Dr. Jeffrey I. Kennis,  D.C.
205 Commercial St.
Boston, MA 02109

( 617)720-2329




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Cold and heat therapy may both provide effective relief from your lower back pain—but how do you know which one to use?

See Heat Therapy Cold Therapy

heat or ice for lower back pain

Many lower back problems can lead to painful muscle spasms. See Lower Back Pain Symptoms, Diagnosis, and Treatment

Read on for helpful advice on deciding whether you should use ice or heat to treat your lower back pain.

See Early Treatments for Lower Back Pain


As a general rule, it is best to apply cold therapy to your lower back in the first 24 to 72 hours following your lower back injury. The application of cold therapy can minimize your inflammation and swelling—which in turn may reduce your pain. In addition, ice can decrease your tissue damage and numb your sore tissues.

See Ice Packs for Back Pain Relief

There are numerous options for cold therapy, including a frozen bag of vegetables, frozen gel packs, and a frozen towel. Regardless of which option you choose, make sure to note the following precautions:

  • To avoid ice burn, place a cloth between your skin and whichever source of cold you select.
  • Apply cold therapy for no more than 20 minutes at a time. You can apply cold therapy 8 to 10 times per 24 hour period.

Watch: Video: How to Make 5 Quick and Easy Ice Packs

Use heat to encourage healing

After your initial swelling and inflammation has subsided, heat therapy can be utilized to encourage healing in your lower back. The application of heat therapy stimulates blood flow to the area, which brings restorative oxygen and nutrients. Additionally, heat can inhibit the transmission of pain signals to your brain and decrease your stiffness.

See How to Apply Heat Therapy

There are two basic categories for heat therapy: dry and moist. Dry heat may leave your skin feeling dehydrated, but many people feel it is easier to apply. Heat therapy may be more difficult to apply, but it can aid in the penetration of heat into your muscles.

Watch: Video: How to Make a Moist Heat Pack

If you have diabetes, an open wound, or dermatitis it is best to avoid heat therapy altogether.


What about chronic lower back pain?

All of the above advice addresses when to use heat and ice following the first occurrence of lower back pain after an injury. But what about chronic lower back pain?

See Types of Back Pain: Acute Pain, Chronic Pain, and Neuropathic Pain

The simple answer is that there is no right answer. Finding the balance between cold and heat therapy for chronic lower back pain is a process of trial and error—and what might work for one patient may not for another. But when it comes to exercise, many people with chronic back pain find heat therapy helps to warm up their muscles beforehand, while cold therapy helps with pain and inflammation afterwards.

See Heat Wrap Therapy Can Reduce Post-Exercise Low Back Pain

Additionally, if you do suffer from extended or chronic lower back pain make sure to receive care from a qualified medical professional. Relying on self-care for too long may make your back pain worse.

See Pain Management for Chronic Back Pain

I hope all of the above advice will help you determine if cold or heat therapy is right for you, which in turn may help you find meaningful relief from your lower back pain.

Learn more:

How to Use Ice Massage Therapy for Back Pain

Benefits of Heat Therapy for Lower Back Pain

Yoga is a low-impact, effective way to relax tight muscles and build strength—which can help relieve lower back pain. Try these 3 beginner-level poses and see if you find relief. Remember to take it slow and stop if the pain gets worse.

Image of a yoga class doing the seated prayer pose

Yoga can help to strengthen and strech the lower back muscles, alleviating tension and pain.
 How Yoga Helps the Back

Sphinx pose

The sphinx pose puts your lower back muscles in a more relaxed position and is sometimes recommended for people who have sciatica pain from a herniated disc. You need to lie on the ground, so use a yoga mat or thick towel.

  1. Lie flat on your stomach with your legs straight. Keep your forearms on the ground next to you, tucked in close to your sides.
  2. On an inhale, tighten your legs and raise your chest off the ground by pushing with your arms. Your forearms and palms should stay on the ground.
  3. Your hips, legs, and feet should maintain contact with the ground, and your elbows should be aligned directly under your shoulders.
  4. Hold this pose for 5 seconds, then gently lower your torso back to the ground.

See Exercise for Sciatica from a Herniated Disc

Repeat this pose as you are comfortable. Gradually work your way up to 30 seconds per repetition.


Cat/cow pose

Illustration of the cat and cow yoga pose for lower back pain

Cat and cow are 2 different yoga poses, but they are typically practiced together. Here’s how to do them:

  1. Start on your hands and knees. Align your arms straight under your shoulders and your knees under your hips.
  2. Look at the floor, keeping your head straight in line with your torso and spine.

Move into the cat pose:

  1. Round your back, lifting your spine toward the ceiling.
  2. Your eyes will face your belly.

After a breath, move into the cow pose:

  1. Slowly lift your chest and tailbone toward the ceiling, letting your stomach sink toward the ground.
  2. Your eyes will look up toward the ceiling.
  3. After another breath, gently return to the cat pose.
  4. Repeat these motions a few times or until you feel adequately stretched.

Together, these poses form a gentle yet effective stretch for your lower back.

See Healing Benefits of Yoga

Modified down dog pose

Downward-facing dog is a popular yoga pose, but it can be difficult to perform, especially for people with painful hand or wrist conditions. Here’s a modified version that may be gentler on the body:

  1. Stand and face a wall. Place your hands on the wall between waist and chest level. Set your feet hips-width apart.
  2. Bend your knees slightly and slowly walk away from the wall, keeping your hips over your feet and your hands pressed against the wall.
  3. Stop in place once your arms form a straight line with your spine, keeping your back as flat as possible.
  4. You should feel a stretch through your back.
  5. Hold this pose for 30 seconds, then slowly walk forward to come out of the pose.

This pose helps lengthen your back muscles.

See Pulled Back Muscle and Lower Back Strain

Not all of these yoga poses may ease your lower back pain, so experiment and see which ones work best for you. If any of these poses worsen your pain, talk to your doctor immediately.

Learn more:

Stretching for Back Pain Relief

Pilates Exercise and Back Pain

When you have back pain, riding in the car for an hour or more can be a real challenge. Consider the following advice and see if it helps on your next road trip.

Stretching for Back Pain Relief

Get out of the car and stretch often to keep you back happier during road trips.
 Stretching for Back Pain Relief

1. Get comfortable immediately

Take the time to make sure you're comfortable from the moment you set off on your trip. The smallest irritant in the beginning of your trip can turn into raging pain later.

  • Keep your back pockets empty. Sitting on your wallet, phone, or anything else may throw your spine out of alignment.
  • Sit up straight with your knees slightly higher than your hips, and keep your chin pulled in so that your head sits straight on top of your spine.

    See Posture to Straighten Your Back

  • Sit a comfortable distance from the steering wheel. For airbag safety, the National Highway Traffic Safety Administration advises sitting with your breastbone at least 10 inches from the steering wheel,1 and keeping your hands on the wheel at 9 and 3 (the sides rather than the top of the wheel).2 But don’t sit too far away either, which can cause you to reach too far for wheel and places more stress on the lumbar spine, neck, shoulder, and wrists.

    See Office Chair, Posture, and Driving Ergonomics

  • Keep your back aligned against the back of your seat. To better support the contour of the inward curve in your lower back, use a small pillow or roll up a scarf and place it between your lower back and the seat. Also, there are many specialized cushions and pillows that can help with sciatica pain and lower back pain.

    See Types of Lumbar Support and Ergonomic Office Chairs

There is no single best option, and it may take some effort and trial and error on your part to find what works best for you.


2. Make your ride as smooth as possible

Bumps in the road can jar your spine and increase pain. For a smoother ride, consider:

  • Riding in a passenger car, rather than an SUV or pickup
  • Replacing worn shocks to limit the bounce in the car
  • Replacing worn tires to reduce vibration or shaking
  • Sitting on a car seat pillow or coccyx cushion to provide more padding between you and the road

See Pain-Free Travel Tips

3. Get out and move around

Sitting in one position in a car will stiffen up your back muscles and can lead to achiness and possibly muscle spasm. Everyone should ideally take at least a 15-minute break for every 2 hours of driving. If you’re prone to back pain, you may want to take breaks more frequently, such as every 30 to 60 minutes.

Watch Video: What Is Your Back Muscle Spasm Telling You?

Try to plan ahead to schedule stops. Get out of the car so you can move around and stretch. Movement stimulates blood circulation, which brings nutrients and oxygen to your lower back.

Watch 4 Easy Stretches for Lower Back Pain Video

4. Shift your position periodically

When possible, try to move a little in your seat. Even 10 seconds of movement and stretching is better than sitting still. At a minimum adjust your seat and change your position slightly every 15 to 20 minutes. Pump your ankles to keep the blood flowing and provide a slight stretch in your hamstring muscles. Any movement that is safe to do in the car will help you out.

See Specific Hamstring Stretches for Back Pain Relief

5. Try cold or heat therapy

Many people find that applying cold or heat therapy is a good way to alleviate pain on a long road trip.

  • Cold therapy can help reduce inflammation and swelling. Consider bringing a cooler to store reusable ice packs or other cold therapy packs. You can buy cold therapy packs at the store or make your own.

    See Ice Packs for Back Pain Relief

  • Heat therapy can help increase blood flow and relax the muscles. Various types of heat therapy are available to buy, such as heat wraps or heat pads. You can also make your own moist heat pack. Some people prefer to place a moist heat pack in the microwave so it’s warm when they go on the trip.

    See How to Apply Heat Therapy

It is recommended to apply ice or heat for only 15 or 20 minutes at a time, then give your skin a rest to recover for at least a couple hours before the next application.

For drivers, it may be best to apply cold or heat therapy while taking a break from driving. Since you are unable to check the skin while driving, it is harder to ensure that the skin is not being damaged during an application of cold or heat therapy. Some cars have heated seats that provide continuous low-level heat, which can be a good option while driving if it is comfortable and provides relief.

6. Support your back with your feet

Supporting your spine starts with bottom-up leverage from your feet. Your feet need to be placed on a firm surface and at the right height to avoid transferring stress to your lower back. It is ideal to have your knees at a right angle. This means, if your seat is too high it is best to put your feet on a footrest. If you are the driver and have the ability to use cruise control for a longer drive, you may want to do this to allow you to have both feet on the floor for periods of time.

See Good Posture Helps Reduce Back Pain

7. Employ diversions from pain

Having something planned to take your mind off the pain could make a big difference. Even if you're the driver, there are still a few options to safely help occupy your mind. Try a new music channel, download a podcast, or listen to an audio book.

Passengers have many additional choices, such as meditating, reading, watching a show, solving a sudoku or crossword puzzle, or playing an electronic game.

Bonus tip

If you know that long car rides give your back trouble, you may want to consider taking an over-the-counter NSAID (nonsteroidal anti-inflammatory drug) right before the trip to reduce the risk of back pain developing or worsening. Some examples of NSAIDs include aspirin, ibuprofen, and naproxen. Just remember to check with your doctor first and read warning labels carefully to reduce the risk of serious side effects or complications.

See Common NSAIDs for Back and Neck Pain

Try out these tips and see what works for you. Hopefully at least some of these tips help reduce your back pain while on the road.

Learn more:

29 Best Travel Tips for Your Aching Back

9 Quick Back Pain Tips for Airplane Rides

Making minor changes to your daily routine can add up to major sciatica relief.

See What You Need to Know About Sciatica

Sciatica Symptoms

Sciatica refers to a set of symptoms caused by an underlying lower back disorder. 
 Sciatica Overview Video

To help you determine the changes you need to make, we identified 2 common mistakes that may be provoking your sciatica symptoms:

1. Wearing high heels

A contributor to your sciatica symptoms may be right beneath you: your high heels. High heels are a common fashion accessory, but they disrupt the natural curvature of your spine by shifting your weight forward. This can place increased stress on your lower back, which in turn may provoke your sciatica symptoms.

See Sciatica Symptoms

Of course, the best course of action is to avoid wearing high heels altogether. Instead, buy a comfortable pair of shoes from a footwear store that also caters to runners. Most of these stores can analyze your gait and foot shape, and in turn they can recommend a pair of shoes that will fit you properly.

See Five More Tips for Reducing Back Pain at the Office

If you have to wear high heels, here is how to minimize your pain during the day:

  • Wear a comfortable pair of shoes to work, and change into high heels once you arrive
  • Limit the height of your heels to less than 2 inches
  • Purchase high heels that fit snugly (but not too tight) so your feet do not slide forward

See Myths About Sciatica Treatment Options


2. Maintaining the same workout routine

By now, you have likely heard that it is important for people with sciatica to exercise. This is because aerobic exercise spurs healing nutrients and oxygen to your lower back, and gentle stretching can relieve tension in your lower back muscles.

See Physical Therapy and Exercise for Sciatica

But keeping the same workout routine from before the onset of your sciatica symptoms can actually provoke your sciatica. For example, you may have been a runner your whole life, but running jars your spine and can pinch or aggravate a sciatic nerve root.

See Exercise and Back Pain

For exercise to be effective in relieving your sciatica symptoms, you need a controlled, gradual exercise plan targeted at the particular underlying cause of your symptoms. If you haven't already, the first step in formulating this plan is to meet with your doctor for a proper diagnosis. She or he can then help tailor a plan to your specific needs.

See Getting an Accurate Back Pain Diagnosis

Change is never easy, but ditching your heels and adjusting your workout plan may noticeably reduce your sciatica symptoms.

A feeling of sudden leg weakness, causing your legs to give out or buckle can be alarming. Weakness in your leg(s) may occur from problems in the nerves and/or muscles in your lower body and is usually treatable. Rarely, the underlying cause may be a serious medical condition requiring immediate medical attention.

Cauda Equina Syndrome

A feeling of sudden weakness in the legs may be due to nerve and/or muscle dysfunction. Read: Leg Pain and Numbness: What Might These Symptoms Mean?

Here are a few potential causes for leg weakness resulting in sudden buckling and possible falls.


When a nerve root (part of a spinal nerve as it exits the spine) between L1 to S3 in your lower back is compressed, you may experience radiculopathy symptoms in your leg. The most common type of radiculopathy involves the sciatic nerve (formed by the L4-S1 nerve roots) and is called sciatica.1 Sciatica is typically felt as shooting pain that starts in the back and radiates through the back of the leg into the foot.

See What You Need to Know About Sciatica

Other radiculopathy symptoms can include leg weakness, heaviness, and/or loss of function. Radiculopathy typically affects one leg at a time. You may also feel pain, numbness, and/or tingling in the affected leg.2 Higher nerve root compression (L1-L3) can affect the front of the thigh and groin region.


Radiculopathy usually occurs as a result of nerve root compression from a herniated discspinal stenosis (narrowing of the bony openings for nerve roots), spondylolisthesis (a vertebral body slipping forward on another), or other degeneration in the lumbar spine. The sciatic nerve controls the movement of the muscles in the thigh, calf, leg, and foot and is the most common source of radiculopathy.2

See Causes of Leg Pain and Foot Pain

Depending on the severity of radiculopathy, your leg weakness may range from:

  • Difficulty in lifting the foot
  • Difficulty in lifting the entire leg
  • Loss of balance while walking or an unstable gait

Radiculopathy usually resolves with nonsurgical treatments, including physical therapy, regular exercise, heat and cold therapy, and/or medication. Rarely, surgery may be required if a nerve root is severely compressed and/or the leg weakness persists and/or progresses.2

Watch Treatment for Lumbar Radiculopathy Video

Central canal stenosis

Narrowing of the spinal canal is called central canal stenosis. Your spinal canal houses the spinal cord. Central canal stenosis can cause compression of the spinal cord and reduction in its blood supply. Narrowing of this canal can occur in the neck, upper back, and/or lower back.3 The spinal cord ends at L1 in adults. Stenosis below this level is not from cord compression but compression of nerve roots.

Read more: What Is Spinal Stenosis?

Central canal stenosis may occur due to severe disc herniation, abnormally overgrown bone (bone spurs), or thickening of the spinal ligaments.3 Other causes include trauma (bleeds) and tumors which grow into the spine.

See Lumbar Herniated Disc: What You Should Know

You may experience3:

  • Weakness in both legs
  • Difficulty in walking
  • Loss of balance
  • Pain after walking variable distances (neurogenic claudication)

Central canal stenosis may be treated nonsurgically or surgically depending on its severity. If the spinal cord compression is severe (more than 30%) with marked leg weakness, surgery may be indicated.3

See Lumbar Spinal Stenosis Treatment


Diabetic neuropathy

Diabetes mellitus can cause damage to the nerves and muscles in your legs and feet. These nerves typically receive lesser blood supply in diabetes, damaging their structure. The strength and thickness of the muscles are also significantly reduced in diabetic neuropathy, leading to leg weakness.4

A few common symptoms include4:

  • Weakness in the leg and ankle
  • Loss of balance and unsteady gait
  • Aching, burning, or sharp pain in the leg
  • Numbness or complete loss of sensation in the leg and feet, typically affecting the areas covered by a stocking (in the hands, the areas covered by a glove may be affected)

Foot symptoms in diabetic neuropathy are usually managed with medications, special shoe inserts, and/or special type of footwear.

Cauda equina syndrome

Cauda equina syndrome is a rare, but serious medical condition. This syndrome occurs when the lower part of the spinal cord (cauda equina) is compressed due to tumors, collection of fluid (abscess), or severe disc herniation.

Cauda equina syndrome may cause:

  • Sudden, severe weakness in both legs5
  • Numbness in the groin, buttocks, genitals and/or inner thighs (saddle numbness)5
  • The inability to control your bowel and/or bladder movements5
  • An inability to pass urine, reduced urinary sensation, loss of desire to pass urine, or a poor stream6

See Cauda Equina Syndrome Symptoms

If you experience any of these symptoms, consult your doctor immediately. Doctors advise treating this condition within 24 to 48 hours of symptom occurrence in order to preserve lower limb function.5,6,7

See When to Seek Medical Care for Low Back Pain

If you experience leg weakness and are unsure about the cause, consult your doctor. A doctor can conduct specific clinical and diagnostic tests to identify the underlying cause for your leg weakness and formulate an effective treatment plan.