A hot topic: Should I use heat or ice for my back pain?

 


Summary

  There is stronger evidence to support the use of heat therapy rather than ice therapy or creams that give the sensation of heat for the treatment of back pain

  Using a heat pack that wraps around the back >2 hrs a day for 5-14days is an effective way to manage low back pain when it has been occurring for less than 3 months.

  Combining a heat pack with home exercises can lead to even better results.


 

In Australia 16% of the population have back problems and 70-90% of Australians will experience back pain at some point in their life.[1]Patients with low back pain commonly want to know what they can do outside of the treatment room to improve their condition. Heat and ice packs are some of the most commonly used treatments.

This article will explore the benefits of using therapies that alter the temperature of the back. We will break down the treatments into three main categories. Firstly, cold therapy (also known as cryotherapy) where an item like an ice pack is used to reduce the temperature of an injured area. Second heat therapy (also known as thermotherapy) where a heat pack or hot water bottle is used to raise the temperature of an injured area. Thirdly creams and ointments applied to the skin that give the sensation of heat but don’t significantly alter the temperature of the affected area. Examples being Deep Heat, Metsal and Dencorub which all give the sensation of heat. {Note: this does not include Volataren Emulgel which is a non-steroidal anti-inflammatory drug(NSAID)[8]}
heat or ice for back pain images

 

 So why do we want to change the temperature of an injured area?

 

Potential benefits of Heat

FireIncreased blood flow and increased delivery of nutrients to area leading to improved

healingReduced muscle spasmFire

Assist in muscle relaxationFire

FireReduced pain

FireImproved elasticity of tissues

Potential benefits of Ice

❅ Reduced swelling
❅ Reduced inflammation

❅ Reduce the chance of further potential damage

❅ Reduced pain

What does the evidence say?
Currently there is solid evidence that a heat pack can reduce back pain in people where it has been occurring for less than 3 months.[3] Studies have shown heat applied regularly can be more effective in reducing low back pain than some medications like paracetamol and anti-inflammatory drugs (NSAIDS)[4] and can increase the effectiveness of home exercises in improving back pain.[5]
There is very little evidence of the effectiveness of cold therapy in treating low back pain3 however there is evidence for the use of cold therapy in the treatment other injuries like ankle injuries.[9]
There is very little quality evidence of the effectiveness of using creams and ointments that create the sensation of heat on the skin in reducing back pain.[6]

Evidence conclusion
There is stronger evidence that heat therapy is effective than ice therapy or creams and there are few studies comparing the three. I t should be noted that there is no evidence ice or creams are ineffective so if they are working for you I would continue to use them.

How to use Heat
There are many options for applying heat, e.g. hot showers or baths, hot water bottles, non reusable heat packs and reusable heat packs. You choose the option which best suits you. A reusable heat pack is a cost effective option.[7] A microwavable heat pack is a good choice as these can be reheated regularly at work or at home. Heat packs that fit around the body can be worn throughout the day. The majority of the high quality studies focused on using a heat pack for the heat pack daily for longer periods of time being 2-8hours daily for 5-14days.[3][5]
David Cork article image 2

– Ends –

For further information, please contact:

David Cork
Osteopath
Spring Osteo Clinic
2/486 Whitehorse Road
Surrey Hills Vic 3127
Tel +61 3 9830 7044 / [email protected]

About David Cork, Osteopath
David enjoys seeing you reach your health goals. His particular areas of interest are back pain, neck pain, jaw pain and sporting injuries. David believes good communication and management is key to providing the best improvements for you. During a treatment with David you may find he explains the nature of your injury and gives clear, practical advice on how to manage it. Your management plan will be tailored to your needs and your lifestyle. David is also a qualified personal trainer and this is where he developed his passion for exercise. David is likely to integrate his hands on osteo techniques with a prescribed exercise plan into your treatments. David is available Mondays, Tuesdays, Thursdays and Saturdays and you can book with him online or call 03 9830 7044.

About Spring Osteo Clinic
Spring Osteo Clinic has been part of the Surrey Hills community since 2010. We offer a range of services under the one roof including osteopathy, myotherapy, remedial massage, studio pilates and clinical pilates. We treat acute to chronic pain and injuries including back pain, neck pain, headaches, migraines, sports injuries, pregnancy related pain, postural related pain and more. We treat people through all stages of life including babies and children; teenagers with study strains; athletes (beginner to professional); pregnant women and new mums; tradespeople and desk bound workers with postural complaints; and the elderly. Our ultimate goal is to work with you to relieve; manage and prevent pain. We are located at 2/486 Whitehorse Road Surrey Hills, Vic. Pop in and say hello.

References
[1] Back problems – Australian Institute of Health and Welfare. 2018. https://www.aihw.gov.au/reports/arthritis-other-musculoskeletal-conditions/back-problems/what-are-back-problems
[2] Malanga G, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. 2018.
[3] French S, Cameron M, Walker B, Reggars J, Esterman A. Superficial heat or cold for low back pain. 2018.
[4]Nadler S, Steiner D, Erasala G, Hengehold D, Hinkle R, Beth Goodale M et al. Continuous Low-Level Heat Wrap Therapy Provides More Efficacy Than Ibuprofen and Acetaminophen for Acute Low Back Pain. 2018.
[5] Petrofsky J, Laymon M, Alshammari F, Khowailed I, Lee H. Use of ThermaCare heat wraps as an adjunct to physical therapy. 2018.
[6]Derry S, Matthews P, Wiffen P, Moore R. Salicylate-containing rubefacients for acute and chronic musculoskeletal pain in adults. 2018.
[7]Lloyd A, Scott D, Akehurst R, Lurie-Luke E, Jessen G. Cost-Effectiveness of Low-Level Heat Wrap Therapy for Low Back Pain. Value in Health. 2004;7(4):413-422.
[8]Voltaren Emulgel for Pain and Inflammation | Voltaren AU. Voltaren.com.au. 2018.
https://www.voltaren.com.au/products/voltaren-emulgel/
[9]Kerkhoffs G, van den Bekerom M, Elders L, van Beek P, Hullegie W, Bloemers G et al. Diagnosis, treatment and prevention of ankle sprains: an evidence-based clinical guideline. 2018.