Back Pain Treatment – Heat Or Cold. What’s Best?

What’s the best back pain treatment, heat or cold? For most anyone who has had back pain, this is a very common question. There is a lot of confusion around whats best. A good understanding of when you use heat, or when you use cold, for an injury can actually save you a lot of time and discomfort if you can remember a couple of important principles. Let me share a story to make the point.

I was looking out the clinic window as Frank got out of his Dodge Ram 2500. At first I thought that he was bending down to pick something up off the ground. He stayed frozen, bent over, looking at the ground for a moment or two leaning on the door. Then, he took a couple of steps and I realized that this guy wasn’t looking for anything…he was in agony with back pain.

I watched him stumble toward the front door to the physical therapy clinic and I can remember asking myself  “What am I going to do with this guy? He looks like he needs to be in the emergency room!”

“Doc” (I have to keep reminding all my patients that I’m not a doctor), he says. “You gotta help me. My back is killing me”.  Frank and I go back a couple of years when he came to the clinic for knee pain. I guess that he figured that since I helped him out then, I could do it again.

“What happened to you and why aren’t you at the hospital?” I asked him. ” You was closer.” he said.

Frank was a garbage collector by profession. He spent most days sitting behind the wheel of a big diesel truck 80-90% of his work day. The rest of the time was spent bent over lifting objects that were too big to fit in the cans and tossing them into the truck. He spent most of his day in a bent forward posture and rarely straightened up or stretched. (I wrote a post about sitting all day)

On the day before he showed up at the clinic, he had hurt his back at work. He went through the usual process of filling out the incident report. He was checked out by the company doctor. Sent home with a prescription for anti-inflammatory pills and told to put ice on his back.

Well, Frank got the pills and popped a couple of them. But, what he didn’t do was put ice on his back. He decided that he was going to use a heating pad because, in his words, “the heat feels a lot better than the ice does, doc”. So, he slept with the heating pad on most of the night. What Frank didn’t realize (at that time, any way) was that putting heat on a recent injury will often make the injury a  whole lot worse.

Back Pain Treatment: When To Use Heat Or Cold

Acute pain Vs. Chronic Pain

Acute and chronic are just terms that medical folks use to describe how old something is. When something is acute, this means that it’s happening “right now”.  An acute injury has happened within the last week or two. When something is “chronic” that means it’s been going on for a while.

A perfect illustration for this is the “old football injury”  that some 50 year old guy brags about from his “college” days. On the day that he actually got injured playing the game, his injury was “acute”.  The fact that it continued to bug him from the time he graduated until now is called “chronic”.

You never want to use heat on an acute injury. That one  that is less than 1 week old. With a fresh injury like a muscle strain or twisted ankle, your body goes through what’s called “the inflammation process”. When you put heat on something that is swollen, it tends to swell up more.  Paradoxically, while swelling is the body’s natural response to an injury, increasing the swelling usually causes more pain.

This is where Frank ran into his problems. By sleeping with the heating pad on for several hours all his muscles and soft tissues became even more swollen. And, since he was sleeping and not moving, he stiffened up to where it was agonizing for him to do anything.

You always want to use ice on an acute injury. This is because ice does a few different things to the injured area. First, it slows the blood flow down so that there is not too much swelling. Second, it deadens the nerve endings that register pain. Another thing that it does is to decrease the stretch reflex in muscles which decreases the amount of spasm in the area.

As for chronic pain. That’s pain that you’ve had for months or years, heat is okay with this type of pain. This is because the pain in generally due to tightness and not injury. Sedentary people who haven’t injured themselves, frequently complain of back pain. This is because their muscles are tight and weak, not because anything has been injured. Heat will usually relax the painful areas and loosen it up. this makes moving around a little easier.

Another type of chronic pain is from having surgery in the past. Some people who have had a back surgery or hip surgery also have pain months and years after the procedure has been healed. As long as you’ve got the okay from your doctor, using heat on your surgery area can give good pain relief for some.

Now, unlike acute injuries, chronic pain also responds well to ice. Many people who have aches and pains with everyday ice prefer to use ice because of the numbing effect it has. However, people who’ve had surgeries requiring metal hardware like plates or screws typically can’t tolerate ice because the ice make the metal cold. This seems to cause a lot more pain for people.

Back Pain Treatment: Heat Or Cold Conclusion

The long and short of it is this: ALWAYS use ice on a fresh injury and NEVER use heat.  A fresh injury is an injury that is less than a week or 2 old. Using heat will generally make things a lot worse. If you cannot tolerate ice because it hurts or its too cold, it’s better to not use anything.

For injuries that are 2-3 weeks or older, using heat will not increase the inflammation and will usually help to relax the muscles and make it easier to move. For chronic pain, you can use ice also (except if you have metal implants from surgery).

The best thing for anyone with chronic pain is to experiment  and see which is the best back pain treatment, heat or cold.

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