Pain intensity scores
Fig 1: Pain intensity scores with and without preventative heat wrap therapy
(larger view)

A recent study concluded that it is now possible to avoid some of the muscle pain and muscle strain that typically follows strenuous exercise involving the lower back muscles. The study, which had more than 60 participants, tested the effectiveness of preventative low level heat wrap therapy for low back delayed-onset muscle soreness.1 Analysis by the U.S. Spine & Sport Foundation concluded that it is possible to minimize delayed-onset muscle soreness by using wearable low level heat wraps across the lumbar region before exercise (back extension exercises on machines) begins and immediately thereafter.2

Most individuals suffering from low back pain know the importance of staying active, whether that means engaging in low-impact aerobic exercise like walking, or pursuing a more comprehensive program of aerobic, strength and conditioning activities. The back and spine structures all benefit from activity that increases blood flow and maintains flexibility. One major obstacle to ongoing exercise, however, is the attendant muscle pain that many people experience in the day or two after a rigorous workout. In fact, post-exercise pain and stiffness derails many fitness programs.


People with low back pain face a conundrum: they need to engage in lower back exercise but to do so risks increasing their muscle pain, or having a sore back, at least in the short term. Thus, the research showing that heat wrap therapy can minimize the intensity of post-exercise pain potentially gives low back pain sufferers more hope of keeping their exercise program on track.

Low Back Pain Intensity Decreases with Preventative Heat Therapy

The study compared the effect of using preventative lumbar heat wrap therapy to performing a set of routine stretches. The heat wraps were lightweight, disposable, air-activated, commercially available wraps designed to deliver low level heat (i.e. a few degrees above body temperature) for eight hours of continuous use. Outcomes were assessed across several dimensions:

  • Pain intensity, using a 6-point scale ranging from no pain to extreme pain
  • Self-reported physical functioning, assessed with the Multidimensional Task Ability Profile (MTAP)
  • Self-reported disability, (as gauged by the Roland-Morris Disability Questionnaire (RMDQ)

On all dimensions, study participants who used the lumbar heat wrap showed statistically significant better scores than those in the control group who did not use the heat wrap, but instead engaged in minimal stretching of various muscle groups.3

Mean pain intensity scores 24 hours after exercising showed a wide disparity between the groups. Figure 1 shows low back pain intensity scores for both groups plotted across 72 hours. At the 24-hour mark when post-exercise muscle generally nears its peak, low back pain intensity scores for those who used the heat wrap were almost 47% less than for the control group.

Similarly, the scores of physical functioning and disability between groups varied widely. The adjusted mean change in physical functioning was more than 44% for the heat wrap group (indicating preservation of physical functioning) and the disability scores varied more than 50%, with 50% more of the control group (the non-heat wrap group) reporting bothersome pain.

Consequently, participants who used the low back heat wrap (specifically, the product marketed as ThermaCare, which covered the whole lumbar region) before they exercised were far more satisfied with the outcome of the study than those in the control group.

In This Article:

Preventative Heat Therapy May be Superior to Traditional Protocols

The study calls into question traditional approaches to pain control or pain management for exercise-induced delayed onset muscle soreness. Many people who undertake a low back muscle exercise program are advised to stretch or loosen their muscles before vigorous exercise to prevent injury, and to use ice or a heating pad after exercise to relieve muscle soreness. While those approaches may work to some extent, several studies with other muscle groups have reported that warming-up or stretching of muscle tissue prior to exercise is ineffective in preventing delayed-onset muscle soreness symptoms and related functional loss. For example, neither passive nor active warm-up of the bicep muscles prior to lifting weights prevented muscle damage. Similarly, another researcher found that active warm-up of the quadriceps muscles in the thigh using low intensity exercise did not prevent delayed-onset muscle soreness.4


Furthermore, there are no studies that indicate whether or how stretching before exercise prevents onset of low back pain after exercising. The lower back is a complex area and can be somewhat difficult to condition. In contrast, the results of the delayed-onset muscle soreness study described above indicate that applying the heat wrap for four hours prior to and after exercise results in a substantial decrease in low back pain intensity.

The researchers hypothesized that the results could be explained by two main factors.

  • First, the heat wrap was worn for several hours (unlike a heating pad that people usually use for less than an hour), thereby increasing the heat wrap’s thermal effect on muscle. Since the heat wrap used in the study administered low-level heat (i.e. a few degrees above body temperature), continuous wear for eight hours was possible.
  • Second, the heat wrap also allowed the individual to continue moving and remain active, unlike an ice pack or heating pad that uses when stationary, so the wrap wearer maintained a higher level of flexibility and blood flow.

Despite the study’s promising findings, one must take its findings with caution. The study enrolled a relatively small number of participants who were free of low back pain at the onset of the study; and the study used a very specific type of heat wrap. Thus, it is unknown at the present time if these findings can be generalized to other populations (e.g. those with chronic low back pain) and other types of heat wraps. Further research is needed in this area.

For some people, the low back muscle soreness that settles in after exercise is intense enough to cause them to skip an exercise session. Worse, it could lead some people to avoid exercise altogether. None of these is conducive to maintaining or improving low back health. Finding a way to control—or better yet prevent—muscle soreness and related pain can significantly enhance both back and overall health. Low level heat wraps are readily available over the counter in drug stores or from medical supply outlets. People seeking to minimize exercise-related low back muscle soreness can ask their health provider if the results of this study apply to them.


  1. Mayer, John M., et al. Continuous Low-Level Heat Wrap Therapy for the Prevention and Early Phase Treatment of Delayed-Onset Muscle Soreness of the Low Back: A Randomized Controlled Trial. Archives of Physical Medical Rehabilitation, Vol. 87, October 2006, pp. 1310-1317.
  2. The study was supported by the Procter & Gamble Health Sciences Institute, a commercial party having a direct financial interest in the results of the research, which has conferred or will confer a financial benefit upon the author or 1 or more of the authors. Mayer, Mooney, Matheson, Verna, and Leggett received grants from Procter & Gamble. Erasala is an employee of Procter & Gamble.
  3. Mayer, John M., et al., pg. 1313-1314.
  4. Ibid., pg. 1315. See also Evans, R., et al. Effects of warm-up before eccentric exercise on indirect markers of muscle damage. Medicine & Science in Sports & Exercise, 2002; 34:1892-9.
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