Lower Back Pain: Hot or Cold?

Should we apply heat or cold after back pain (or any other physical pain)? This is the question that almost all my patients ask me following an episode of lumbago, sciatica, cruralgia, herniated disc, etc.

As everyone wishes avoid medication and other invasive treatments (such as seepage or surgery), many are turning to more natural methods to relieve their back pain.

If you're reading this article today, you've probably heard conflicting answers. Ice or heat? How long should these terms be applied? What are the risks ? In short, what to choose and what to do concretely?

For those who have lower back pain, I explain the difference between hot and cold to relieve your symptoms, in light of the latest scientific recommendations.

Hot or cold: why so many contradictions?

Your colleague tells you that he has warmed up following his episode of lumbago (heating bag or hot water bottle). Another tells you that it was the cold (ice compress) that relieved his sciatica.

Even if you ask for the opinion of health professionals, you will find conflicting answers.

Why ? It's simple… there is JUST no right answer!

If we rely on scientific evidence, current studies are unfortunately not of high quality. And if we look at the conclusions of these studies, we see varied conclusions, and even contradictory.

In some studies, it is the ice which seems more effective following lumbago.

In others it is the heat that demonstrates the most benefits.

Believe it or not, but there are also studies where none of these modalities have been shown to be effective!

What can we conclude? First, you should not rely solely on the conclusions of a single study when looking for solutions to relieve your back pain.

The next thing is that each person reacts differently to the various treatments available. So, there is truly only ONE way to choose between hot and cold for your pain. after acute lumbago… it's'try for yourself !

Well, we can still make some recommendations depending on your condition. To do this, let us first examine the theoretical effects ice, then heat. This will allow us to assess the risks and possible options in order to optimize their use after back pain.

Ice following an episode of back pain

In the case of ice, the theoretical objective is to reduce the temperature in the lower back region in order to obtain a desired biological response. Among the targeted therapeutic effects, we have:

Hypothetical mechanism of cold:

Slowing of metabolism
Vascoconstriction
Slowing of nerve conduction
Decreased body temperature
Numbing effect
Reduction of edema
Decreased muscle spasms

Now there is a great debate around inflammation following an injury. Specifically, we used to think that inflammation was systematically bad, and should be treated as aggressively as possible.

It is for this reason that we prescribe non-steroidal anti-inflammatory drugs (NSAIDs), that we do cortisone injections, or that patients are offered ice cream for its anti-inflammatory effect.

On the other hand, we realized that inflammation was not only useful, but necessary for healing optimal tissue. This is also the reason why many doctors prescribe less and less NSAIDs or infiltration.

Now the inflammation is often associated with pain and edema via its various mediators. This (temporary) sensitization of the tissues sometimes prevents us from moving, sleeping, or going about our business.

For this reason, it is sometimes useful to minimize inflammation to allow the body to benefit from the other modalities necessary for a good healing of the back (physical activity, sleep, favorable mood, etc.).

It is with this in mind that cold helps reduce inflammation following an acute episode (in addition to other therapeutic effects), thus helping to relieve your symptoms in the lower back.

Heat following an episode of back pain

Heat is often recommended to relieve lumbago (and other muscle pain). It’s actually people’s number one reflex as soon as they feel pain in their back. Here are the therapeutic effects targeted by the application of heat:

Hypothetical heat mechanism:

Acceleration of tissue metabolism (therefore acceleration of healing)
Vasodilation (therefore bringing oxygen and nutrients to your tissues)
Relaxation and muscle relaxation
Increase in flexibility
Increased body temperature
Action on thermal receptors
Blocking action of nociceptors (pain sensory receptors)

Heat and ice: What are the risks?

The risks associated with the use of heat and ice are rare. However, they should not be minimized, especially if you have skin or blood circulation problems.

Here is a (non-exhaustive) list of conditions requiring specific measures:

Caution when applying ice or heat

Any cardiovascular problem
Any dermatological problem
Peripheral vascular disorders (hemoglobinuria, diabetes, etc.)
Raynaud's disease
cold urticaria
The elderly

Let me tell you one horrible story related to the use of ice cream. An elderly woman had sprained her ankle and then called her physiotherapist (physiotherapist) for advice. Here are the exact words used by the therapist:

“Put your foot in ice water until we see each other.” »

Guess what ? The patient prepared a tub of cold water, added several ice cubes to it, then put his foot in it…all night long!

result: foot amputation due to tissue necrosis. Of course, the physio meant to use cold INTERMITTENTLY until the patient's next appointment. This did not prevent him from losing his therapist's license forever...

Let's come back to our back pain, and the role of hot and cold in relieving you. Certainly, the side effects are (generally) minimal, but here is what has been identified in the scientific literature:

Redness of the skin
slight burning
muscle inhibition
(Temporary) reduced mobility
Cold intolerance

Practical application: what to do in practice?

I have to put the hot or the cold during How long after an episode of lumbago?

Currently, there are no official recommendations suggesting a specific application time for heat or ice. Here are the things to keep in mind when applying these terms:

For the ice cream:

If you have a short stature (low fat percentage, small frame, etc.), the ice application time should be less to avoid adverse effects.

Cold-induced vasoconstriction appears to be followed by vasodilation of blood vessels after about 10 minutes. This is a body protection reaction to avoid tissue hypoxia (called lewis reaction). Thus, if you only want a slowing down of the metabolism during an inflammatory period (after a lumbago, for example), you should not exceed 10 minutes.

If the goal is only to reduce pain, without necessarily having therapeutic effects (such as slowing down the metabolism), you don't have no need to hold the ice for a long time. Why ? Because the objective in this case will only be to desensitize your brain and your nerves, without looking for the physical effects (like the reduction of swelling). This desensitization can be done relatively quickly, and does not require intense cold.

Not all ice packs are created equal. Some provide a more intense feeling of cold compared to others. Immersing yourself in freezing water is not the same as putting a cold water towel on your back. This is also the reason why it is necessary modulate the treatment time according to the intensity of the cold. In hierarchical order from coldest to least cold, here are examples of therapeutic modalities:

Immersion in ice water → Bag of ice cubes → Bag of frozen vegetables → Gel pack → Sprays and ointments

Instead of applying ice for long consecutive minutes, you could apply it in alternating with rest periods. More concretely, instead of putting an ice pack down for 20 minutes following an episode of lumbago, consider putting it down for 10 minutes followed by a short rest period (10-15 minutes), then putting the ice back down for another 10 minutes. This will also help avoid the Lewis reaction discussed above.

For people at slightly higher risk (circulatory problems, elderly people, etc.), additional precautions should be taken when applying cold:

Reduce application time

Place an intermediary between the skin and the ice/heat (for example, a wet towel)

For heat:

For heat, there are also various therapeutic modalities available. A common treatment is balneotherapy. This involves physical exercise in the pool, often in water between 32 and 38 degrees Celcius.

Other thermal modalities available on the market are:

heat bag
Pads and heating pads
Heating belts
Ultrasound, Shockwave, Infrared Radiation: It should be noted that there is very little evidence supporting their use in the treatment of low back pain.
Etc

As for the heat packs, it is recommended to put them on your lumbar region for 15-20 minutes. As with ice, the application time must be adjusted according to your stature and associated medical conditions.

If the aim is to increase circulation, we must never forget that physical exercise is THE modality of choice to increase blood circulation.

What are the alternatives ?

Although often effective, applying heat or ice to the lower back is not the only way to treat back pain.

If you have already tried cold compresses or a heating bag, but they have not succeeded in calming your pain, you should not stop there! Indeed, there are many natural solutions aimed at relieving back pain without resorting to medication, infiltration or surgery.

In addition, there are several products and accessories available on the market to relieve lower back pain. It should be remembered that these tools generally provide temporary relief, and should be used sparingly. Among the products recommended by our professionals, we have:

What about natural remedies?

Like accessories and anti-back pain products, natural products and grandmother's remedies are very popular with people suffering from back pain.

Often, these remedies include anti-inflammatory properties to relieve various body pains.

On the other hand, it should be noted that most of these natural products are not scientifically proven. It is therefore important to speak to your doctor before using them, particularly to avoid any interaction with your medications.

Natural remedies that may relieve symptoms include (click on the product you are interested in for purchasing options):

Turmeric

Thanks to its antioxidant and anti-inflammatory powers very powerful, turmeric is one of the most used plants in a culinary and therapeutic context. The composition of turmeric is essentially made of essential oils, vitamins (B1, B2, B6, C, E, K) and trace elements. But it is to its composition rich in curcumin and curcuminoids that we owe them and calm skin of this spice.