Ice and Heat for Back Pain: When to Use Each (and for How Long)

Ice and heat for back pain each work best at a different stage. Ice is usually best for a new back injury, such as a strain or sudden flare, in the first 1 to 3 days. Cold constricts blood vessels, which can numb the pain and calm inflammation and swelling. Heat is better for stiffness, tight muscles and ongoing (chronic) aches, because it relaxes muscles and increases blood flow. Keep either one to about 15 to 20 minutes with a cloth between it and your skin, and never use them while you sleep.

Below: a one-glance decision table, how to use each one, what the research shows, whether to alternate, safety rules and when to see a doctor.

Ice or heat? A quick decision table

Ice is best for a new injury, and heat is better for stiffness and pain that has lasted more than a few days.

The same ice-first, heat-later order is used for muscle strains in general. If your ache sits higher up, our guide to pain between the shoulder blades covers the common causes.

When to use ice for back pain

Use ice for back pain in the first days after a new strain, twist or sudden flare. Advice ranges from the first 24 to 48 hours to the first 72 hours. Cold constricts blood vessels, which numbs pain and limits inflammation.

1. Wrap it. Put an ice pack or a bag of frozen peas in a tea towel or damp cloth.
2. Keep it to 15 to 20 minutes. Spine clinics use 15 to 20 minutes for the back.
3. Check your skin every 5 minutes. Take the pack off straight away if the skin turns blue, blotchy and painful, or very numb.
4. Rest between sessions. Leave about 2 hours before the next one.

After 2 or 3 days, ice usually stops helping and may leave your back feeling stiff.

When to use heat for back pain

Use heat after the first 2 to 3 days, or whenever your back feels stiff, tight or sore without swelling. Heat opens blood vessels and increases circulation, which relaxes tight muscles. It also makes connective tissue more elastic.

1. Pick moist or dry heat. Moist heat, such as a warm damp towel, passes heat into your body more efficiently than a dry electric pad.
2. Keep it warm, not hot. Gentle warmth is enough.
3. Watch the clock. Use heat for 15 to 20 minutes at a time.
4. For long-lasting pain, go low and steady. For pain lasting over 4 weeks, Spine-health suggests continuous low-level heat, such as an adhesive wrap, following the package directions.

If you use an electric pad, our guide to choosing a heating pad for your lower back covers types, settings and session times.

For warmth from a cushion you lie back on, the Thera Back Pillow has 3 modes: traction, heat and vibration. Its traction lifts at a 26° angle. It isn't a medical treatment, just one way to add warmth to a rest at home.

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What the research says about ice and heat for back pain

The evidence for heat is moderate, and for ice it is thin. A Cochrane review of 9 trials with 1,117 participants found moderate evidence that heat wrap therapy gives a small, short-term reduction in pain and disability in acute and subacute low back pain. Adding exercise to the heat wrap reduced pain further and improved function. The same review found too little evidence to judge cold, and conflicting evidence on whether heat or cold works better.

In a trial of 371 people with acute low back pain, a low-level heat wrap (40°C / 104°F, 8 hours a day) gave more pain relief than ibuprofen or acetaminophen. A 2015 review notes that most heat and cold advice is based on experience, with limited trial evidence behind it.

Should you alternate ice and heat?

You can use both, in order: start with ice, then switch to heat once the inflammation settles. Within a day, try heat before you stretch or exercise and ice afterwards.

Research hasn't settled whether heat or cold works better, so let your comfort guide you. Stop if either one makes the pain sharper.

Safety rules for ice and heat

A few simple rules keep ice and heat from hurting your skin.

• Always use a cloth barrier. Don't put ice or a heat pack directly on your skin; wrap it in a towel or pillowcase first.
• Never use them while you sleep. Don't lie on a heating pad or ice pack, or fall asleep with one on; it can burn your skin.
• Skip numb skin. Use ice only where you have normal skin feeling and circulation. People with reduced skin feeling are especially prone to heating pad burns.
• Ask a doctor first if you have a long-term condition. Spine-health advises avoiding heat with diabetes, multiple sclerosis, poor circulation, a spinal cord injury or rheumatoid arthritis.
• Not on open wounds or damaged skin.
• Stop if the pain gets worse.

If your back hurts most at night, our guide on how to sleep with lower back pain covers positions and support.

When back pain needs a doctor

See a doctor if your back pain follows a fall or accident, wakes you at night, comes with a fever, or spreads to your legs with weakness or numbness. Also see one if you've lost weight without trying, or the pain isn't better after a few weeks of home care.

Call 911 or go to the emergency room if you have numbness, tingling or weakness in both legs, loss of feeling around your genitals or bottom, or new trouble with your bladder or bowels.

If you're a woman and your back pain keeps coming back, our guide to lower back pain in women covers causes worth checking with a doctor.

For more drug-free ideas, see our 10 home remedies for back pain without medication.

FAQ

Sources

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