Is Heat or Cold Therapy Better for Sciatica Pain?

Sciatica is a unique type of nerve pain that begins in the lower back and extends through the lower extremities.

People with sciatica often experience sharp low back, hip, and leg pain as well as burning sensations, tingling, numbness, and muscle weakness. This level of discomfort is alarming and calls for the assistance of an ice pack or warm towel, but which is actually fit to alleviate your pain?

In this article, we will discuss whether heat therapy, cold therapy, or a combination of both is best for sciatica.

What Causes Sciatica Pain?

Sciatica is caused by the compression of one or more nerve roots in the lumbar spine (low back) or sacrum (area above the tailbone). These nerve roots form the top piece of the sciatic nerve which extends all the way to the big toe, explaining sciatica’s radiating pain.

The top portion of the sciatic nerve becomes compressed when it makes contact with another spinal structure, such as an intervertebral disc or bone. Intervertebral discs and spinal bones are commonly misplaced after enduring injuries like disc herniation, bony spurs, or spondylolisthesis (slipped vertebrae), resulting in irritation of spinal nerves.

Regardless of the reason for your sciatic nerve pain, you are probably looking for immediate relief. Your best bet is to contact your doctor or physical therapist. A medical professional can perform the sciatica test to determine if the source of your pain is truly sciatica; from there, your doctor will likely prescribe conservative care focused on physical activity and pain management—including the use of both cold and heat therapy.

Cold Therapy

Medical professionals recommend using cold therapy for the first 48 to 72 hours of experiencing sciatica because it reduces the intense pain and inflammation associated with the onset of nerve-related injuries. However, avoid heat treatment until this time has passed, as it could worsen inflammation.

• Cold therapy decreases nerve conduction to alleviate sharp pain and sensitivity. The primary duty of nerves is to provide feeling and give us the ability to move. Our nervous system accomplishes this by transmitting electrical impulses along the nerve cell, a process known as nerve conduction. When a nerve is injured, it transmits sharp, tingling, or painful sensations. However, cold treatment provides relief by suppressing these distressing signals.

• Cold therapy decreases blood flow to numb painful areas. When exposed to low temperatures, blood vessels constrict and decrease the flow of warm blood toward the skin in order to prevent any loss of body heat. This reaction causes poor circulation and in turn, numbness useful to pain relief.

• Cold therapy slows tissue metabolism to reduce harmful inflammation. The cells surrounding an injury release chemicals that cause blood vessels to leak. The nearby tissues metabolize this fluid and induce swelling. While this is your body’s way of protecting the area from further damage, the blood vessels may leak into the additional soft tissue, causing unnecessary inflammation. However, cold therapy narrows blood vessels, preventing excessive leakage and needless inflammation.

How to Apply Cold Therapy

Cold treatments are most effective when applied to the back of the pelvis where your sciatic nerve is located. Cold therapy can be practiced using ice packs, frozen gel packs, or even frozen vegetable bags. These treatments should be used three times a day for 15 to 20 minutes.

Patients with wide areas of pain, such as the back, find ice massage to be especially beneficial. Ice massage can be done at home. Simply freeze water in a paper cup, then cut off the top half of the cup to uncover the ice. Next, have a partner rub the ice in circular motions on painful areas for a few minutes or until it becomes numb.

After a few days, a majority of your pain and inflammation should subside and you can begin heat treatment.

Heat Therapy

Once a majority of your sharp pain and swelling has subsided, you can begin applying heat. Heat therapy primarily promotes healing. Let’s go over how.

• Heat therapy increases circulation to speed up the healing process. Unlike the cold, high temperatures expand blood vessels and improve circulation. As blood flows through the sight of injury, it removes any damaged cells, while delivering oxygen and nutrients crucial to healing wounded soft tissue.

• Heat therapy activates heat receptors to alleviate minor pain. When soft tissue becomes damaged, our body releases adenosine triphosphate (ATP), a molecule that signals injury by activating cells’ pain receptors. However, heat receptors easily overpower pain receptors. High-temperature stimuli such as a heating pad or warm towel, can energize heat receptors and adequately reduce pain.

• Heat therapy increases tissue metabolism to soothe stiff muscles and reduce painful muscle spasms. Heat dilates blood vessels to increase circulation. When the injured tissue experiences increased blood flow, it metabolizes the blood’s nutrients, relaxing the surrounding muscles and increasing their flexibility.

How to Apply Heat Therapy

Heat therapy can be applied using dry or moist methods. Dry heat includes heating pads, hot water bottles, heat wraps, heat patches, or saunas, while moist heat consists of warm baths, steamed towels, or moist heat packs. You can also apply heat locally, regionally, or fully.

Let’s go over the differences and when to use each.

• Local heat therapy is best for small areas of pain, like a stiff lower back, and is achieved using a heat patch. Since sciatica affects multiple areas, this probably isn’t the best option.
• Regional heat therapy typically consists of warm towels and heating pads and is best for widespread pain such as the lower back and behind your pelvis, making it a great option for sciatica pain.
• Full heat therapy is also ideal for sciatic nerve pain extending to the lower extremities. It can be practiced in a sauna or warm bath. However, sciatica may make it difficult to sit in the tub, but warm showers are just as effective.

If your sciatica causes extreme tension in your lower back, you can apply heat for 30 minutes to 2 hours, but if your sciatic pain is mild, stick to 15 to 20 minutes per session.

Benefits of Using Both Cold and Heat Therapy

With conservative treatment, sciatica typically resolves on its own. If severe sciatica pain persists, we suggest visiting your physical therapist who will more than likely supply you with stretches and low-impact exercises to maintain proper posture, build muscle strength, and increase flexibility. When used in tandem, cold and heat therapy can optimize this treatment.

Many medical professionals recommend using heat before a stretching routine or lightweight exercise during nerve, muscle, or joint injuries. This will loosen and prepare your muscles to strengthen as well as improve flexibility. After your workout, we recommend switching to cold therapy to treat any residual pain or swelling.

FAQ

Why does sciatica pain get worse at night?

An unhealthy sleeping position or unsupportive bed can exert excess pressure on your lower back, further compressing the nerve roots. To avoid this, try sleeping on your back with pillows beneath your knees. This position will prevent pain by properly distributing body weight and optimizing spinal alignment.

If you suffer from chronic sciatica, consider investing in a mattress for back pain. Some beds are specifically constructed to prevent and relieve such pain, offering purposeful support and options fit for your particular sleeping position and body type.

Is bed rest good for a pinched nerve?

If your pain is severe, one or two days of bed rest is fine, but prolonged rest may worsen sciatica. Muscle stiffness and weakness often accompany sciatic pain, and immobility will only intensify these symptoms. “Getting in some low-impact exercise as soon as you feel ready will loosen and strengthen the affected muscles and aid your recovery,” says Dr. Bhavik Sheth, Physical Therapist.

How long does sciatica last?

With proper treatment, most sciatica cases resolve within 4 to 8 weeks. However, some symptoms, such as tingling, may take slightly longer to subside. If your sciatica pain lasts longer than 8 weeks, it is considered chronic—it may require lifestyle changes or the attention of a specialist to appropriately manage recurring episodes.

Does exercise help nerve regeneration?

Lightweight exercises, such as walking and swimming, can desensitize nerves and help reduce pain, but they do not help nerves regenerate. “Nerves regenerate at a very slow pace, and there is no evidence to support that walking increases the rate that nerves regenerate,” says Dr. Sheth.

How do I prevent sciatica?

If you currently have a herniated disc or bone spur, consider taking measures to prevent sciatica pain. To do so, build your low back and abdominal muscles. These muscles support your spine and are crucial to healthy alignment. You can also practice good posture and avoid long periods of sitting or standing, as these activities place pressure on your lower back.

Conclusion

There seems to be constant debate surrounding whether heat or cold therapy is better for sciatica pain. When used correctly, both pain management solutions can be extraordinarily beneficial. The therapy you choose, as well as when you use it, will depend on your type of pain and progression of injury.

If your injury involves nerve pain, we suggest working with your doctor or physical therapist to create the most effective treatment plan possible. As frustrating as sciatic nerve pain can be, it typically resolves with simple-home remedies like heat and cold therapy, ensuring you will return to your everyday activities in no time.