Cold Therapies for Back Pain

Along with heat, the cold therapies are often used to treat lower back pain. Cold can be delivered in many forms e.g. ice packs, gel packs, frozen peas wrapped in a towel, cold baths and sprays.

How does cold therapy work?

cold-therapiesI am often asked whether it’s better to use heat or cold therapies when treating lower back pain. In honesty they both work in a very similar fashion.

Both increase circulation and blood supply to the area.

This has the useful effect of reducing ischaemia (reduction in blood supply which is often very sore) and muscle spasm. It also helps sweep away the chemicals of inflammation.

Both encourage the release of the bodies own pain relieving chemicals

These are called endorphins and are opiates that help reduce pain.

However, I have often found that heat therapies are better at reducing muscle spasm and seem to leave a greater sense of well being, this is more likely to lead to greater endorphin release. Cold seems to be better at reducing inflammation and swelling.

Do cold therapies help lower back pain?

I don’t know, but I suspect from working with many patients that cold doesn’t help as much as heat. There is very little research out there to guide us. A recent review (1) stated that there is still not enough evidence about the effect of the application of cold for low-back pain whether acute or chronic.


The research review has been updated but the authors have not changed their conclusions - there is still not enough research to be sure if it works or not.

My advice would be experiment and see which suits you.

If you use cold or make sure you do not burn. Patients with poor skin sensation or temperature awareness should not use either. Remove the heat or cold if it becomes uncomfortable, do not press down on heat or cold i.e. lie on a heat pad/ ice pack and do not fall asleep while using it. Do not use cold over very thin or bony areas. Discuss the use of heat or cold with your health care professional.

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1. French, S. D., Cameron, M., Walker, B. F., Reggars, J. W., & Esterman, A. J. 2006, "A cochrane review of superficial heat or cold for low back pain", Spine, vol. 31, no. 9, pp. 998-1006.