Topical application of ice or heat therapy can bring a surprising level of pain relief for most types of lower back pain—but each treatment is unique and works better in specific situations.

Ice therapy reduces swelling and pain while heat therapy reduces muscle spasms and increases the flow of nutrients.

This blog provides tailored insights on when ice and heat therapies may be used, and which option works better in different situations.

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
Read more about Causes of Lower Back Pain
Direct lower back injury from falls, sprains, sports injuries (twisting injury from swinging a golf club), or collisions ¹ Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2014;127(1):57-65. doi:10.1080/00325481.2015.992719
Pulled back muscle due to excessive strain or force leading to overstretching of the muscle fibers, such as from lifting weights ¹ Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2014;127(1):57-65. doi:10.1080/00325481.2015.992719
See Pulled Back Muscle Treatment
Exercise-induced muscle soreness, such as a from trying a new exercise, exercising without an initial period of warming up, or overdoing a specific exercise ¹ Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2014;127(1):57-65. doi:10.1080/00325481.2015.992719

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 Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. J Clin Diagn Res. 2014;8(9):LC01–LC4. doi:10.7860/JCDR/2014/7404.4818 Lowering the body temperature will help constrict the blood vessels, reduce swelling, decrease inflammation, and cause a numbing effect. ¹ Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2014;127(1):57-65. doi:10.1080/00325481.2015.992719 ^, ³ Garra G, Singer AJ, Leno R, et al. Heat or Cold Packs for Neck and Back Strain: A Randomized Controlled Trial of Efficacy. Academic Emergency Medicine. 2010;17(5):484-489. doi:10.1111/j.1553-2712.2010.00735.x

See Ice Packs for Back Pain Relief

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.

See How to Apply Heat Therapy

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 Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. J Clin Diagn Res. 2014;8(9):LC01–LC4. doi:10.7860/JCDR/2014/7404.4818

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 Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. J Clin Diagn Res. 2014;8(9):LC01–LC4. doi:10.7860/JCDR/2014/7404.4818 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 Petrofsky JS, Khowailed IA, Lee H, et al. Cold Vs. Heat After Exercise—Is There a Clear Winner for Muscle Soreness. Journal of Strength and Conditioning Research. 2015;29(11):3245-3252. doi:10.1519/jsc.0000000000001127 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. ⁴ Petrofsky JS, Khowailed IA, Lee H, et al. Cold Vs. Heat After Exercise—Is There a Clear Winner for Muscle Soreness. Journal of Strength and Conditioning Research. 2015;29(11):3245-3252. doi:10.1519/jsc.0000000000001127

Tips to combine heat and cold therapy in your daily routine

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.

DIY and store-bought options for heat and cold therapy

Finding the most effective mode of therapy may require a process of trial and error. Here are some specific options for you to consider:

Heat pack options:
- Make your own heat pack using a sock filled with rice and heated in the microwave
- For continuous low-level heat, a commercial adhesive heat wrap is useful
- For moist heat, use a moist hot towel and for dry heat use a heating patch or a hot water bottle
Watch Video: How to Make a Homemade Heat Pack
Cold pack options:
- A bag of frozen vegetables or ice-cubes wrapped in a towel
- Instant cold packs that activate on-demand can be bought from the store and are useful while you’re traveling or at work
Watch Video: How to Make 5 Quick and Easy Ice Packs

You can also buy heat and/or cold patches, warming blankets, or specialized heat-emitting devices, such as ultrasound machines and/or infrared mats from the store.

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. ¹ Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2014;127(1):57-65. doi:10.1080/00325481.2015.992719

It is also advisable to avoid laying directly on the heat source due to the risk of burns, skin damage, or permanent changes in skin color. A protective barrier such as a cloth or towel may be used between your skin and the source of heat.

In general, many people feel heat therapy works better to relieve their lower back pain compared to cold. Also, taking oral pain-relieving drugs while using these therapies may have an added effect on the overall pain relief. ² Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. J Clin Diagn Res. 2014;8(9):LC01–LC4. doi:10.7860/JCDR/2014/7404.4818

Learn more:

How to Use Ice Massage Therapy for Back Pain

Benefits of Heat Therapy for Lower Back Pain

1 Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2014;127(1):57-65. doi:10.1080/00325481.2015.992719
2 Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. J Clin Diagn Res. 2014;8(9):LC01–LC4. doi:10.7860/JCDR/2014/7404.4818
3 Garra G, Singer AJ, Leno R, et al. Heat or Cold Packs for Neck and Back Strain: A Randomized Controlled Trial of Efficacy. Academic Emergency Medicine. 2010;17(5):484-489. doi:10.1111/j.1553-2712.2010.00735.x
4 Petrofsky JS, Khowailed IA, Lee H, et al. Cold Vs. Heat After Exercise—Is There a Clear Winner for Muscle Soreness. Journal of Strength and Conditioning Research. 2015;29(11):3245-3252. doi:10.1519/jsc.0000000000001127

Dr. Marco Funiciello is a physiatrist with Princeton Spine and Joint Center. He has a decade of clinical experience caring for spine and muscle conditions with non-surgical treatments.