How do I use heat or ice for back pain?

Typically, you will use ice on newer injuries and heat for more chronic conditions. However most back conditions, even chronic ones, are constantly being re-aggravated or re-injured from daily activities. So, you are are always better off to err on the side of caution and try ice before heat.

When there is active inflammation, swelling or sharp pain, I recommend that you use frozen gel packs (as with dics injuries, sciatica, spained backs, arthritis, etc). This will decrease both pain and swelling, promote proper blood circulation, and set the stage for healing. You should apply the gel pack for no more than 10 minutes at a time. Start with application of cold for 10 minutes with breaks of at least 20 minutes between applications.


Cold “Gel” Pack on for 10 minutes
Off for at least 20 minutes
Repeat 3 times in a row

Repeat the entire procedure several times throughout the day.

* Please place either a paper towel or thin cloth between your skin and the frozen gel pack. I personally like using a pillow case to help hold the frozen gel packs in place. Use only one layer of the pillow case between the gel pack and your skin. 

* Should there be increased pain or muscle spasm/tightness while using the frozen gel packs, then immediately remove the gel-packs and discontinue until speaking with a doctor.

The gel packs should be at least 10 inches by 10 inches (10"X10") and remain very soft and pliable when frozen. Do not use ice cubes in a plastic bag. For people living in the Venice area, we carry quality gel packs which can be purchased at the reception desk.

After a condition has progressed past the acute stage and symptoms feel more stiff and sore, I would like to recommend you start to use moist heat. Moist heat applications will continue to promote healing by increasing the blood circulation and reducing muscle spasm. Heat should not be used if there is swelling, shooting or radiating pain. You should use moist heat for no more than 20 minutes at a time. It is best to use moist heat for 5 to 10 minutes prior to doing any of your prescribed stretching exercises. Should the pain increase after using heat, then return to using the cold packs.

If you have long term swelling, you may want to stimulate circulation by using a combination of heat and cold treatments, one after the other. You must always start and end with heat.


Use heat for 10 minutes
Use cold for 10 minutes
Use heat for 10 minutes
Use cold for 10 minutes
Use heat for 10 minutes

As with any back condition, there is a reason for the pain and you should seek professional care before more damage occurs to the back and surrounding tissues. We will be happy to evaluate your back pain and supply you with recommendations on how to correct or manage your condition.

Jeff Johnson

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