What is Better? Ice or Heat for Lower Back Pain?

Back pain is a common issue that can immediately affect your personal and work life.

Luckily, one of the most recommended treatments for lower back pain is ice and heat.

The question on everyone’s mind is when to use heat or when to use ice for lower back pain.

This article will explain the best option and exactly when to use it.

Just keep on reading!

What Back Problems Can be Helped by Heat & Ice Therapy?

Hot and Cold therapy is often one of the first things a doctor will recommend – and for good reason. It is cheap, readily available, and has little side effects other than a cold or warm backside.

Doctors often recommend ice or heat therapy for:

  • A pulled lower back muscle
  • A physical injury to the lower back
  • Recurring back pain from lower back conditions
  • Muscle soreness due to exercise
Lower Back Pain Man

Does Ice and Heat Actually Work for Lower Back Pain?

Ice is effective at reducing blood flow to a specific area.

This reduction in blood flow can reduce swelling and inflammation which causes pain, particularly around tendons and joints.

Ice Therapy for Lower Back Pain

Ice also numbs nerve activity which can provide temporary pain relief.

Heat does the opposite. It improves circulation and blood flow to the affected area.

Heat for Lower Back Pain

The increased blood flow to the injured area relaxes the muscles and helps promote healing to the damaged tissues.

The rising temperature can also provide pain relief in the lower back.

Several studies have shown that hot and cold therapy are effective for low back pain, can help with exercise induced muscle soreness, and can help with neck and back strain.

When to Use Ice for Lower Back Pain (Ice First, Heat Later)

It is generally recommended both in research and by Doctors to use ice on your lower back for the first 24 – 72 hours after the onset of pain / injury.

Ice, or cold therapy, can help to minimize the swelling, constrict the blood vessels, reduce inflammation, and numb the pain associated with the early stages of injury.

There are many options for cold therapy including:

  • Ice packs
  • Cooling pads
  • Ice from your freezer wrapped in a rag or plastic sandwich bag
  • Or, even the good old frozen bag of peas.
Bag of Peas

It is recommended to use ice or cold therapy intermittently in 20 minute intervals with a 2-hour break in between sessions.

It is good to have layer between the ice (such as a thin rag) to avoid ice burn.

When to Use Heat for Lower Back Pain

After the initial 24-72 hour of cold therapy, it is recommended to switch to heat therapy as the swelling and inflammation subside.

The heat will stimulate blood flow back to the area to help with healing, and of course, the ever important soothing effect of the heat.

Like ice therapy, there are many ways to apply heat therapy including:

  • Electric heating pads
  • Heated gel packs
  • Heat Wraps
  • Hot/warm baths
  • A hot water bottle
  • Or, you could microwave a bit of rice within a sock.
Hot Bath for Lower Back Pain

It is recommended to use heat therapy intermittently in 20 minute intervals with a 2-hour break in between sessions.

Be careful to avoid burning or overheating the skin. Either take a break from the heat or put something between your heat source and your skin to avoid burns.

Cold Therapy vs. Heat Therapy for Chronic Lower Back Pain

Unlike acute lower back pain, it is a bit more difficult to nail down when cold vs heat is best for chronic low back pain.

Recommendations should be determined from your Doctor based on his/her assessment of your particular source of chronic pain and treatment options.

Low-level continuous heat is often recommended for chronic back pain relief.

Heat before exercise can help warm-up the muscles and lessen pain during your back exercises.

Medical Advice Needed

Cold therapy is also very helpful after exercise to reduce muscle soreness.


Lower back pain, can be a pain in the… Back.

Ice and heat therapy are one of the easiest and most accessible treatments available. In most cases, knowing when to use ice or heat for lower back pain is easy.

Ice first (24- 72 hours). Heat next.

Hopefully this guide has been helpful and has eased your pain.

If so, please let us know in the comments below.

Remember, this information is for informational purposes only and does not substitute for advice from your Doctor or Medical Professional. Please see a Healthcare Professional for medical advice specific to your medical condition.


  1. Dehghan, M., & Farahbod, F. (2014). The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. Journal of clinical and diagnostic research : JCDR, 8(9), LC01–LC4. https://doi.org/10.7860/JCDR/2014/7404.4818
  2. Bieuzen, F., Bleakley, C. M., & Costello, J. T. (2013). Contrast water therapy and exercise induced muscle damage: a systematic review and meta-analysis. PloS one, 8(4), e62356. https://doi.org/10.1371/journal.pone.0062356
  3. Garra, G., Singer, A. J., Leno, R., Taira, B. R., Gupta, N., Mathaikutty, B., & Thode, H. J. (2010). Heat or cold packs for neck and back strain: a randomized controlled trial of efficacy. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 17(5), 484–489. https://doi.org/10.1111/j.1553-2712.2010.00735.x
About the Author Paul Thomas

I've been plagued with lower back pain since my late teen years. As an avid fitness enthusiast, I've struggled for years trying to balance my active lifestyle while avoiding injury. I've done physical therapy, visited a myriad of specialist and sports physicians, and tried everything under the sun to continue my journey.

But it wasn't just me. It seems it runs in the family. I've watched my Dad and Aunts struggle with debilitating back pain.

As President of MisterBack, my goal is to help as many people enjoy a healthy, happy lifestyle as I can - picking up their kids or grandchildren, hiking, biking or even simply walking to get the mail with less pain.

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