Evidence based

Ice or Heat for Back Pain Relief: How Do I Pick?

Last updated: 
October 8, 2019
Gerrie Lim
Researcher and author
Dr. Juliana Bruner, DPT
Researcher and author, Physical Therapist

Suppose you pull a muscle in your lower back during an intense workout. You’ve heard of applying a hot compress to help relieve your back pain, but you remember icing your injuries when you were younger. Do you apply ice or heat? Which will relieve the pain more effectively, and why?

Ice and heat therapy can each provide quick, affordable relief to stiffness and pain, but they come with significant differences (1, 2). In this article, we’ll cover the specifics of each therapy, how they work, and which one to use in which situation.

Ice Therapy

Ice therapy helps numb pain from acute injuries or reduce inflammation in the treated area.

Icing an injury decreases the body’s temperature and creates local hypothermia, which slows your blood flow and curbs your swelling. This so-called vasoconstricting effect lowers circulation in the tiniest blood vessels by 60% and can last for almost 30 minutes after you take the ice off.

Ice therapy works most effectively when you apply the cold compress to the injury site immediately. Research has found that the use of a cold compress following an acute musculoskeletal injury “results in improved clinical outcomes compared to no treatment” (3).

How to Apply a Cold Compress

You can purchase an instant cold pack, or you can make your own.

To make a cold compress, take a clean sealable bag (like a Ziploc) and fill it with ice cubes or frozen vegetables work too. Before placing on an injury, wrap the bag in a thin cloth or paper towel to protect the skin. Place the cold compress on the skin of the injury for up to 20 minutes. If you need to reapply, wait two hours before doing so again.

Supplement the ice pack with other treatments. When using the cold compress, follow the standard RICE (rest, ice, compression, and elevation) method. If the pain persists throughout the day, consider painkillers like Tylenol or Advil. If the pain continues for more than a few days, talk to a doctor.

When to Use Ice Therapy – Benefits and Risks

Cold compresses work best on (4, 5): 

  • Ankle sprains
  • Tendonitis
  • Bruises
  • Contusions
  • Osteoarthritis
  • Gout
  • Fevers
  • Headaches
  • Eye pain or allergies
  • Sciatica

Different types of injuries call for different types of compresses. For example, when it comes to eye pain, use a cool towel as opposed to an ice pack directly on the eye.

Ice therapy is a fast, affordable, and easy way to treat acute injuries. Acute injuries usually result from sudden trauma that manifests within 48 hours of the injury. Some symptoms include pain, swelling, and redness (6). Cold compression through ice packs is an easy, at-home treatment for these injuries.

Icing carries some risks and drawbacks if performed incorrectly.

Do not apply the ice pack directly to the skin. Cold compression slows blood flow, and if left too long and directly on skin, it can stop blood flow completely or cause nerve damage. Always keep a cloth barrier between the container of the ice pack and the skin at the pain site. Icing should be conducted in 20 minute intervals, with 20 minute breaks in between, over the course of 48 hours (7).

Ice packs can also be used for certain chronic conditions. One example is overuse injuries in athletes. However, make sure to ice the injury after the activity, never before. Additionally, do not put ice packs on your left shoulder if you have a heart condition, or on the neck area (8).

Summary

Icing reduces inflammation and pain from acute injuries, by slowing blood flow in the region of application. Care should be taken to wrap the ice in protective cloth and to take breaks in between icing sessions.

Heat Therapy

Heat therapy can treat chronic pain by relaxing and loosening tissues.

Heating pads stimulate vasodilation, the widening of the blood vessels (9). This allows blood to flow more freely and quickly, delivering proteins, nutrients, and oxygen for improved healing. Heat also stimulates your body’s sensory receptors to block the transmission of pain signals, resulting in a pleasant, relaxing feeling. Additionally, heat promotes your natural metabolic rate, which generates more energy for healing the injury (10).

The heat used in this therapy comes in two forms: dry heat and moist heat. Dry heat is heat from rubber hot water bottle, dry heating packs, and heat pads. This heat is easy to apply and usually readily available. Moist heat comes from steamed towels, warm baths, saunas, etc. It takes time to prepare these, but they may be more effective. Most physicians recommend moist heat as they believe it warms deep tissues better than dry heat does. Moist heat uses water as a medium, as opposed to dry heat’s air, and therefore, moist heat tends to heat more quickly and thoroughly (11).

Even though they are called “hot compresses,” you should always aim to have the compress feel warm, not hot, as you may burn yourself or potentially worsen your injury with excessive heat.

How to Apply a Hot Compress

There are many ways to make a hot compress. Here are a few simple methods.

How to make a dry warm compress

For small-sized areas, hold a metal spoon under hot running water for around 10 minutes. Then, after making sure it will not burn you, hold it to your skin for up to 20 minutes.

For medium-sized areas, fill a sock with uncooked rice. Tie it shut, and heat it in the microwave for 1 - 2 minutes. Make sure to test the sock on the inside of your arm before applying it to the area.

For large-sized areas, place a damp, folded towel in an oven set to 300 degrees Fahrenheit. It needs to be damp so it won’t catch on fire. Leave the towel in the oven for 5-10 minutes, though the duration may vary on the thickness of your towel and strength of your oven. Once complete, wrap the towel in a thin dry cloth, and place it on the area for up to 20 minutes.

How to make a moist warm compress

Fill a bowl with hot water. Make sure the water will not burn you. Soak a towel in the hot water, then wring out the excess. Apply the towel to your skin for up to 20 minutes.

This page will show you how to make a scented compress.

Regardless of which compress you use, be sure to use a clean one every time, especially if you are using the moist warm compress or dealing with an infection. Otherwise, you could spread the infection.

When to Use a Hot Compress – Benefits and Risks

Hot compresses work best on: 

  • Sore muscles
  • Sinus congestion
  • Eye issues, such as styes and pink eye
  • Menstrual cramps
  • Soft or deep tissue injury
  • Sprains

Thermotherapy works best when used in conjunction with other treatments (12). When it comes to lower back pain specifically, a study in Spine found that patients reported that continuous low-level heat wrap therapy relieved their pain better than acetaminophen (Tylenol) and ibuprofen (Advil) (13). Taking fewer analgesics reduces the strain on your kidneys (14).

Check with your doctor if you have a heart condition or high blood pressure.  Do not use heat therapy after exercise or an activity. Heat should not be used if the skin is red, hot, or inflamed, if there is an open wound, or if you have dermatitis. When applying a heat compress to skin, make sure the temperature of the compress does not burn you, by testing it with the back of your hand. When applying heat therapy, stay well hydrated, and be sure to stay alert. If you fall asleep with a heating pad on, you could seriously burn yourself.

Summary

Heat therapy can be especially helpful in cases of chronic pain, by stimulating nutrient flow and inhibiting pain receptors. When using heat, be careful to avoid burns by testing the temperature of your pack before you apply it -- it should be warm to the touch, not hot.

Ice vs. Heat – which one is better?

The answer to the question of which temperature therapy is better depends on what you’re applying the compression to. Ask yourself, “which one is better for (insert condition here)?”

If you have a fresh injury or swelling, try using ice to reduce inflammation in the area. If you feel muscle pain, consider using heat therapy to dilate the vessels to promote blood flow and healing. It’s important not to mix these up. Heat applied to a swollen area can exacerbate swelling by promoting even more fluid and blood to flow to a location. Likewise, ice applied incorrectly can sometimes worsen an injury. Never use extreme heat or place ice directly on skin.

Some might find it helpful to alternate between cold and heat therapy. This is especially useful for osteoarthritis, exercise-induced muscle damage (EIMD), and delayed onset muscle soreness (DOMS). Contrast water therapy alternates cold and hot therapies by allowing a person to immerse a limb or their entire body in hot (but not boiling) water, then following with an immersion of the same part in ice water. The procedure is repeated several times. A 2013 study suggests contrast water therapy is better for muscle soreness than rest is following intense physical activity (15).

Hot and cold therapy for lower back pain

Should you apply heat or cold therapy to your lower back pain?

Use a cold compress for new injuries. Otherwise, in cases such as neck and back strain, studies have found minimal difference between the efficacy of these approaches. The right choice for a particular case essentially comes down to patient preference (16). Conditioning produces a psychological effect whereby the body reacts to cold by tensing up, which is detrimental for lower back pain. Our bodies are more accustomed to heat, and so heat does not agitate our body in the same way. We often find heat soothing, maybe even comforting. So while there is no scientific evidence that heat therapy is better than cold therapy, most people prefer using heat for treating lower back pain.

As long as there is no swelling, doctors believe that either ice or heat can relieve back pain. It simply depends on the patient. If you start your day with back pain, one specialist suggests treating it in the morning with some heat. At the end of the day, you’ve probably built up some swelling, makes sense to apply ice (17).

Summary

The literature suggests that ice and heat can each be used to treat many types of pain. With the exception of a few particular cases like fresh injuries (for which a cold compress is more appropriate), you should feel free to try both and stick with the one that best suits you.

Final Recommendations

There are clear benefits to using temperature therapy. It’s easy and affordable to make heat or cold packs from household items, potentially cutting down on the need for painkillers or hospital visits. One study even found that if you wait 24 hours after physical activity, both cold and heat therapy work well in reducing muscle tissue damage (18).

Here’s a simple way to remember which therapy does what: ice is for injuries, heat is for muscle pain.

Don’t use temperature packs:

  • On areas of the body with unhealthy skin
  • On areas of the body prone to infection (open wounds, sores, etc.)
  • On areas of the body with poor circulation

Consult your doctor if you have diabetes before applying a temperature pack.

The next time you get hurt or you’re hurting, consider heat or ice therapy before reaching for a painkiller. When it comes to deciding between the two temperature therapies, remember to listen to your body— for example, when you feel overheated or flushed, it’s probably best not to use heat. Use whichever treatment makes your body feel best. If cold therapy does not reduce swelling within 48 hours or if heat therapy does not alleviate pain within a week, seek professional help. While temperature therapy may not fix the root of your injury or condition, it can at least alleviate pain, and that’s worth something.

The information provided in this article is not a substitute for professional medical advice, diagnosis, or treatment. You should not rely upon the content provided in this article for specific medical advice. If you have any questions or concerns, please talk to your doctor.

Research Citations

Researched, written, and reviewed by:
Gerrie Lim
Researcher and author
Gerrie holds a Master's in Public Health from Columbia University and has worked with a number of healthcare organizations in the past. She's especially passionate about using media and technology to improve healthcare for marginalized populations.
Read full bio
Dr. Juliana Bruner, DPT
Researcher and author, Physical Therapist
Dr. Bruner is a physical therapist who is highly trained and skilled in helping people overcome their physical ailments to live the best life they can. She is also a writer who enjoys spreading knowledge about various topics in the PT and healthcare industry.
Read full bio
Is pain holding you back?
We offer online doctor visits, at-home physical therapy regimens, and safe medications delivered to your door
Schedule a Free Consult

Related Articles

This article is based on scientific evidence, written by experts and fact checked by experts.

Our team of board-certified physical therapists, physicians, and surgeons strive to be objective, unbiased, honest and to present both sides of the argument.

This article contains scientific references. The numbers in the parentheses (1, 2, 3) are clickable links to peer-reviewed scientific papers.