Let’s start with an acute back. You’ve just done it. It’s fresh. When you injure your back, two things happen at once — and this is the key to getting it right, because they need opposite treatments.

The first thing is that right where the actual problem is, over the spine, you get an inflammatory response. The disc, or whatever the primary issue is, becomes acutely inflamed. So directly over the spine, where that inflammation is, that’s where you want ice — a bit of cold, over the spine, to calm that inflammation down and control that inflammatory response.

But here’s the second thing that happens. Around that injury, the muscles either side of your spine go into a protective spasm. Think of it like a constant version of cramp in your back — the muscles clamp down hard to guard the injured area. And here’s the mistake people make: if you put ice on those spasming muscles, you make them worse. Cold makes a tight, cramping muscle tighten up even more, so you get more spasm and more backache. Those muscles want the opposite — they want heat, because heat relaxes a muscle and eases that cramp.

So this is the clever bit, and the thing I really want you to take away for an acute back. Ice over the spine, in the middle, where the inflammation is. And heat on the muscles either side, where the spasm is. Cold on the inflammation, heat on the spasm, at the same time. They’re two different problems, in two slightly different places, needing two different things. Get that right and you’ll calm a fresh back down far quicker than just bunging an ice pack on the whole thing.

A chronic back is much simpler. If your back’s been problematic for a long time — months, years — it tends to respond far better to heat.

Because a chronic back isn’t really about fresh inflammation anymore. It’s about chronic tightness — increased tension, muscles that are cramping and gripping constantly. So heat is your friend here. Warm it up, and it’ll often just feel better and looser.

And here’s a bonus tip for a chronic back. If you’re planning on stretching or doing your exercises, heat it first. Warm those muscles up before you stretch, and you’ll get a lot more out of it — the tissue’s more relaxed, more pliable, and it’ll respond much better.

So let me bring it all together. When it comes to ice or heat for back pain, it depends which kind you’ve got.

A fresh, acute back wants ice over the spine to control the inflammation, and heat on the muscles either side to ease the spasm. A chronic, long-standing back wants heat — and heat before you stretch to get more out of it. Simple as that. But that little detail on the acute back — ice in the middle, heat on the sides — is the bit that makes all the difference, and it’s exactly what most people get wrong.

Joe Sharp
BSc (Hons) Physiotherapy