Cold and Heat Therapy for Sciatica

Immediate and meaningful relief of sciatica pain may be achieved through the application of cold and/or heat therapy. Care must be taken not to use cold and/or heat therapy for prolonged periods to avoid skin and/or nerve damage.

Cold Therapy

Placing an ice pack over the rear pelvic area may help relieve sciatica pain by the following mechanisms:

• Cause a numbing effect due to the constriction blood vessels and decrease in blood flow ¹ 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
• Reduce pain by decreasing the conduction of nerves of the skin ² 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
• Decrease muscle spasm, which usually creates pain, by cooling the muscle fibers ¹ 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 ^{, 2} 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
• Reduce inflammation, which is a common contributor to pain, by decreasing tissue metabolism and oxygen intake ¹ 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
• Decrease swelling and fluid collection ³ 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

Cold therapy usually provides immediate pain relief and reduces the need to take pain-relieving medication. ¹ 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 ^{, 3} 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

It is important to note that the overuse of cooling therapy may lead to skin damage, such as frostbite and/or damage to the superficial nerves (neuropathy). ¹ 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 ^{, 2} 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 General guidelines for cold therapy include cold application (with ice packs) on the affected area for 15 to 20 minutes at a time with breaks in between. Ice packs are available in the form of cold wraps or gel packs. A bag of ice or frozen vegetables may also be used.

Ice Massage for Sciatica

An ice massage is the application of ice directly on the affected area in a circular motion. Ice massages help relieve pain over a wider region. A hand-held ice unit can be made by freezing water in a paper cup and cutting the top half of the cup to expose the ice (like a popsicle).

In the rear pelvic area, ice massage may be done directly on the skin for 3 to 6 minutes (care must be taken to avoid bony portions of the spine). An ice massage creates a cold feeling followed by a slight burning or tingling sensation, and finally, numbness occurs. Once numbness is felt, icing must be stopped to avoid frostbite. When the numbness wears off, the procedure can be repeated. This treatment can be done 2 or 3 times a day.

See How to Use Ice Massage Therapy for Back Pain

Heat Therapy

Heat therapy is useful in relieving sciatica pain by mechanisms that help promote tissue healing. Applying heat over the rear pelvic region typically ¹ 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 ^{, 2} 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 :

• Improves nerve function by increasing its conduction capability
• Increases the temperature of tissues, causing blood vessels to dilate, improving the flow of blood, oxygen, and nutrients to the affected region
• Increases tissue metabolism
• Increases the joint’s range of motion
• Decreases muscle tension and spasm

Since the mechanism of action of heat is directed toward promoting healing, this therapy is best employed after the initial pain flare-up and accompanying inflammation have been controlled with cold therapy.

See Benefits of Heat Therapy for Lower Back Pain

Heating can be achieved by using hot water bottles, heated packs/ wraps, hot towels, and electric heating pads. Heat therapy can be used for 15 to 20 minutes, with breaks in between to avoid skin damage. Overuse of heat therapy may cause burns, scalding, or ulcers. ¹ 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 For a continued heating effect, long-lasting, low-level heat wraps that adhere to the skin and can be worn under the clothing during the day.

When pain relief is experienced with cold and/or heat therapy, simple stretches can be done to stretch out the muscles and soft tissues. These stretches help relieve the sciatic nerve compression and control the pain. When the pain returns, the ice or heat pack can be reapplied. A simple guideline is to apply heat before stretching to warm up the muscles and use ice after the stretching, to soothe activity-related flareups.

For more information, see Heat Therapy Cold Therapy