Do I Ice for Back Pain is a very common question posed by our patients in the clinic. We will talk about how to ice effectively for back pain and at the end we will discuss some controversial ideas on icing that most doctor won’t tell or don’t know.
If you have ever experienced back pain one of the first questions many people ask in my clinic is whether you should ice or use heat.
For most injuries the the short answer is most injuries is to ice in the first 48 to 72 hours. The prevailing thought is icing provides both pain relief and decrease inflammation in the area which may prolong the recovery for back pain or other types of injuries.
In the cases of back pain most times the origin of the pain or tissue injured in very deep in the back and the ice probably acts more like an analgesic and probably really doesn’t reduce inflammation. I will recommend the use just to allow you to experience some pain relief even temporarily to allow you to participate in exercise or gain some much needed sleep.
In the last 10 years there’s been growing controversy about the use of ice for various injuries and conditions. Many doctors will reflexively say you should ice and decrease information the area and that is why you’re feeling better. Some people view that stopping the inflammation is stopping the healing process and is something that should be avoided similar to taking and Advil Motrin medication that can affect the ability for tissues to heal light tendons and ligaments bones.
A pioneer physician Dr. Gabe Mirkin in the 1970’s put forward the idea that in order to speed healing one should adhere to Rest Ice Compression and Elevation (RICE) following any orthopedic injury by reducing inflammation. In the last couple of years he has changed his stance and believes icing is detrimental.
My feeling is icing for back pain is probably not causing a delay in inflammation and it may allow greater engagement in exercise. So have. The depth of tissues that are inflamed are probably too deep to negatively impact those structures and the inflammatory process significantly. The primary influence of icing is to reduce pain in the area. What I get concerned about is a passive approach to recovering from back pain after the initial 2-3 days. My goal for all my patients is to remain as active as possible and less fearful about their condition. Taking a few basic steps will help you significantly. In addition to icing I preach the following:
• Don’t sit, stand or lie down for greater than 20 minutes and in extreme cases 10minutes
• Move as much as possible without increasing your pain levels
• Start a gentle walking program
• Ice as needed if it makes you feel better
In my physical therapy clinic I will typically advise patients to ice their back or lower back pain for 10-20 minutes on the hour. Most times we have the patient lie on their back actually on the ice pack or if on their stomach. If they are on their stomach we will advise patients to use one or two pillows under their waist and stomach to avoid excessively arching the lower back. Most studies have shown the least amount of disc pressure is experienced on your back with your knees bent.
When applying an ice pack be sure to put a towel or pillow case in between the ice pack and your skin. Certain people who have neuropathy, open wounds, or circulation problems should not use ice.
When you first apply ice you will experience a series of sensations going through the following stages:
Stage 1 cold feeling
Stage 2 is a stinging or burning sensation.
Stage 3 is aching.
Stage 4 is numbness.
I prefer using an ice pack that is soft and more pliable so when lying on it does not put excessive pressure on the lower back structures and conforms to the individuals anatomy similar to a tempurpedic pillow. Very rigid pack or crushed ice can cause more irritation may increase or produce muscle spasm which can occur in the early stages of an episode of back pain.