I scoured the internet in search of surveys, testimonials and scientific studies looking for the answers when it comes to the debate over Ice or heat being better for acute (flair up/short term back pain) and I am here to share my summerized results.
Just like anyone else, I deal with back pain flair ups from time to time. Sometimes they are bad and other times it’s as simple as taking off my flip flops and putting on some more supportive shoes (yeah, I have pretty flat feet which causes over pronation, which causes my knees to misalign along with my hip blah blah blah). On this journey that I have been on working through what used to be severe chronic back pain I have heard over and over different opinions on Ice vs Heat on lower back pain. Today, I want to settle this debate and hopefully bring clarity and confidence into your next treatment.
Let me throw some basic science at you real quick.
So, normally when you go to the doctor complaining about an acute flair up or sometimes even chronic pain the doctor prescribes ice and rest. They are taught “When in doubt use ice”. That may work for some back pain sufferers but I am hear to say that that isn’t always the case.
Even I was under the impression that ICE is the only way to go, well at least thats what my specialist would always say.
See, the problem we run into is trying to prescribe “rule of thumbs” to the treatment of back pain. Ice being the most common. Remember this one thing, rarely is inflammation an issue when it comes to back pain. So applying ice 10 out of 10 times to treat back pain thinking that inflammation is the issue is just plan misguidance. It’s not always the case.
Ice is used to lower inflammation with major injuries or strains while heat is used to reduce knots, minor muscle spasms and tense muscles (common cause of back pain).
For some, ice actually makes it feel better but for others it actually makes it worse. Often times back pain sufferers will run into what is called muscle knots in the lower back and slapping a pack of ice on the area could actually cause it to tense and constrict more, worsening symptoms and extending the recovery time. I prescribe a morning walk before attacking your day or even any kind of exercise. Getting the muscles in the lower back nice and warm helps relax the area and open the blood vessels up. This allows fresh oxygenated blood to enter in and help release these knots. For most, this walk relieves the individuals pain or allows them to get into the right position so that they can work on their core [such as using the McGill Big 3]
How the heck am I supposed to tell the difference between a strain and a non-inflammatory injury?
I am not going to lie, it’s tough. But think about it this way. A tear or strain is the only time ice is really the first go to treatment and that typically consists of serious damage. “Throwing your back out usually results in severely locked muscles which need HEAT to allow to open up (which is why I pump hot salt baths all the time!)
Think back on your last hot bath? How did your back feel getting out? I know for me personally I feel 100% better with zero pain. Now unfortunately due to a 14 years of training wrong, the pain can quickly return a few days later but thats why I am constantly working to reverse everything that I have neglected over the years. Another example would be during your actual workout. If your not doing any targeted back work and you notice the pain in your lower back slowly going away as the session goes on, why do you think that is? HEAT! Your body is heating up and pumping more blood to areas then before.
Alright, so never use ice, I get it.
Never is a strong statement that should “never” be used when dealing with back pain. It would be dumb to rule out ice all together because at the end of the day you want to do what works best for YOU. Your going to take the things that I say and test and tune everything on your own body. If it causes you more pain then STOP. If it brings relief then keep working on it. Case in point, a sample study of both ice and heat working equally can be found here. There is a lot of debate around this study such as the use of over the counter medication and the power of the mind on back pain. Some people say the results were similar on with both ice and heat do to the method of application. For example, if Dr Stuart McGill (world renown back pain specialist) came to me and said a heat pack will cure my back pain forever vs a stranger saying the same thing, I am willing to bet the results from Dr. McGill handing me that heat pack will be greater then if some random stranger did it.
So what do I do form here?
Do what works for you. You now have the science behind heat vs ice, apply what you have learned and make your own judgment call. Icing your back WILL NOT put you in the hospital (I use it myself from time to time). Sometimes I feel great and other times I just feel the same if not worse.
I say it over and over on this site. Try it out on yourself, if it works keep it if it doesn’t throw it out! Remember, always consult with your physician before doing anything!
Use a form of WET heat for about 20 minutes at a time (do not cycle ice and heat). This could be used as heated gel packs, heat cream, hot bath (with epsom salt), hot tubs ect. If you have a flare up lasting days on end repeat the treatment multiple times a day (2-3x) until you start to feel the lower back release.
Treat it the same way. Stick to about 20 minutes at a time. Hit it multiple times a day and don’t cycle heat and cold. If the ice brings relief then stick with it until you start to feel your back release.
Thanks for reading guys!
What has worked better for you over the years? Ice or Heat?