When red-hot sciatica pain sears down your leg, using ice therapy can be uniquely effective in immediately soothing the pain.

The key is to know when and how to use ice therapy for the best results:

Use ice therapy as soon as your pain starts

Ice or cold therapy is recommended when your sciatica is acute or flares up. Cold therapy typically works by:

  • Increasing your tolerance to pain and slowing down the speed at which your nerves send pain signals to the brain 1 Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Phys Ther. 2010;90(4):581-91. , 2 Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med. 2007;41(6):365–369. doi:10.1136/bjsm.2006.031237
  • Acting locally, as opposed to taking oral pain-relieving medications, which have a body-wide (systemic) effect

The application of cold directly affects your body tissues, providing more effective pain control.

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How ice therapy reduces sciatica pain

When you use ice therapy, the following changes occur in your sore tissues:

  • Lessens pain. Cold therapy reduces pain by decreasing the conduction of nerves of the skin. 3 Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2014;127(1):57-65. doi:10.1080/00325481.2015.992719
  • Numbs the area. The reduction in tissue temperature causes a numbing effect due to the constriction of blood vessels and a decrease in blood flow. 4 Kim EJ, Choi YD, Lim CY, Kim KH, Lee SD. Effect of heating and cooling combination therapy on patients with chronic low back pain: study protocol for a randomized controlled trial. Trials. 2015;16:285. Published 2015 Jun 26. doi:10.1186/s13063-015-0800-4
  • Reduces muscle spasm. Cold therapy decreases muscle spasm, which usually creates pain, by cooling the muscle fibers. 3 Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2014;127(1):57-65. doi:10.1080/00325481.2015.992719 , 4 Kim EJ, Choi YD, Lim CY, Kim KH, Lee SD. Effect of heating and cooling combination therapy on patients with chronic low back pain: study protocol for a randomized controlled trial. Trials. 2015;16:285. Published 2015 Jun 26. doi:10.1186/s13063-015-0800-4
  • Decreases inflammation. Lowering the tissue temperature causes a decrease in tissue metabolism and oxygen intake, reducing the overall inflammatory process. 4 Kim EJ, Choi YD, Lim CY, Kim KH, Lee SD. Effect of heating and cooling combination therapy on patients with chronic low back pain: study protocol for a randomized controlled trial. Trials. 2015;16:285. Published 2015 Jun 26. doi:10.1186/s13063-015-0800-4
  • Prevents swelling. Reduction in inflammation results in decreased fluid collection and swelling. 5 Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. J Clin Diagn Res. 2014;8(9):LC01–LC4. doi:10.7860/JCDR/2014/7404.4818

Ice therapy can provide effective pain relief when used in acute conditions and may also help prevent the need to take pain-relieving medications. 4 Kim EJ, Choi YD, Lim CY, Kim KH, Lee SD. Effect of heating and cooling combination therapy on patients with chronic low back pain: study protocol for a randomized controlled trial. Trials. 2015;16:285. Published 2015 Jun 26. doi:10.1186/s13063-015-0800-4 , 5 Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. J Clin Diagn Res. 2014;8(9):LC01–LC4. doi:10.7860/JCDR/2014/7404.4818

Apply the icepack to your lower back

Sciatica is caused by an underlying lower back condition. The lower back problem typically pinches or irritates one (or more) of your sciatic nerve roots, which in turn sends pain and other symptoms along your long sciatic nerve.

When you use ice therapy for sciatica pain, apply the icepack to your lower back and rear pelvis—where the sciatic nerve roots are located. Icing this area, rather than your thigh or calf where the pain may be more, will help control and numb the pain at its origin and also calm the nearby nerves.

Watch Sciatica Causes and Symptoms Video

Tips to use ice therapy

Useful tips and methods to use ice/cold therapy for your sciatica symptoms while at home or on-the-go are:

  • Find a cooling source at home. You can use crushed ice, a frozen water bottle, a bag of frozen vegetables, or a home-made gel pack.

    Watch Video: How to Make a Gel Ice Pack

  • Try an ice massage. An ice massage is the application of ice directly on the affected area in a circular motion. You can make a hand-held ice unit by freezing water in a paper cup and cutting the top half of the cup to expose the ice (like a popsicle).
  • Keep an ice pack in your car and at work. Consider keeping a disposable (instant) ice pack in your car and at the office. Through a chemical reaction, these packs produce cold on-demand, and they can help you find quick relief when you need it the most.

A useful tip while using ice therapy is to alternate it with heat therapy. After your acute pain has subsided, you can then begin applying heat therapy. Heat provides a soothing, healing effect and also helps reduce pain. 3 Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2014;127(1):57-65. doi:10.1080/00325481.2015.992719 , 4 Kim EJ, Choi YD, Lim CY, Kim KH, Lee SD. Effect of heating and cooling combination therapy on patients with chronic low back pain: study protocol for a randomized controlled trial. Trials. 2015;16:285. Published 2015 Jun 26. doi:10.1186/s13063-015-0800-4

See How to Apply Heat Therapy

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Precautions while using cold therapy

Overuse or an extended duration of cooling therapy may lead to skin damage, such as frostbite and/or damage to the superficial nerves (neuropathy). 3 Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2014;127(1):57-65. doi:10.1080/00325481.2015.992719 , 4 Kim EJ, Choi YD, Lim CY, Kim KH, Lee SD. Effect of heating and cooling combination therapy on patients with chronic low back pain: study protocol for a randomized controlled trial. Trials. 2015;16:285. Published 2015 Jun 26. doi:10.1186/s13063-015-0800-4 General precautions to be taken during the application of cold therapy include:

  • Check the duration. Apply the ice pack (or another cooling source) on the affected area for 15 to 20 minutes at a time with a 2-hour break before the next application.
  • Put on a barrier. Protect your skin by placing a cloth or other protective barrier between yourself and the source of cold.
  • Use ice massage sparingly. While performing an ice massage directly on your skin, avoid the bony protrusions of the spine and stop as soon as numbness is felt (3 to 6 minutes). Repeat only after the numbness wears off completely and avoid several repetitions of this treatment.

    Watch Video: How to Make an Ice Massage Applicator

Ice therapy can provide immediate and meaningful relief to your sciatica pain. Ice therapy is particularly useful in acute pain, a flare-up of chronic pain, and/or activity or exercise-induced pain. Follow these guidelines to safely use ice therapy for your sciatica symptoms. Consider performing simple lower back (lumbar) stretches and exercises  when your pain subsides—to help strengthen your lumbar tissues and prevent a recurrence of sciatica.

Watch 7 Easy Stretches For Low Back Pain Relief Video

Learn more:

Cold and Heat Therapy for Sciatica

4 Commonly Overlooked Sciatica Remedies

  • 1 Herrera E, Sandoval MC, Camargo DM, Salvini TF. Motor and sensory nerve conduction are affected differently by ice pack, ice massage, and cold water immersion. Phys Ther. 2010;90(4):581-91.
  • 2 Algafly AA, George KP. The effect of cryotherapy on nerve conduction velocity, pain threshold and pain tolerance. Br J Sports Med. 2007;41(6):365–369. doi:10.1136/bjsm.2006.031237
  • 3 Malanga GA, Yan N, Stark J. Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine. 2014;127(1):57-65. doi:10.1080/00325481.2015.992719
  • 4 Kim EJ, Choi YD, Lim CY, Kim KH, Lee SD. Effect of heating and cooling combination therapy on patients with chronic low back pain: study protocol for a randomized controlled trial. Trials. 2015;16:285. Published 2015 Jun 26. doi:10.1186/s13063-015-0800-4
  • 5 Dehghan M, Farahbod F. The efficacy of thermotherapy and cryotherapy on pain relief in patients with acute low back pain, a clinical trial study. J Clin Diagn Res. 2014;8(9):LC01–LC4. doi:10.7860/JCDR/2014/7404.4818

Dr. Zinovy Meyler is a physiatrist with over a decade of experience specializing in the non-surgical care of spine, muscle, and chronic pain conditions. He is the Co-Director of the Interventional Spine Program at the Princeton Spine and Joint Center.

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