Ice and cold therapy

Cold therapy means cooling a sore area from the outside of the body. Clinicians sometimes call it cryotherapy. At home, people use a gel pack from the freezer, ice cubes in a plastic bag, or a bag of frozen vegetables, wrapped in a thin towel.

People use cold on the low back, the upper back and the neck, most often in the first few days after a strain or a new flare of pain. It is something you can do on your own at home. A physical therapist or athletic trainer may also use it during a visit.

Cold numbs the skin and the tissue just under it. It also slows the signals that nerves carry, which can turn down pain for a while.

Cold may ease muscle spasm for a short time.

Cold also narrows small blood vessels near the skin. This may limit swelling after a fresh injury, but that has not been well studied in the back or neck.

Cold does not heal a strain or change what is causing the pain. The hope is to take the edge off for a short while.

Getting set up

Wrap the cold pack or ice in a thin, dry towel or cloth. Never put ice or a frozen pack straight onto bare skin.

Many clinicians suggest about 15 to 20 minutes at a time. Then take the pack off and let your skin warm back up before the next round.

How it feels

At first the area feels very cold. It may then sting, ache or burn a little before it goes numb.

Check your skin each time you lift the pack. Pink or red skin is expected and fades as it warms. White, gray or waxy skin, or blisters, are warning signs.

After

The numb feeling fades as the skin warms up. Some people repeat cold a few times a day for the first few days.

For most new back or neck pain, staying as active as you comfortably can is part of recovery. Cold is at most one small tool alongside that.

There is very little good research on cold for back pain. A Cochrane review of low back pain found only three poor-quality studies of cold and could not draw any conclusions from them. [1]

The same review found conflicting results when studies compared cold with heat. [1]

A US guideline from the American College of Physicians lists heat among the first treatments to try for low back pain of less than about three months. It does not list cold. [12]

In one emergency room study of 60 adults with a recent neck or back strain, a cold pack and a heating pad gave similar, mild relief. Everyone also took ibuprofen (Advil, Motrin), so it is hard to tell how much the pack itself added. [2]

For neck pain, the research is even thinner. A review done for a Canadian neck pain guideline concluded that heat and cold treatments were not effective for neck pain. Those studies looked at treatments given in the clinic, not at home use. [11] [13]

Cold is cheap and simple, and the risk is low when it is used with care. Some people find it soothing, especially in the first days after a strain. Because the research is so limited, many clinicians say it is reasonable to choose between cold and heat by what feels better.

Common and mild

• Discomfort, aching or stinging while the area cools.
• Red or pink skin that fades as the area warms up.

Less common

• Skin injury from cold, sometimes called an ice burn or frostbite. It can happen when ice touches bare skin or stays on too long. Some reported cases needed wound care or a skin graft.
• Flare-ups of cold-sensitive conditions, such as Raynaud’s (fingers or toes that turn white or blue in the cold) or cold hives (an itchy rash caused by cold).

Rare

• Nerve injury. Rarely, long periods of cold over a nerve that lies close to the skin have caused numbness or weakness. In most reported cases, it got better on its own over time.

Who needs extra care

Tell your clinician before using cold if you have diabetes, nerve damage or numbness, poor circulation, Raynaud’s, or a known sensitivity to cold. Reduced feeling makes it harder to notice skin injury starting.

Take extra care if you cannot feel the skin well or check on it, such as right after a numbing injection or if a medicine makes you drowsy. Never fall asleep with a cold pack on.

Skip cold on open wounds or broken skin, since cold can slow healing.

Other downsides

Any relief is usually short.

When to get help

Stop using cold and get prompt medical care if your skin blisters or turns white, gray or waxy. Call your care team if numbness or pain stays after the skin warms up.

See the warning signs.