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Heat or Ice? What's Best for Back Pain?

Dr. Anand Blog Article

From the very physically active to the sedentary, most of us will encounter at least one acute back pain episode at some point in our lives. Whether you’re on a sports team, practice yoga at home, garden in the yard, or are just bending down to pick up the kids, a little back strain or sprain may make its way to you at some point. As a physician who specializes in the treatment of the spine, one question I often hear from those looking for fast back pain relief is: Do I apply heat or ice? There are a couple schools of thought on this. Some will tell you to go straight for the ice, while others swear by heat. So which is it that’s going to make your injury feel better? For different circumstances each method serves a purpose, however there are certain guidelines to help you make the better choice for your specific situation. The kind of injury sustained and the type of pain it brings are the basic factors in determining whether to apply ice or heat, but it doesn’t have to get too complicated. Let’s take a look at when to use each method, and why.

Heat or Ice for Back Pain?

The first and most important rule to remember is for new acute muscle injuries, use ice. The initial pain felt is the body’s response to the inflammation and swelling of the injured tissue. Applying ice to the area will constrict blood flow to the injury, reducing the amount of inflammation and swelling and thereby reducing the pain. Alternately, adding heat at this stage of an injury would most likely make the pain worse and delay healing, as it increases the body’s blood flow and inflammatory response around the injury.

Before beginning cold therapy, it is important to know the proper mechanics for icing. First, always make sure there is a barrier between the ice and your skin, and do not hold it on the area for longer than 20 minutes at a time. Here are some of the easiest options for icing:

  • Ice pack:fill a plastic bag with ice and water, seal tightly, and wrap in a thin towel before placing on the skin
  • Ice towel:place a damp towel in the freezer for 15 minutes and then place directly on the skin

Out of supplies? Not to worry. A bag of frozen peas will work just as well! Just remember to place a paper towel between the bag and the skin.

So if ice is the answer for initial treatment of a new acute back injury, how often should it be applied? The first 72 hours (3 days) after the injury are the most imperative to obtain optimum pain relief and healing. For the first 24 hours, icing the area for ten minutes every hour is the most effective option. This may seem like a lot of work and may be inconvenient if you have to go to school or to the office, but if done right it will set the tone for the healing process. In the next 48 hours, aim for fifteen minutes of icing every two-three hours. Once the initial 72-hour icing period has passed, it is recommended to continue icing. However, at this point fifteen minutes, three times a day is all that’s needed. Think morning, afternoon, and evening. Plus, icing in the night time slot just before bed will give you a little extra pain relief to help you sleep better through the night. And if you do plan to participate in any strenuous activity- make sure to throw in an extra ice therapy after the activity to help the muscles recover.

Now that we’ve thoroughly covered ice, let’s talk about heat. As a good rule of thumb, heat therapy should only be used on injuries that are over 6 weeks old. Quite literally, applying heat is great for “warming up” tissues. The heat will dilate blood vessels, allowing more blood flow to the area and helps to loosen muscles while enhancing flexibility. In the case of chronic back pain, heat may be used to loosen up muscles that have been stiff for a lengthened period of time. Heat can also be a great option for warming the back muscles up before any strenuous activity to avoid injury due to stiffness. The looser the muscles, the greater range of motion they can endure without sprains or strains. Just the same as ice, heat should never be applied for longer than 20 minutes at a time and moist heat (warm baths or saunas) are much more effective than dry heat. If you do end up using an electric heating pad, always make sure to keep it on low or medium setting and unplug it after the 20 minutes is up!

Dealing with back injuries can be tricky, but following these guidelines will hopefully ensure the least pain and the quickest healing period, so you can get back to living the life and participating in activities you enjoy!


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