Using Heat or Ice for Low Back Pain

To quote Olaf from Frozen, “The hot and the cold are both so intense. Put ’em together, it just makes sense.” Well, the same goes for employing heat and ice to help alleviate lower back pain. It’s so simple, inexpensive, and readily available that it often gets overlooked as a beneficial treatment. Alternatively, you may just not be sure when to use which. In this blog, we discuss the “why,” the “when,” and even the “when not” for using heat and ice so you can find a balance for effective pain relief.

Painful or Stiff?

First, to know which treatment is best for you, assess what you feel in your body. “We recommend using the ‘painful or stiff’ rule of thumb,” advises Dr. Rick Gross of Quality Care Chiropractic. “Use ice when it hurts and use heat when it’s stiff or aching.” These treatments often are applied after an acute injury, but, Dr. Gross adds, often “it’s hard to tell by the timing of the injury. Some people use ice only in the first 24–48 hours, but many people experience back pain for months or years after an injury or have pain that started gradually over several days or weeks.”

All About the Blood Flow

As simple as it seems, the timing of ice and heat application is critical. Using them at the wrong time actually can worsen your condition because the temperature differentials affect blood flow and therefore healing.

Ice reduces blood flow by constricting blood vessels, so it should be used when you want to decrease circulation to an inflamed area. Heat, on the other hand, increases blood flow by dilating blood vessels and increasing circulation.

When Do I Use Ice?

Generally, use ice with an acute injury that resulted in increased inflammation, blood flow, swelling, and pain. Applying ice reduces inflammation, swelling, and pain and increases healing speed. Dr. Gross concurs, “The low back is inflamed or still injured when there is pain (such as sharp, shooting, or stabbing) or numbness and tingling. In those cases, use ice first.”

General Cold Guidelines: Every case is different, but here are a few helpful tips:

• Duration: Apply ice for 20 minutes at a time, followed by a 40- to 60-minute break. Using ice longer can produce negative responses as your body tries to regulate; it will end up increasing blood flow to the area along with inflammation and pain.
• Frequency: During the first 72 hours of an injury, use ice multiple times a day (5–6 times a day for a severe injury) separated by 1- to 2-hour breaks.
• Buffer: Never apply ice directly to skin; always protect your skin with a barrier, such as a thin towel or shirt, to prevent frostbite.
• Sensations: You will feel cold, perhaps mild burning and aching, and eventually numbness at the end of the application. This is good.
• Cold Materials: Items include ice packs, instant cold packs, ice massage, ice baths, coolant sprays, ice cubes in a towel, or even bags of frozen vegetables.

When Do I Use Heat?

Heat is good for chronic or long-term issues with dull and achy pain or muscle tightness. Heat increases flexibility of muscles, which decreases pain and improves function. “If you feel like it’s just hard to move and you are not as flexible because the muscles in your lower back are aching and stiff, then try heat first,” says Dr. Gross.

With an injury, once the initial inflammation and swelling have subsided, switch to heat. This stimulates blood flow and helps facilitate healing. It may decrease stiffness and prevent pain signals from traveling to your brain.

General Heat Guidelines: Again, every case is different, but here are a few tips:

• When to Use: After the inflammatory phase (generally the first 72 hours) of an injury, you can introduce heat in most cases; however, if you still have sharp or radiating pain, it’s too early. Let the pain symptoms subside.
• Duration: Use heat for about 30 minutes at a time. Anything longer than, and you may experience increased inflammation and pain.
• Two Types: When using heat, you can choose between dry or moist. Dry heat is generally easier to apply but may make your skin feel dehydrated. Moist heat penetrates your muscles better but may be more inconvenient.
• Dry Heat Basics: Also known as conducted heat therapy, this is easy to apply with materials, such as heating pads, dry heat packs, heating patches, adhesive heat wraps, hot water bottles, or socks filled with rice and heated in the microwave.
• Moist Heat Basics: Also known as convection heat therapy, this is slightly more effective and takes less time, but it may be more difficult to apply because of the moisture. Useful materials include moist heat packs, hot steamed towels, and hot baths.

Contrast Therapy

This practice uses heat and ice together to affect the dilation and constriction of blood flow to the injured area. Start dilating the blood vessels with heat then follow by constricting the blood vessels with the ice. This creates and active pumping effect and generally is used after the first 72 hours of an injury.

Using Heat and Ice Daily

You may wonder whether it is safe to apply heat and ice regularly as a preventative measure? Of course. They can have great benefits when used in your daily routine. Here are a few ideas:

• If you wake up with an achy or stiff back, keep a heat patch near your bed for use first thing in the morning to warm up your muscles.
• If you have exercised or exerted your back, apply a cold patch before bed.
• If you have chronic back pain, use heat before sleeping and after waking up.
• You can always carry self-activating heat patches and ice packs in your bag or car to use as you need them.

When NOT to Use Either

Although heat and ice are amazing healing partners in many painful situations, it’s not the treatment for everything! For one, do not apply heat or ice to open wounds. In addition, don’t use ice if you have circulatory issues or use blood thinners, and don’t use ice or heat if you have sensation issues (e.g., peripheral neuropathy, diabetic neuropathy). Please consult your doctor or chiropractor if you are unsure.

If you have any questions or want to learn more, contact Quality Care Chiropractic at (630) 499-2225.

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