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Ice or heat for back pain: a simple guide

Ice or heat for back pain
  • Published: 7 May 2025

Back pain is one of the main causes of disabilities worldwide1, not to mention the number of individuals who require healthcare or emergency services for it2. In addition to taking over-the-counter drugs and other medical interventions prescribed by specialists, you can follow some therapeutical strategies on your own, too, ideally while still asking for expert advice3. One option is to apply cold or heat, like a hot bath, heat packs or ice4. Is ice or heat better for back pain? It depends on what the cause is, when it started and if you have any other health issues4. Here is how to decide, plus a few other suggestions.

 

Ice or heat for spine pain?

ICE:

Cold is vasoconstrictive, i.e., it reduces blood flow, slows the metabolism and lowers pain, swelling, inflammation and muscle contraction5.

There is an ongoing, somewhat controversial debate in sports medicine on the use of ice, which is recommended for sharp sudden pain5 caused by overexercising or trauma for example. So it is ideal for pulled muscles, falls, and sprains6. It is not recommended for those with cardiovascular diseases or peripheral vascular diseases like Raynaud syndrome4.

You can use it repeatedly every two hours until the pain and swelling decrease, but not for too long each time (20 minutes maximum) because it could delay recovery7.

HEAT:

Superficial heat therapy is widely recommended for musculoskeletal pain7. Heat is a vasodilator, therefore it increases blood flow in the region where it is applied, as well as the metabolism and the elasticity of connective tissue3. This aids muscle relaxation and reduces muscle stiffness, increasing muscle strength and ultimately improving recovery8. Heat therapy is recommended for muscle spasms, contractions, neck pain and is instead not recommended if you have a tumour, infection, open wound or other health conditions which should be discussed with a physician4. Using heat continuously is best at a later time rather than right after the trauma occurred8.

Oftentimes, you can combine ice and heat and alternate them in repeated cycles9.

 

How to help lower back pain

The right approach is to find out what is causing back pain, and based on that, to act accordingly2. One common source of pain is bad posture, so one of the first steps to take is to improve that2. If you are experiencing strong, nagging back pain it may be essential to contact a doctor9. It is best to refrain from heavy physical work, sudden movements, and unapproved sports, asking for a doctor’s advice2. The standard recommendation is to take some time to rest, especially during the acute stage7, and to resume moderate exercise once the symptoms allow it10.

Staying active by doing light exercises like stretching, but also swimming or yoga10, can help up flexibility and lower muscle tension and symptoms11.

 

“Natural” back pain remedies

Non-pharmaceutical remedies, too, can come to the rescue, such as physical therapy which increases strength and muscle flexibility2. Alternative therapies are another aid, like acupuncture and massage therapy, not to mention some lifestyle changes2. To improve lifestyle and health, overweight or obese patients should lower their body weight, while smokers should quit smoking2. Regular exercise also helps prevent back pain and other health issues12,13.

It is important to prevent back pain, but when the pain gets intense or persists, do not hesitate to ask your doctor for help in deciding what measures to take7.

 

 

  1. World Health Organization (WHO), “Low back pain”, 19 June 2023
  2. Casiano V. E., Sarwan G., Dydyk A. M. et al., “Back Pain”, [Updated 2023 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK538173/
  3. Hotfiel T., Fanlo-Mazas P., Malo-Urries M., Paulino E., Sequeira de Medeiros L., Massimo Blondett M., Vetrano M., Freiwald J., “Importance of heat therapy in the treatment of pain in the daily clinical practice”, Journal of Bodywork and Movement Therapies, Volume 38, 2024, Pages 263-268, ISSN 1360-8592, https://doi.org/10.1016/j.jbmt.2024.01.015 (https://www.sciencedirect.com/science/article/pii/S1360859224000299)
  4. El-Tallawy S. N., Nalamasu R., Salem G. I. et al., “Management of Musculoskeletal Pain: An Update with Emphasis on Chronic Musculoskeletal Pain”. Pain Ther10, 181–209 (2021). https://doi.org/10.1007/s40122-021-00235-2
  5. Wang Z. R., Ni G.X., “Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?” World J Clin Cases. 2021 Jun 16;9(17):4116-4122. doi: 10.12998/wjcc.v9.i17.4116, PMID: 34141774; PMCID: PMC8173427, https://pmc.ncbi.nlm.nih.gov/articles/PMC8173427/
  6. Cleveland Clinic “Back strains and sprains”, 11-09-2018
  7. National Health Service (NHS – Uk), “Management of acute injuries (sprains and strains) PRICE guidelines”, 16 July 2024
  8. Freiwald J., Magni A., Fanlo-Mazas P., Paulino E., Sequeira de Medeiros L., Moretti B., Schleip R., Solarino G., “A Role for Superficial Heat Therapy in the Management of Non-Specific, Mild-to-Moderate Low Back Pain in Current Clinical Practice: A Narrative Review”. Life (Basel). 2021 Aug 2;11(8):780. doi: 10.3390/life11080780. PMID: 34440524; PMCID: PMC8401625, https://www.mdpi.com/2075-1729/11/8/780
  9. Versus Arthritis (nonprofit, Uk), “Back pain”
  10. National Health Service (NHS – Uk), “Back Pain”, 10 June 2022
  11. Mayo Clinic (nonprofit, Usa), “Back exercises in 15 minutes a day”, 15 August 2023
  12. British Heart Foundation, “Exercices for lower back pain”
  13. Institute for Quality and Efficiency in Health Care (IQWiG), Cologne, Germany, Low back pain: Research summaries – Can exercise prevent recurrent low back pain from coming back? InformedHealth.org [Internet], 2006, [Updated 2022 Dec 6]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK284937/
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