A Simple Guide For When to Use Heat or Cold Therapy to Treat Lower Back Pain

Many people worldwide suffer from lower back pain, regardless of age, activity level, diet, or overall health. It is a very common condition brought about by anything from the type of job you have to a car accident.

In addition to over-the-counter and prescription pain medication, heat and cold therapies are effective ways to reduce lower back pain. However, the effects of each treatment are different, and they work best in specific situations.

Here’s how and when to use either hot or cold therapy for your lower back pain.

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Types of lower back issues 

Lower back pain is one of the most common reasons people seek medical attention. While some are more susceptible to it than others, nearly seven out of ten people¹ experience back pain at some time during their life.

The pain can make it difficult or even impossible to walk, sleep, work, or perform essential activities.

What is better for lower back pain when it comes to at-home treatment—heat or cold therapy?

Both, actually.  Heat and cold therapy are beneficial and can effectively relieve different types of lower back pain. These treatments are often overlooked despite being simple, cost-effective, and practical.

Various lower back pain conditions can be treated with heat or cold therapy, including the following.


Arthritis is a common condition that affects the joints.

One of the most common types of arthritis that affects the lower back is osteoarthritis. It causes inflammation and stiffness in the affected area. Eventually, this could lead to pain, stiffness, and difficulty moving.  


Spondylolisthesis is a spinal condition that can cause lower back and sometimes leg pain.

This condition occurs when vertebrae in your spine slip out of place. The spinal cord and nerve roots can become pinched when this happens, causing pain.

Structural issues

Several structural problems can lead to severe lower back pain. For example, the disks that cushion your vertebrae can flatten with age, leading to a condition known as degenerative disk disease. This condition causes the disks to bulge and press on the surrounding nerves.

Another condition is spinal stenosis, which occurs when the space around the spinal cord narrows and pinches the nerves.

Scoliosis may also lead to lower back pain. It is a curvature of the spine, usually diagnosed in adolescents, that can worsen without treatment and lead to stiffness and pain.

Strains and sprains

Any excessive stress or repetitive movements can injure the muscles, tendons, and ligaments in your back.

Some examples of aggravating activities include lifting heavy items, trying a new exercise, exercising without adequate warm-ups, repetitive bending of the back, twisting awkwardly, or simply sneezing and coughing.


Direct injuries to the lower back may result from a fall, car accident, or sports injury. If not managed properly, a traumatic event could increase the risk of chronic lower back pain.  


Heat or cold therapy may also relieve lower back pain resulting from infection or kidney stones. However, always consult your physician before applying these types of treatments. 

How to use heat or cold therapy 

While heat and cold therapy are beneficial for relieving lower back pain, using the right treatment for your condition at the right time can maximize the benefits.

Heat therapy, for example, is best at reducing muscle pain and stiffness, while cold therapy is typically used to reduce inflammation and swelling. Here’s how to use either hot or cold therapy for your lower back issues.

Cold therapy

Cold therapy is most effective for pain that comes on suddenly, such as from an accident or direct injury. By lowering your body temperature in the affected area, cold therapy causes your blood vessels to constrict, reducing swelling and inflammation. Additionally, it can also numb the area to reduce your discomfort.

Cold therapy is simple to use and doesn’t require any special equipment. Ice in a plastic bag, a bag of frozen vegetables, or even a damp towel can do the job.

To prevent skin or tissue damage from the cold, make sure your homemade ice pack is wrapped up in cloth. Apply it for no more than 15 minutes or less if it becomes painful. Prolonged exposure to cold packs can lead to permanent tissue damage. 

Heat therapy

Heat therapy provides relief by improving circulation and blood flow to the treated area. Even a slight increase in body temperature can provide comfort by soothing muscles and helping damaged tissues heal.

Continuous, low-level heat therapy² is one of the most effective treatments for long-term or chronic lower back pain. However, when using continuous low-level heat, such as an electric heating pad or other commercial devices, be careful and follow the manufacturer’s instructions to prevent skin damage.

Heat can be applied in several ways: a heat pack, hot water bottle, heating pad/blanket, or a hot shower/bath. Wrap your preferred heat pack in a cloth to prevent skin burns and tissue damage.  Moist heat typically provides better results than dry. Apply no longer than 15 to 20 minutes for safety reasons and stop if the treatment becomes painful. 

Heat and cold therapy combined

Some people find that they can get the most effective relief from a combination of heat and cold therapy³. Cold therapy first provides numbing relief. Following it with heat helps stimulate blood flow, ensuring that your muscles and connective tissues receive the oxygen and nutrients they need to heal.

For example, heat can help improve blood flow to the muscles in preparation for a workout or exercise and help with performance and injury prevention⁴.  Following the strenuous activity, applying cold therapy to the painful area helps reduce inflammation⁵ and pain, allowing the tissues to heal. Once the muscles are relaxed and the inflammation subsides, applying heat therapy will improve your muscles’ flexibility and mobility⁴.

Cold therapy should be used for up to 20 minutes, followed by 15 to 20 minutes of heat therapy. Cold therapy can be safely applied as needed, as long as there is no additional pain. Heat can also be used intermittently throughout the day to improve tissue healing and relax tight muscles.

Here are a few simple ways to add heat and cold therapy to your daily routine:

  • Carry a few self-activating heat and cold patches with you to use when your lower back starts to hurt.

  • Apply an ice pack or cold patch after discomfort from exercising or any strenuous activity.

  • If you suffer from chronic lower back pain, use heat therapy before going to bed and after waking to help relax muscles and relieve discomfort.  

When shouldn’t you use heat or ice treatment for lower back pain?

While heat and cold therapy can provide relief for many types of lower back pain, there are certain conditions and situations where you should not use them.

Heat therapy can aggravate chronic issues such as multiple sclerosis, spinal cord injuries, or rheumatoid arthritis. When heat is applied to these conditions, it can increase inflammation or even cause skin ulceration or burns.

Heat and cold therapy should also be avoided if the affected area has open wounds or bleeding, blistering, or oozing fluid. Avoid direct contact with the source of heat or cold to protect your skin from damage. A protective barrier such as a cloth or towel between your skin and the source can prevent burns and skin damage.

The lowdown

Lower back pain is a common condition that, in some cases, can seriously impact your quality of life. Heat and cold therapy have been used for centuries to relieve muscle aches, sprains, and injuries. While often overlooked, they are safe, affordable, and effective treatments for lower back pain relief.

While each therapy has specific benefits that can help provide pain relief, improve mobility, and promote healing, combining both types of treatments can give the best results.

Keep in mind that while the advice provided here can be helpful, make sure to always consult your physician before undergoing treatments for lower back pain.

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