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Heat or Ice for Back Pain?

When is the best time to use heat or ice for back pain?

I deal with back pain patients every day in my clinic.  I find that some of my patients are confused about when to use ice for back pain, and when to use heat.


Why ice for back pain?

When it comes to acute back pain or new back injuries, you should always apply ice.  This is because with any back sprain, back strain or back bruising there is some bleeding into the underlying tissues.  This may cause swelling and pain and could delay healing.  An ice pack can decrease circulation, metabolic activity, inflammation and numbs the skin.  You may have heard from some other back pain specialists that ice can also be used in later rehabilitation, but I don’t agree with this.  It is better to use heat rather than ice in later rehabilitation.  Icing is primarily an analgesic for acute back pain and it is not an actual treatment.  It only numbs the painful, inflamed back joints and tissues.  It is good if you can use ice instead of ibuprofen when your back injury is new.


Benefits of ice for acute back pain/fresh back injuries:


Decreases back pain;

Decreases back tissue swelling;

Decreases inflammation of back joints;

Reduces spasm/cramp in back muscles.


How long should I apply ice for back pain?

Usually apply an ice pack on the painful area for 15 to 30 minutes per session, 3 to 4 times per day.  You can do this up to once every 2 hours if you have severe back pain.  I only advise my patients to use it for the first 24 hours.  After the first 24 hours, bleeding should have stopped, and from then on heat should be applied to the painful area.  Prolonged use of ice can cause frostbite.


How do I make ice packs for my back injury?

If you just injured your back, the quickest way to make an ice pack is to go to your freezer and get a packet of frozen peas and put it on your back.  Otherwise, ice packs can be made from ice cubes in a plastic bag or wet tea towel.  You can also buy a cold pack from pharmacies and keep it in the freezer all the time for emergency use.  Please note that you should roll a wet flannel around ice and cold packs (if you directly take it from a deep freeze) before you put them on your back.  You may get ice burns by using ice directly on your back.  Some back specialists might advise you to have an ice bath, but if you do this you may end up with pain in other parts of your body due to bad circulation.


Why heat packs for back pain?

I suggest heat packs for all chronic back pain, back pain during pregnancy and back injuries older than 24 hours.  I know that some people suggest applying heat packs after 48 hours, but applying ice for longer than 24 hours leads to a longer recovery time according to Traditional Chinese Medicine.


Heat will increase blood circulation because heat causes vessels to open wide (dilate).  Heat also removes cold and dampness.  Heat brings more blood with all new things into the back area to stimulate the healing of damaged back tissues; you will feel a direct soothing effect and also instant relief from pain/cramp/spasm.  It can also ease stiffness and tightness by making the tissues softer.


Simply applying a heat pack won’t fix your back pain, but application of heat will help heal your back pain faster than acupuncture treatment by itself.


Where should I apply heat for my back pain?


I advise all my back pain patients to apply a heat pack along the spine from the upper back down to the lower back.  Don’t just keep it on where you feel the pain in your back.  This is because I have found that all chronic back pain is caused by tight muscles and tendons in the upper back area rather than just the area where the pain is felt.  Therefore a big long heat pack is necessary.


What kind of back pain can benefit from heat packs?

Apply heat for all kinds of back pain, except for new back injuries.  Heat should be used for chronic back pain, back pain during pregnancy, back pain after giving birth, back pain after hysterectomy (this kind of back pain is becoming more common), back pain after epidural, hernia disc back pain, kidney back pain.


How long should I apply heat for back pain?

You should apply a heat pack to your back as often as you can, not just for 30 minutes.  Whenever a patient asks me, “How long should I apply a heat pack on my back?” I always answer: “24 hours per day.”  Then my patient always looks at me with a questioning look on their face, and I will explain to them “well, I know it is unrealistic for you to apply a heat pack along your spine for 24 hours a day, but I want you to keep it along your spine as often as you can.  I mean you should keep it on when you are sitting and sleeping, only be without it when you are standing (if you can keep it on your spine while you stand it is even better).  The longer you keep it on the better.  The more often you keep it on, the faster you will get your back pain free with my treatments.”

Please note that if heat is applied to your whole back it should not be hot, it just needs to keep it warm, gentle warmth will suffice.  If excessive heat is applied there is the risk of burns and scalds.  It is a good idea for you to place a towel between the heat packs and your back for protection if it is too hot.


What kinds of heat can I apply to my sore back?

Heat can be applied in the form of a wheat bag, heat pads, deep heat cream, hot water bottles, heat lamps or having a hot bath. I suggest a wheat bag to all my back pain patients.  Heat packs can be used for any kind of chronic pain (such as shoulder pain, hip pain, sciatica, neck pain), so it is better for you to keep a wheat bag at home in case you need it in the future.


Why can’t I use heat pack for a new back injury?

The reason I don’t suggest you use heat on a new back injury is simply because heat will increase bleeding around the injured back area and may make the problem worse.  But there is an exception to this: if you have a new-onset back strain, your back pain in this case is caused by muscle spasm rather than tissue damage, so heat is often more helpful than ice.   I have suggested to some of my acute back pain patients to apply heat instead of ice in the first 24 hours in the past, but that was only when I was sure that they had no tissue damage.


I hope this article has given you an idea of when is the best time to apply ice and heat in back pain.


If you are uncertain about the use of ice or heat, consult a health professional such as a doctor, nurse, acupuncturist or physiotherapist.




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