Heat or Cold Therapy for Back Pain?

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Over the years as a chiropractor, myotherapist (SLM) & massage therapist I have noticed some confusion when it comes to using ice or heat on an acute injury or pain. A lot of pain sufferers are unfortunately incorrectly guided by other professionals in this matter, which I think is partly due to a lack of understanding when it comes to treating the myofascial system (myo= muscle) (fascial= connective tissue) & what treatment works, what doesn’t & why. I have written this article to help you make a better, more informed decision, not only with ice/heat but acute back pain in general.

It is a commonly held belief that Ice is always best for acute pain & injury, but this isn’t always the case. If you have experienced an acute injury to an area which involves micro tearing/damage to your soft tissue’s usually resulting in inflammation, pain, swelling, reddening, bruising etc… This tends to happen more so when there is a sudden & excessive force applied to an area which then damages the muscle, such as kicking a ball and ‘pulling’ your hamstring, or colliding with something or someone. Icing for the first 24 hours is widely accepted and probably is the right approach.

Where a lot of the confusion seems to stem from is when their is a sudden onset of acute pain that doesn’t normally involve any damage (injury) to the soft tissues but more of a spasm & aggravation of a myofascial trigger point (‘knot’) . This usually occurs when there is a chronic issue and is usually aggravated by everyday activities such as vacuuming, rolling over in bed, looking over your shoulder etc… These circumstances generally require heat.

Probably the most common situation I have encountered is people simply vacuuming and aggravating two very important muscle’s in the low back namely the erector spinae and the quadratus lumborum, these will go into spasm and can leave the person in extreme pain and unable to stand up straight as these spasm’ed muscles pull them to one side. In my experience these muscles also have the highest incidence of latent (inactive) trigger points and often underlie the vast majority of chronic myofascial back pain. This may also result from a disc injury or facet joint sprain among other things, but either way the muscles surrounding the area will be in spasm.

The good news is that when ice and/or heat is used correctly it can be quite effective, safe and inexpensive. Just to mention one study that found the continuous application of low level heat over 5 days combined with gentle exercise is significantly more effective with dealing with acute back pain than either one alone. (Mayer 2005).

One thing I would also highly recommend is to read my self treatment article on low back pain and when your able to tolerate self treatment to these trigger points add these simple yet effective techniques to heat & exercise not only for acute but chronic or ongoing back pain, also make sure you cover all the trigger points in the spine and hips/pelvis. Im sure some of you who do this, will experience greater relief when combined with your current treatment by a therapist or practitioner or even on its own, so give them a go and hopefully it helps your back pain and saves you money at the same time!

If you would like to find out more about how your Syndey CBD & Waterloo chiropractor can help you overcome pain & injury contact me or visit me for treatment at my Sydney CBD or Waterloo chiropractic clinics.


Mayer JM, Ralph L, Look M, Erasala GN, Verna JL, Matheson LN, Mooney VTreating acute low back pain with continuous low-level heat wrap therapy and/or exercise: a randomized controlled trial. Spine J. 2005 Jul-Aug;5(4):395-403.

kieranfHeat or Cold Therapy for Back Pain?

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