I have this conversation about a couple of times a week. The ice v heat conundrum is one that gets patients and usually when they need an answer – and fast.
It is worth thinking about the type of injury you are trying to treat. Low-back pain is nearly always caused by an injury to the facet joints in the low-back. This is covered in a bit more detail in this blog article about low-back pain and the whys and wherefores. I explain this to my patients by saying that their injury is like an ankle sprain, but usually done at slower speed and with less force (most of the time!). So, you know that you treat an ankle sprain with ice. In fact, if you treat it with heat, you make the injury last 5 times as long. Your low-back injury is just the same. So, your response should be just the same.
Hot-water bottles feel good. But they are doing exactly the wrong thing. They are increasing the chemical activity and making the inflammatory process worse. This is a bit like getting in a warm shower with sunburn. What you are doing is listening to the grumble of the muscles that are splinting (see ankle sprain) the low-back. This is understandable as we all know that muscles like heat if they are suffering. We are also quite used to using heat to treat stiff or tight muscles, so this feels like the right thing to do. However, it is worth thinking about the underlying injury. Are these low-back muscles injured – I’d suggest that this is pretty unlikely. Then why do they hurt. Well, the reason is that they are working over time to protect your low-back joints and stiffen the spine. They are acting like scaffolding and are doing you a favour – leave them to it and your body will dismantle the scaffolding when it thinks it doesn’t need it any longer. You taking it away too early will not help.
Ice helps to reduce the inflammatory activity and its associated collateral-damage. The aim is to calm things down in the low-back and reduce any inflammation. This is why anti-inflammatories are used and the clue’s in the name. You can do the same by using ice. Ice has an added benefit which is that bit can be precisely targeted at the area in trouble. Or use ibuprofen which gets all your body but not as well. And, we all should know that, non-steroidal anti-inflammatory drugs (NSAID) have some significant problems associated with their long-term use. I know which one I prefer.
The ice protocol:
This is the most important 1st aid trick you can use to treat acute back pain.
- Apply crushed ice in a couple of freezer bags or an ice pack or even frozen peas to the injury.
- Don’t put the ice directly on your skin, as you may give yourself an ice burn if you do. Put something as thin as a handkerchief between you and the ice.
- Don’t apply the ice for too long (if you want the precise timings, they are 20 minutes on, then 20 minutes off, and then 20 minutes on and repeat as often as you can).
- Repeat this for as long as you can. You’ll know when to stop as it’ll just feel cold and be very boring.
And this is all well covered in a great post by a US medical organisation that’s shown in this link. If you can, get professional advice on applying ice.