Heat or Ice for Back Pain: Which Is Better?

Heat or Ice for Back Pain: Which Is Better?

This is a question I always hear—and it’s no surprise. As a physical therapist, I’ve seen a lot of confusion around when to use ice or heat.

The good news? You really can’t go wrong. Both ice and heat are safe options for back pain when used correctly, and neither penetrates deeply enough into the tissue to cause further injury. So even if you don’t pick the “perfect” one for your situation, you're not going to do any harm—you might not get the maximum relief you're hoping for.

I recently recommended heat to a patient, but they mentioned they preferred ice, so they iced and felt like it helped.

That said, there are some general guidelines that can help you get the most out of using heat or ice. And since everyone’s body is different, it’s worth experimenting a bit. Try one method, then the other. The bottom line is to find what works best for you. Some people even find that alternating between ice and heat within the same episode of pain (depending on what's going on) gives them the best results.

Ice is better for acute back injuries, and heat is better for muscle spasms.

When most people have a new onset of low back pain, or they feel that they threw their back out, they may be left wondering what treatment can help them as fast as possible. Most patients quickly think of using heat, ice, or over the counter pain medications for treatment. While ice is better than heat for acute injuries, such as a muscle strain, heat can be better to relax muscles that are spasming.

Honestly, when I treat patients, I typically recommend they use whichever feels better! 

You will find the hot or ice packs I recommend here

Must Know Tips When Using Heat and Ice Therapy For Back Pain

There are some things worth remembering when using heat or icepacks anywhere on your body. Both heat and ice are generally safe to apply to the upper or lower back.

• For acute or new pain ice is often a great first choice.
  • When applying ice, always use a protective layer (fabric) between your skin and the ice pack. Ice should never be in direct contact with your skin. This will prevent frostbite, which occurs when your skin begins to feel numb from the ice.
  • For best results, apply every 2-3 hours for the first 24-72 hours after injury

• For chronic or old pain heat is often preferred
  • When applying a heating pad to your back, it is preferable to lie on your belly and apply the pad over the back. This avoids pressing into the heating pad with your body weight and prevents the risk of a burn or skin irritation.
  • Avoid falling asleep with a heat pack on to prevent burns
• You can also use heat for discomfort from sitting, standing or generally poor posture, joint stiffness, or arthritis
• You my also use heat before physical activity or exercise: this will reduce stiffness, improve flexibility and decrease the risk of any additional strain

Can Heat or Ice Make Back Pain Worse?

‍Yes, in some cases, heat can actually make back pain worse.

While heat is often helpful for relaxing tight muscles and easing chronic discomfort, it can also increase inflammation if applied too soon after an acute or new injury. Here’s why: Your body responds by increasing blood flow and sending healing chemicals to the area (inflammation). When you apply heat, it further dilates blood vessels.This allows even more blood and inflammatory chemicals to rush in.

That said, if heat feels good—like a hot shower or heating pad—then it’s probably okay for your body. But if it seems to make things worse, don’t worry. Just switch to ice and see if that helps more. The key is to listen to your body and adjust accordingly.

‍Yes, ice could also make back pain feel worse in the short term, especially if used too long or at the wrong stage of healing.

While ice is a great choice right after a minor injury to reduce swelling, it can potentially slow healing if overused. Here’s how:

1. You hurt your back, and your body starts the healing process by increasing blood flow and inflammation.
2. Applying ice causes blood vessels to constrict.
3. This reduces circulation and limits the delivery of healing chemicals.
4. The inflammation goes down, but too much icing might slow recovery if used for too long.

Still, ice is a safe and effective option for short-term relief—especially in the first 24–48 hours after an injury. Just like with heat, pay attention to how your body responds and don’t overdo it.

Is Alternating Heat and Ice For Back Pain Okay?

Yes, alternating between using both heat and cold is perfectly fine. You may even find that using heat feels better for one part of your day whereas cold therapy feels better for a different part. Both are completely fine options. With chronic back pain, there isn’t specific tissue damage that we are concerned about. The issue is more about increased sensitivity of the tissue in the low back and movement patterns that have been engrained over the years.

In that case, you can use both ice and heat depending on what makes your pain feel better. Give your body at least 30 minutes between each to return to a normal temperature though to make sure your skin stays healthy.

What Is The Fastest Way To Relieve Back Pain?

1. Rest when needed
2. Gentle Exercise
3. Modalities such as TENs, ice, heat
4. Stretching
5. Make healthy food choices

The research shows that physical therapy treatment is more effective when for acute lower back pain compared to chronic lower back pain. Our spine is very strong and resilient. Working with a physical therapist who has a passion for treating the spine helps to maximize the efficacy of your care. If you are searching for faster relief and want to try on your own, check out these youtube videos for more information!

Summary

In a nutshell, both ice and heat therapy can be helpful tools for managing back pain—each with its own unique benefits.

• Heat therapy is ideal for soothing chronic pain, loosening tight muscles, and easing joint stiffness. Its biggest advantage is that it increases blood flow to the affected area, which helps relax muscle tissue and ease discomfort. A 15–30 minute session is usually enough to feel the benefits.
• Ice therapy, on the other hand, works best for fresh injuries that come with inflammation and swelling. It helps by narrowing blood vessels, which reduces swelling and also numbs the area to ease pain. Applying ice for 10–20 minutes can offer quick relief from acute pain.

Everyone’s body reacts differently, so it’s worth experimenting to see what works best for you. Some people get the most relief by alternating between ice and heat (known as contrast therapy), while others prefer sticking to just one method. The key is to follow general guidelines, but always listen to your body and adjust as needed.