Harvard Men's Health Watch

Hot or cold for back pain?

Q. Which is best for pain and stiffness from a sore back—heat or cold?

A. When choosing between heat and cold, you may be a better judge than your doctor. Nerve fibers that carry pain sensation also sense change in temperature. As a result, stimulating the nerves with either heat or cold can diminish your discomfort, so you can choose which one to try. Both may ease your pain.

On the other hand, some experts advocate heat or cold based on the potential effects on blood flow. Applying ice or a reusable gel pack constricts blood vessels and reduces swelling around the injury. This is particularly useful for conditions, like a sprained ankle, that cause significant swelling. Heat has the opposite effect, increasing blood flow to the area. This relaxes muscle fibers, which can help when you experience spasms or stiffness. Unfortunately, the medical evidence for both these treatments is slim. There is more support to use heat for back pain, because muscle tightness tends to predominate.

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