swelling and numb pain
• Ideal for the first few days after injury
• Can be used alongside heat therapy for chronic pain

Cold therapy (cryotherapy) is used in all sorts of healing procedures. It is a component of the RICE (rest, ice, compression, elevation) method of pain management and is used to treat acute conditions, such as a muscle sprain or strain in the low back. Cold therapy could be as simple as placing a bag of frozen vegetables on a twisted ankle or as complex as taking a dip in a whole-body cryotherapy chamber at a spa.

At its core, cold therapy works by reducing swelling, especially around the joints and tendons. At the same time, it cools the nerves and creates a numbing sensation to help dull the pain. The back is one of the most difficult parts of the body in which to identify swelling. Unlike the ankle or wrist, the inflammation usually stays contained beneath the skin. However, if you believe that your back pain was caused by an injury, such as a pulled muscle, it is probably swelling beneath the surface and could most likely benefit from an ice compress.

Try cold therapy by placing an ice pack onto the injury site for a period of 10 to 15 minutes at different intervals throughout the healing process. Take a break for 40 minutes to an hour in between icing sessions to give your body a chance to go back to normal so the next session will be effective. In the first couple of days following an injury, such as a back sprain, use ice five or six times a day.

You can use ice packs, gel packs, frozen towels, or a package of frozen peas to administer cryotherapy. For best results, do not place an ice pack directly on the skin, as this can cause burns. Always wrap it in a protective layer of fabric or a towel to prevent discomfort. It’s best to rest while using ice, as any pulling or moving can make the injury flare up further. Lying on an ice pack is a good way to target back pain, but you want to make sure you don’t fall asleep on the pack.

Heat therapy increases blood flow and dilates blood vessels (vasodilation), which helps speed up healing and reduce pain. It’s best for treating chronic back pain and can help treat dull, aching pain and stiffness. Never use heat immediately following an injury when swelling is still present. Wait four or five days following injury.

• Best for chronic back pain
• Works for dull, aching pain
• Helps increase blood flow and could worsen swelling
• Helps make muscles more flexible and less stiff
• Moist heat can be helpful for arthritis in the back

Heat therapy (thermotherapy) is the process of using heat to ease pain and promote healing in non-inflammatory conditions. It helps to increase the flexibility of the muscles and stretch the tissues, muscles, ligaments, and tendons in the back to ease stiffness. At the same time, the heat helps to boost blood flow and increase the delivery of nutrients to the area, which can help the body heal damaged tissue faster.

For certain chronic conditions, including arthritis, it may be beneficial to use moist heat, such as a hot bath or steam room. The moist heat is especially good at relaxing those chronically stiff muscles and joints, which can help combat the pain so you feel better relatively quickly. If you are experiencing stiffness due to an injury, you can use heat therapy to loosen those muscles, but only if the inflammation has already subsided.

To apply heat to an injury, you can use an electric heating pad, a heated water bottle, a heated gel pack, or a heated wrap. You can reap the benefits of moist heat in a sauna, steam room, hot tub, or bathtub. No matter whether you’re using dry or moist heat, try to stick to 20-minute intervals and no more. Too much heat therapy can actually worsen your condition and cause extreme stiffness and burns, so be sure to take it easy.

Always make sure to avoid heat therapy if you’re experiencing pain radiating down your leg or if you have sharp, acute pain, which usually indicates inflammation and swelling. Heat can worsen the swelling and significantly slow your healing. Another important thing to note about using heat therapy for back pain is to make sure you never fall asleep lying on a hot pad of any kind—this can cause burns and counteract the effects of hot therapy. Short intervals of low heat is key.

Another great treatment option for chronic back pain is low-level laser therapy (LLLT). By using low-level laser technology, wearable devices like the Curavi belt can help temporarily relieve minor muscle and joint aches, pain, and stiffness. How does laser treatment help back pain? Like heat therapy, it works by relaxing the muscles and temporarily increasing local blood circulation, which helps deliver nutrients to the site and improve flexibility.

But laser therapy is NOT heat therapy. Unlike heat therapy, lasers use safe wavelengths of laser energy to penetrate the skin for deeper healing. Another benefit of Curavi laser therapy devices over heat therapy is that they feature timed, automated sessions so there’s no risk of overheating, burning, or worsening your condition. Your Curavi belt will turn off automatically after each 30-minute session and will never cause burns. Plus, there’s no awkward positioning. You simply wear the device around your waist like a belt for targeted treatment.

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Contrast therapy is a combination of cold and heat therapy involving switching between the two every 15 to 20 minutes, first dilating the blood vessels with heat and then constricting them with cold. This switch-off creates a pumping mechanism, which helps send fluids into and out of the area, effectively reducing inflammation and pain. Contrast therapy can be effective, but it’s best used for chronic pain and stiffness rather than injuries. However, it can be used in acute situations, as long as swelling has subsided (at least four days after the injury).

Tip: You can make your own hot and cold packs fairly easily at home (see instructions here). These packs are filled with rice, dried beans, oats, walnut shells, or other fillings that absorb heat and cold and are safe to microwave or freeze. They’re quite handy to have on hand and are much more affordable than store-bought hot-cold packs.

As you can see, both thermotherapy and cryotherapy bring a number of measurable benefits when treating chronic or acute back pain. However, they should not be applied to all conditions, and extreme caution should always be used. If you’re experiencing any of the following conditions, it’s best to avoid hot and cold therapy altogether. Consider speaking with your doctor before trying these options if you have any health conditions.

• NO HEAT if you have an open wound. It’s best to let your open wound heal on its own, but if the area surrounding a cut or scrape has begun to swell, you can use a bit of ice to help it go down. Just be sure to properly disinfect your ice pack to prevent bacteria from getting in the wound and causing infection.
• NO HEAT if you suffer from circulatory problems or use blood thinners. Heat increases circulation and boosts blood flow, which may be bad for your condition if you’re already dealing with a circulatory problem or vascular disease.
• NO HEAT OR COLD if you have any condition that dulls your senses, such as peripheral neuropathy, diabetes, Raynaud’s disease, or paralysis. When your senses are dull, you’re unable to feel when your skin is coming into contact with high heat or extreme cold, which can cause severe burns.
• NO COLD if you are hypersensitive to cold or if you’re starting your therapy already cold. Let your body warm up to a normal temperature before applying an ice pack.

Utilizing heat, cold, and laser therapy can help improve your back pain and help you get on the path to healing fast. No matter whether you’re recovering from a serious injury or have chronic back pain that holds you back every day, having these options available to you can help you deal with the pain so you can get back to doing all the things you love to do. Just make sure to use the right therapies at the right time and always consult your physician if you aren’t sure which to use.

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