Ice or heat? Heat or ice?
That's probably the most common question asked about treating back pain. The best way to answer it, I have found, is to explain exactly what ice and heat do and why they help relieve pain. Once you understand the mechanism behind these treatments, you'll be more likely to use them when your own back pain flares up.
The Pain-Spasm Cycle
Let's say you have sciatica. Your piriformis muscle goes into spasm. Your body reacts to this "injury" by sending more white blood cells to the injury site to fight the problem. That means fewer red blood cells go there, which means the injured area is getting less oxygen and nutrients, and waste products aren't being carried away. This causes what's called Secondary Hypoxic Injury. The site is actually injured even more by lack of oxygen (hypoxia).
It may also put the muscle into a pain-spasm cycle. The injury triggers nerves to send signals to the brain, which interprets it as pain. This pain tells the brain to send a signal back to the injured area, which contracts the muscles to close off blood supply to prevent swelling. But this lack of blood supply actually leads to more pain, more swelling and more spasms.
To review: The initial spasm causes pain and swelling, which leads to more injury and further spasms. More pain, more spasms, more pain, more spasms—a vicious cycle. Without treatment, this cycle can last for years. The only way to begin healing the muscle is to break this cycle. That's where ice and heat come into play.
Breaking the Cycle
Heat and ice both do same thing—they shock the body into breaking the pain-spasm cycle. Heat causes the body to circulate more blood to the area in order to cool it down. That brings more oxygen and nutrients, and removes waste products, which help heal the tissue. Cold is similar—the body sends more blood to the area to warm it up and promote healing.
Heat or cold also shut down the nerves that fire the pain signals—heat relaxes them, cold numbs them. When the brain doesn't get the pain signals, it doesn't act to contract muscles and constrict blood flow. After applying heat or cold consistently and continually for a certain period of time, the pain-spasm cycle is broken. Then, real healing can begin.
Which Is Best?
If both heat and ice do the same thing, which is better to treat back pain? There are really no hard and fast rules, but I typically have my patients do the following:
1. When an injury first occurs, use ice first. This is true whether the injury is acute (caused by some trauma like lifting something heavy or sitting too long) or subacute (a flare-up of a chronic condition, like sciatica). It's also important to use ice fast. You need to get ice to the injury within 5 minutes to get the best effect. If you're not at home and don't have ice handy, head to the 7-11 and buy a bag of ice. Begin treatment immediately. Apply ice for the first 48-72 hours. Use it for 20 minutes, then take it off for 20. Repeat as often as you can.
2. After 48-72 hours, when you feel the swelling has gown down and the pain-spasm cycle is broken, you can begin stretching the injured muscle with the appropriate exercises. At this point, choosing ice or heat is really up to you. Most people like heat before they exercise and ice after. Either way, you're getting red blood cells to the area to promote healthy healing.
3. For a really advanced treatment plan, I recommend a contrast bath. Try 20 minutes of heat followed immediately by 20 minutes of ice. Repeat three times. The contrast really shocks the body and gets it out of the pain-spasm cycle.
The Path to Pain Relief
Remember that heat and ice are not the solution to long-term pain relief. They are the paths to the solution. The goal of both ice and heat is to break the pain-spasm cycle and allow you to do the stretching exercises that build muscle strength and flexibility.
That's what brings prolonged pain relief. And that's the ultimate goal, isn't it?