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Both heat and cold can cause discolouration of the skin when applied at extreme temperatures or for prolonged periods. Toasted skin syndrome (discolouration from prolonged exposure to heat) occurs when you apply heat for long periods at temperatures that are not high enough to burn the skin. Ice burn can create a similar skin discolouration. It’s important when using either application to keep an eye on how your skin is coping and take a break if you notice any discolouration, burning or itching.
When and why should you use ice for back pain?
Icing is likely to have a small influence on the inflammatory processes and cellular changes in body tissues close to the skin surface after an injury. While this may have some impact on the way the body deals with things like low back pain, the main impact of icing is on the perception of pain. The brain registers and feels the cold messages coming through from the skin nerves, and this reduces the awareness of underlying pain messages coming from other structures. It’s effectively a distraction technique that increases your pain threshold, and works while the ice is on the skin and for a short period of time afterwards. This effect often allows you to move better as a result of less pain, and it is this more-normal movement that may well be the most-important therapeutic aspect of ice application.
From a research point of view, there’s no conclusive evidence that ice is more helpful for low back pain than a placebo, but this may be in part due to the small number and low quality of the research conducted. It’s simple to apply, very low cost, very low risk (apart from ice burns) and is usually quite helpful in temporarily relieving pain. Make sure the ice isn’t damaging your skin by checking it after 30-60 seconds, and don’t use ice if your nerves are damaged or you don’t have normal feeling in the area.
When and why should you use heat for back pain?
Heat application is also very simple to apply, low cost, and patients anecdotally report that heat works better than ice in most cases. The heat will increase the flexibility of your tissues, produce some mild-moderate pain relief, increased blood flow to the area (close to the skin), and help to relax tight, cramped muscles. It also has a distraction element, similar to the application of ice, so the brain “feels” less pain and allows you to move more normally.
Research in low back pain demonstrates some small improvements in pain and less muscle spasm and stiffness, so it’s a no-brainer to give it a try.
What are your best tips for applying heat and ice for back pain?
There are a number of commercial wraps/belts that you fill with heat/cold packs and strap to yourself. These are quite effective and allow you to continue to do other things while you’re applying the hot/cold. Heat strips that you apply to the skin can be worn unobtrusively under your clothing and can offer some relief for multiple hours without having to reapply or reheat. Sprays and creams can also provide a similar effect through the sensation of heating or cooling the skin. All these things work in the same way to distract your brain from the pain, allowing you to move more normally (always a good thing!).
Apply heat in blocks of 20-30 minutes, every 2-3 hours. The benefits are felt when the warmth distracts your brain from the pain, so feel free to keep it warm! Just be careful not to burn yourself. Always check after 30-60 seconds of application to ensure you are tolerating the heat and it won’t burn the skin.
Apply ice in shorter blocks and repeat regularly. For example, 15 minutes, every 2 hours. The ice works in a similar way to the heat, distracting you by numbing the skin and sending different messages to your brain so you don’t feel as much pain.
When should you see a health professional if you are experiencing back pain?
Most cases of low back pain will resolve within 2-4 weeks on their own. However, there are certain times that seeing your Physio or GP is important to check things out and to help you get on the right track:
- see your Physio if you need to get better faster – evidence shows that treatment of low back pain early in an episode can accelerate your recovery;
- if your pain isn’t starting to improve after a week;
- if you have pins and needles, numbness, pain that extends into your leg, any loss of strength or any change in your toilet habits (more or less often, losing control etc.) that coincide with your back pain;
- if you are having repeat episodes;
- if you are feeling unwell in association with your back pain;
- if you feel anxious about your back.