Heat therapy for back pain relief

By: Stephen H. Hochschuler, MD
April 24, 2006

Ice massage and ice application is generally most helpful during the first 48 hours following an injury that strains the back muscles. After this initial period, heat therapy is probably more beneficial to the healing process. For some people, alternating heat therapy with cold application such as ice massage therapy provides the most pain relief.

Benefits of heat therapy

Moist heat, such as a warm bath or whirlpool, is thought to aid the healing process by increasing circulation and relaxing muscle spasms. Whether one uses moist heat or dry heat, the desired effect is for the heat to penetrate down into the muscles. When warmth and heat penetrate the injured and sore muscles, this provides the dual benefits of:

• Relaxing the back muscles (to reduce painful spasms)

• Facilitating stretching the injured tissues to reduce stiffness.

In addition, heat therapy is both inexpensive and easy to do. Several types of heat application are readily available and include heating pads, hot water bottles, commercial heat wraps, hot baths, warm gel packs, and more.

Precautions for heat therapy

As with ice application, when applying heat therapy, care should be taken to avoid burning the skin. Any type of heat source should be “warm”, not hot, to avoid burning the skin.Also, it is cautioned never to fall asleep with the heating pad on. As with ice therapy, it is important to always use a protective barrier, such as a towel, between the heat and the skin to avoid burning the skin.

Please note that heat should not be used in certain circumstances. For example, if the lower back is swollen or bruised, heat should not be used and it is better to use a cold pack to reduce the inflammation or swelling in the area. Patients should consult with their treating physician if they have heart disease or hypertension. In general, heat therapy should also not be used if the patient has dermatitis, deep vein thrombosis, diabetes, peripheral vascular disease, an open wound, or severe cognitive impairment. There is no exact prescription for ice and heat application, and many physicians and physical therapists will recommend trying different forms of heat therapy and cold application to see which approach provides the most pain relief.