You have a flare-up of low back pain, upper back pain, or headaches – what should you use over your spine – heat or cold?
Typically, ice is recommended for sudden onset injury (“acute”), and heat for longer term injuries (“chronic”) (1).
So if you have a sudden flare-up of back pain, there is most likely inflammation present, and cold/ice would be more appropriate.
The use of heat over the spine is not typically recommended in our practice, as most spinal problems have some element of inflammation. The exception is the situation where there is little inflammation, and only isolated muscle tightness (hypertonicity). In these cases, application of heat over the muscle may result in relaxation of the muscle.
If you have a chronic disc problem, and you have a flare-up of that condition, application of heat is not recommended. Ice/cold is recommended in this situation, as there is most likely inflammation involved.
What does the scientific literature say?
Regarding heat –
“there is moderate evidence that heat wrap therapy reduces pain and disability for patients with back pain that lasts for less than three months. The relief has only been shown to occur for a short time and the effect is relatively small. The addition of exercise to heat wrap therapy appears to provide additional benefit.”
Regarding cold –
There is still not enough evidence about the effect of the application of cold for low-back pain of any duration, or for heat for back pain that lasts longer than three months.
As often occurs with research – “the results are inconclusive, and we need more research.”
The take home message:
Many spine problems have elements of inflammation. We recommended the use of ice/cold if in doubt.
Cold therapy is used to reduce inflammation, pain and oedema. Superficial cold includes cryotherapy, ice, cold towels, cold gel packs, ice packs and ice massage.
- Grana 1993; Michlovitz 1996).
(French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. Superficial heat or cold for low back pain. Cochrane Database of Systematic Reviews 2006, Issue 1. Art. No.: CD004750. DOI: 10.1002/14651858.CD004750.pub2.)