Hot, Hot, Hot…Or Cold? Ice vs. Heat for Lower Back Pain

Life is an unforgettable rollercoaster ride where our backs often take one too many twirls and end up feeling like rusty garden gates. Cue lower back pain - the wicked, unwelcome guest at our otherwise fun-filled party. And now, you're left wondering whether to invite ice or heat to kick this party crasher out. Let's delve into this frosty-hot mystery!

My son is now of the age where he is enjoying adventure stories. His dad is an avid reader, so together we read stories that often encounter dragons, so I thought this could be a perfect metaphor on when to use ice or heat for lower back pain.

Let’s imagine your lower back pain as a pesky fire-breathing dragon that's taken up residence in your back garden. When it's freshly arrived, huffing and puffing, setting your roses ablaze - that's when you bring in the ice! Look at ice is your valiant knight, armed with his shiny shield and frosty sword, ready to subdue and repel the fiery beast.

Ice is most effective within the first 72 hours of the dragon's invasion – let’s refer this as an acute/new injury. This chilling hero numbs the pain, tames inflammation, and reduces swelling, like turning a fire hose on our dragon's fiery breath. You can use an ice pack (or frozen peas if you're in a pinch!), wrapped in a thin tea towel to protect your skin, and apply it to the inflamed area. Keep it there for about 15-20 minutes and give it a rest for at least two hours before going another round with your icy warrior.

But what if our dragon has decided to stick around? After a couple of days, it's just there, sulking, still causing mischief but no longer breathing fire. That's when it's time to change the guard. Send the icy knight back to his frosty fortress and bring on the heat!

Heat is your gentle, charming diplomat, carrying a tray of your best baked cookies and ready to trick the dragon into a peaceful slumber. Heat is best for chronic or long-lasting pain. It increases blood flow, relaxes muscles, and eases the stiffness in your back, much like lulling our dragon into a cookie-induced nap. Apply a warm (not scorching hot!) heat pack to your aching back for also about 15-20 minutes. Just remember, no napping while using a heat pack. We wouldn't want you to wake up as a roasted marshmallow! I kid, but I have had a few clients do this in the past!

Now, you might wonder, "What if I call on the wrong hero? Ice instead of heat or vice versa?" Well, it won't be like pouring water on a grease fire, but it may not give you the relief you need. So, it's best to choose wisely.

And, of course, while our icy knight and warm diplomat do a fantastic job, you may need reinforcements. If your fiery dragon is of the stubborn variety, consider visiting your local chiropractor, especially to identify and address the underlying cause of the lower back pain to begin with. You can read more on lower back pain here: They're like the dragon whisperers, skilled in convincing even the most stubborn dragons (or lower back pains) to pack up and leave. To book a consultation, you can do so here:

Whether you're taming dragons or simply navigating the rollercoaster that is life, always treat your back with care. After all, you only get one ticket – in other words, one spine - to this show. So make sure you enjoy the ride!


  1. Urits, I., Burshtein, A., Sharma, M., Testa, L., Gold, P. A., Orhurhu, V., ... & Kaye, A. D. (2019). Low Back Pain, a Comprehensive Review: Pathophysiology, Diagnosis, and Treatment. Current Pain and Headache Reports, 23(3), 23.
  2. Malanga, G. A., Yan, N., & Stark, J. (2015). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine, 127(1), 57-65.
  3. Bialosky, J. E., Bishop, M. D., Price, D. D., Robinson, M. E., & George, S. Z. (2009). The Mechanisms of Manual Therapy in the Treatment of Musculoskeletal Pain: A Comprehensive Model. Manual Therapy, 14(5), 531–538.