Does Ice Help Back Pain?

The Case For Breaking Out The Frozen Peas...

The Short Answer

Conventional wisdom says ‘always treat an injury with ice’ (cryotherapy). But in the case of back pain, some theories argue that this is not necessarily the case. The real issue is just what effect ice can actually have on your spine and what effect mind over matter could have.

Does ice help back pain? Not as much as you might think….

Does Ice Help Back Pain – The Theory…

There are 3 key ways in which proponents of using ice argue that it helps back pain –

  • Ice slows the blood flow, reducing inflammation which is frequently the source of the pain
  • Ice can help to numb the nerves around an injury, resulting in less pain messages being transmitted to the brain
  • The cold feeling delivers a placebo effect, convincing the brain that it is reducing the pain

There is an old saying amongst clinicians ‘if it feels nice, it might suffice’. This really refers to the fact that we know that your brain has a powerful impact on how well you recover.

So if a treatment feels good and makes you feel like it’s making a difference, then the chances are it will have exactly that effect – it’s what is commonly know at the placebo effect.

You’re told to use ice because it will help, so you put ice on your back injury and expect to feel an improvement.

That expectation convinces your brain that it should feel better, so your brain ignores some of the pain signals, therefore actually making you feel better.

For that reason alone, ice can help back pain – but in truth that is not ice helping, it is your brain and the placebo effect that is making the difference.

In certain circumstances, cold can also numb the pain receptors in to reducing the number of pain signals emitted to the brain.

But the most established clinical theory is that making the injured area cold will slow your blood flow to it (the opposite to heat) and therefore reduce inflammation around an injury.

In many cases, such as rheumatoid arthritis, it is the inflammation that is the biggest factor in delivering pain. Reduced inflammation = reduced pain.

We know in these cases, that ice does have a positive impact

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The Alternative Theory For How Ice Might Help Back Pain

A key part of whether ice itself really helps comes down to whether it’s possible to actually cool down your spine.

Many of the arguments against using ice on your back pain rest on how effectively this really happens.

You see your spine and the many of the muscles around it sit under inches of skin, insulating fat and other muscles (depending on your physical shape). Furthermore, it’s close proximity to your heart makes this process even harder.

Dropping the temperature of your big toe, an ankle or even a knee is relatively easy. They are naturally cooler because they are further from your blood-pumping heart and not surrounded in insulation like your spine.

Similarly cuts and superficial injuries to the skin are easy to treat effectively with ice.

In both of these cases, ice drops the temperature of the affected area which slows blood flow and decreases the level of inflammation.

If you injured your kidneys or liver for example, clinicians would never dream of asking you to put ice on your kidneys. Firstly, it wouldn’t do anything and secondly you’d never be able to get it cold enough.

In order to get it cold enough to make an impact, your core temperature would have to drop significantly, bringing with it considerable health risk.

Does Ice Help Back Pain – The Evidence.

Another theory that runs against the use of ice on back pain, is that inflammation is an essential part of the healing process.

By reducing inflammation could you actually be slowing down the recovery process. Well, not according to the data.

Unfortunately, data on the sole use of ice in patients with back pain is about as inconclusive as you could get.

Even if you open the study to any soft tissue injury, the evidence is paper-thin. Collins in ‘Emergency Medicine’ reviewed the only six relevant trials (four of which were on animals) and concluded that there was

“…insufficient evidence to suggest that cryotherapy improves clinical outcome”
(Cryotherapy is the technical name for cold therapy typically using ice)

Another more up to date review by Malanga et al in ‘Postgraduate Medicine’ was a little more definitive.

This began with the challenge that…

“Most recommendations for the use of heat and cold therapy are based on empirical experience, with limited evidence to support the efficacy of specific modalities.”

Following a review of a handful of clinical trials they reached the conclusion that

“heat-wrap therapy provides short-term reductions in pain and disability in patients with acute low back pain and provides significantly greater pain relief of DOMS than does cold therapy.” 
(DOMS stands for ‘delayed onset muscle soreness’)

One of the biggest problems with proving decisively the effect of ice on back pain is that many people use multiple pain relief techniques – heat wraps, cold wraps and painkillers.

Very often this works, but it is then very difficult to split the variants and work out what benefit has been given by the ice.
Dehghan et al (2014) is just one of a host of trials that show positive results from a combination approach and perhaps that is the real take away –

That ice can be effective – but is better as part of a multi-faceted approach involving heat as well.

The Final Word – Finding Empirical Evidence.

Ice is undoubtedly key in many forms of pain relief. Many say ‘ice is for injuries, heat is for muscles’, but the truth is not as simple as that.

Top athletes with some of the best medical advice money can buy, take regular ice baths after competing, because it helps their muscles to heal.

In truth much of the strongest evidence comes from this empirical evidence.

Whether it is cold alone or the rest of their warming down procedure, which frequently includes heat and professional massages, is another question.

So…does ice help back pain? Well, yes, the clinical evidence and the empirical evidence that I could add personally, concludes it does.

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References Used –

1. Collins NC. (Feb 2008). Is ice right? Does cryotherapy improve outcome for acute soft tissue injury? Emergency Medicine Journal
2. Malanga GA, Yan N, Stark J. (2014). Mechanisms and efficacy of heat and cold therapies for musculoskeletal injury. Postgraduate Medicine Journal.
3. Morteza Dehghan and Farinaz Farahbod. (Sept 2014). The Efficacy of Thermotherapy and Cryotherapy on Pain Relief in Patients with Acute Low Back Pain, A Clinical Trial Study. Journal of Clinical and Diagnostic Research.

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