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Heat or Ice for Back Pain: Which Is Better?

Heat or Ice for Back Pain: Which Is Better?

Dr. Michael Derry, DPT, PT, OCS Jacksonville, Florida
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Is heat or ice better for back pain?

Ice is better for acute 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.

Most importantly, you aren't going to harm yourself by using either (as long as you don’t go over the top). If you have a pulled muscle and you forget that ice is better for a strained muscle, you haven’t caused your body any damage that it won't be able to fix. Alternatively, if you have a muscle spasm and you use ice, the effects are very short term and your body will work itself out eventually.

Honestly, when I treat patients, I say use whichever feels better! 

Can heat make back pain worse?


Yes, heat can make back pain worse in theory.  While there is some evidence that heat will help decrease low back pain, there is a possibility that it can increase inflammation via the following process:

  1. Initial injury causing muscle soreness
  2. Increased blood flow and healing chemicals (inflammation)
  3. Heat application
  4. Blood vessels dilate
  5. Even more blood flow and healing chemicals
  6. Increased inflammation

This is all short term. If you apply heat because you thought it would be the best treatment but it made you hurt more, then just don’t do that again. Try ice. Everyone’s body is different, but listening to yours will help you the most.

If the host shower or hot bath feels good, then use heat! 

Can ice make back pain worse?

Yes, ice can make back pain worse, but only in the short term. While you should start with ice when your back hurts after a minor injury, there is a possibility that this treatment can slow healing via the following process:

  1. Initial back muscle injury
  2. Increased blood flow and healing chemicals (inflammation)
  3. Ice application (aka cold therapy or ice therapy)
  4. Blood vessels constrict
  5. Less blood flow and healing chemicals
  6. Decreased inflammation

If you are searching for relief for your back pain, it is okay to use ice (aka cold therapy, ice therapy, or ice baths) for a short period of time.

However, we want some inflammation, and unfortunately pain, in that area because that is a signal of your body healing the tissue.

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. Seek care from a physiotherapist
  2. Exercise
  3. Cold therapy or heat application
  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!

Exercise helps to promote blood flow, increase endorphin release, and improve our overall health.

We need blood flow to heal our tissues and endorphins can help to curb the amount of pain we feel.  

Cold and heat can help with pain relief. If you are trying to decide between ice or heat, remember that ice is better for acute injuries and heat is better for muscle spasms. Applying either one is an easy way to help yourself from the privacy of your own home.

Stretching muscles, such as our hip flexors or back muscles, can help to improve pain by relaxing our muscles. In a clinical setting, we suggest our patients hold a stretch for 30-60 seconds to give that muscle time to respond. Surprisingly, our hip flexors snake through our pelvis and attach to our lower spine. Decreasing some of the tension in these muscles can result in less pull on your lower back.  

hip flexor and quad stretch
Hip flexor and quad stretch

The lower back has a group of muscles that work together to produce all sorts of movements, from twisting to bending sideways to folding forwards. A downward dog stretch can help to target multiple muscles with one movement.

lower back stretch at home

Our food and water are literally the building blocks of every single cell in our entire body. The sum of every cell in our body determines our health. When we are sick or injured, it is crucial that we care for our bodies by providing them with extra nutrients to rebuild with. Just like trying to improve our overall health, think about eating more fruits and vegetables and less processed items. Not only can this help to decrease the amount of systemic inflammation in our system, but it can also greatly improve our overall health and resiliency.

Should I use ice or heat for lower back pain from sciatica?

This is a challenging question because sciatica means leg pain! If you are having leg pain and also having back pain but you haven’t had a recent injury, heat usually feels best. If there is truly a nerve issue in your back causing your leg pain, neither ice nor heat will not penetrate to the tissue at that level. The ice and heat is more to send a competing signal to your brain to block out some of the pain. If you use heat to care for your pain, your lower back muscles may also feel more relaxed after.  

Should I use ice or heat for back pain from a herniated disc?

If you have herniated your disc within the past few days, you can use ice.  After that, use whichever one makes you feel best, or a combination of ice and heat!

Our discs are very deep in our back.  So deep that a superficial application of ice or heat will not reach those deep tissues.  However, if you have acutely herniated your disc, there is most likely an inflammatory healing process occurring, which is why you may get some benefit from ice.  After that, the back muscle may be guarded or sore, making heat feel more comfortable. Both heat and ice are perfectly acceptable options after the first few days.

Should I use ice or heat for upper back pain relief?

Heat therapy is usually recommended for upper back pain relief because pain in this area is usually due to muscle soreness. Heat therapy via a heating pack, a warm bath, or an extra long shower should help the muscles to relax.  Ice won't do any damage, but it may make you feel more stiff until that tissue warms up again. We also love some self massage of these muscles with a theracane!

In summary, using ice or heat for back is a low risk way for your have pain relief. Whcih is better is based on a few factors including how new the injury is as well as how it feels. Either way, what I see when I treat patients is that your body will tell which one it likes better! Try both of them and see how long the relief lasts.

Revision Health Services offers telehealth for Florida residents as well as massage and physical therapy locally in Jacksonville, Nocatee, and St. Johns, Florida. To find out if our services could be the best fit for you, reach out and let's chat!

Until next time, stay healthy, keep moving, and take care of yourself.


1. French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database Syst Rev. 2006 Jan 25;2006(1):CD004750. doi: 10.1002/14651858.CD004750.pub2. PMID: 16437495; PMCID: PMC8846312.

Dr. Michael Derry is a Doctor of Physical Therapy and board certified in orthopedics. He is very passionate about treating lower back pain and helping people build their resiliency. He has spent time assisting at universities as well as managing large clinics before starting his own practice in Jacksonville, FL.

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