ICING YOUR BACK
All You Need To Know
Updated: Sept 5th, 2022
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Icing the lower back immediately after an injury is a common strategy. However, the evidence supporting cold therapy to the low back is extremely limited. Heat is a better option for chronic pain.
THE BASICS
WHEN & WHY TO ICE
Cryotherapy (applying ice to an area) may be used for strains, sprains and overuse injuries. The goal is to help decrease the pain and help keep you moving. In cases of an acute lower back injury (defined as an injury that occured in the last 24-72 hours), icing may facilitates joint recovery by reducing pain and improving your tolerance to early movement after an injury. Although the evidence for lower back icing is extremely limited (see evidence review below.)
HOW TO ICE
Use a Skin Barrier: Place a towel between your skin and the ice. This will help avoid any damage to the underlying skin. 20 Minutes Max: Icing for longer than 20 minutes can lead to damage to the underlying tisssue. Listen to your body! Icing should not hurt. If it does, take a break and make sure you have a large enough barrier between the skin and ice. Take Breaks: Alternate icing and resting your skin. The general rule is 20/30: Ice for 20 minutes and take a break for 30 minutes. Frequency: After an acute low back injury, ice therapy may be useful in the first 24-48 hours. 3-4 times a day is reasonable. Never sleep while icing.
THE EVIDENCE
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EVIDENCE RATING: POOR
The evidence supporting the use of cryotherapy for low back pain is extremely limited. We would even go so far as to say it is almost shockingly poor when you consider the historical prevalence of icing for low back injuries. A 2006 meta-analysis (1) found insufficient evidence to evaluate the effects of cold therapy on acute or sub-acute low-back pain. They found moderate evidence to support heat wrap therapy to provide a small, short-term reduction in pain and disability, but icing evidence was almost non-existent. Indeed, they found no studies that examined the use of cold therapy for acute low-back pain. Once again, we found this quite surprising considering the commonly held belief that icing in the first 48-72 hours is a standard recommendation for low back injuries. The three studies (2, 3, 4) that were found looked at chronic low back pain and were of poor quality. We conclude that more research is needed, and ice is most likely useful to promote early movement after an injury. Which has been shown to promote a faster recovery.
REFERENCED STUDIES
1. French et al. Superficial heat or cold for low back pain. Cochrane Database Syst Rev. 2006 Jan; 2006(1): CD004750. Published online 2006 Jan 25. doi: 10.1002/14651858.CD004750.pub2 2. Landen BR. Heat or cold for the relief of low back pain?. Phys Ther 1967;47(12):1126‐8. 3. Roberts D, Walls C, Carlile J, Wheaton C, Aronoff G. Relief of chronic low back pain: heat versus cold. In: Aronoff GH editor(s). Chapter 13, Evaluation and Treatment of Chronic Pain. 2nd Edition. Baltimore: Urban & Schwarzenberg, 1992:263‐6. 4. Grant AE. Massage with ice (cryokinetics) in the treatment of painful conditions of the musculoskeletal system. Arch Phys Med Rehabil 1964;45:233‐8.
YOUR OPTIONS
ICE BAGS
Good old fashioned ice bags can often do the job. Fill a plastic, sealable bad with ice. Either break the ice up, or add a little water to help it conform to your body.
FROZEN FOODS
This is one of our favorites. Grab a couple bags of frozen peas and place them around the injured area. We did have one person tell us this failed miserably after the "peas ran all over the place." So we'll say it - be sure to not open the bags before applying! But seriously, once the frozen food has been used for icing, do not eat the food in the future. It's now officially just for icing.
HOMEMADE ICE PACK
We love this trick. Fill a plastic freezer bag with 1 cup of rubbing alcohol plus 2 cups of water. Do your best to get as much air out as possible of the bag before sealing it up. Place that bad into another bag (this helps minimize leaking) and leave it in the freezer for a couple hours. Congratulations, you made your own ice pack!
COMMERCIAL ICE PACK
While all of the above works just fine, many people prefer an over the counter ice bag that is effective and easy to reuse many times over. See below for our recommended options.
Icing for the lower back has very little evidence to support it. Indeed, heat therapy has a stronger base of support. If you have found icing your lower back was helpful in the past, it was unlikely due to any anti-inflammatory effects. Cold therapy is not going to penetrate deep enough to effect the joints or discs of the low back. Any positive results would be purely from pain relief. This in turn could could help you tolerate early movement - which has been shown to be a key component to low back pain recovery.
Taken altogether, we believe conservative icing in the first 24-72 hour period after a back injury or pain flare-up is acceptable if you've found ice helpful in the past and it helps keep you mobile. After 72 hours, we would lean toward heat therapy for back pain.
CONCLUSIONS
THE BEST
Arris | Magic Gel
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Our Pick
WHY WE LIKE IT
The Arris Gel Ice Pack for Back Pain Relief stands out for it's large gel pack and double-pull tension straps. Let's start with the gel pack, which is filled with 800g of freezable gel (1.77 lbs), which was the biggest gel back we found with a wrap around support sleeve. It provides a large area of cooling and stays plenty cold for a full 20 minute icing session. Regarding the support, the double-pull tension straps provide two things: First, additional support to prevent loosening or slipping of the ice pack. This is key if you are wearing it while on the move. Second, it can provide additional compression to support your back.
While not marketed as one, it is essentially a light back brace and ice pack in one. We have mixed feelings on low back braces (see our Back Brace Review to learn more), however when lightly tightened it does a great job of helping to keep the cold therapy in place and adding an extra sense of support. Just don't come to rely on the brace part too much. We want your core muscles working to support your back - not a brace.
Can also be used as a hot pack. Only comes with one gel pack, but it's not an issue as long as you remember to put it back in the freezer between uses.
PROS
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Reusable, stays quite cold
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Stays in place well
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Can be used for light back support
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High-quality, durable
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Heating option as well
CONS
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Just one ice bag provided (for us this is a non-issue)
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Straps could lead to reliance as a back brace. Be careful to not let this happen.
CONCLUSIONS
It's a great ice pack for lower back pain. The combination of large gel pack, quality, price, and stabilization straps make it hard to beat. Just remember, it's main use is to help you remain mobile. Movement is the most proven route to recovery with low back pain.
Runner-up
WHY WE LIKE IT
The Magic Gel Ice Pack for Back Pain Relief does the job very well, is built out of high-quality materials, and comes with a 2 year warranty.
The cold pack gel remains cold for more than enough time for a 20 minute icing session. The velcro holds well and the design allows you to move around while icing (this is critical when considering our conclusions that movement is the real healing power - the cold just helps you tolerate more of it.) Belt comes with two icepacks, which is nice but not necessary in our opinion.
The only downsides we noted was a velcro seam where you insert the icepack into the belt was slightly rough on the skin, and a smaller ice pack (compared to our first pick.) The velcro seam is a minor issue, but if you have sensitive skin you may want to wear a thin undershirt when using this brace. The smaller ice pack size could be a good thing for individuals with smaller frames.
FEATURES
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Reusable, stays cold up to an hour
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Two-in-one product. Can deliver heat therapy as well.
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Design fits nicely around the lower back for excellent cold (or heat) transfer
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Thick viscosity gel which allows the pack to remain pliable right out of the freezer
PROS
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Stays cold for >20 minutes
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Can wear it while up and about
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Fits snugly
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Comes with two icepacks
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High quality materials
CONS
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Velcro insert seam was slightly rough
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Ice bag was smaller than the Arris
CONCLUSIONS
Great ice pack if you are looking for a simple icing solution and have a smaller body frame.