Heat Wraps for Back Pain Melting the Pain Away or Firing Up the Problem?

A recent, multi-national study out of Europe is heating up the old debate about heat treatments for non-specific back pain.1 It’s an important question.

Each year, worldwide, low back pain causes 65 million years lived with disability.² What’s more, the problem appears to be on the rise.

For decades, professionals treating sports injuries have accepted that applying cold to injuries is better than applying heat. Some even argue that heat can be counterproductive. They hypothesize that heat for too long can be pro-inflammatory in a management phase where the goal is to reduce swelling.

On the other hand, in a clinical setting, it may not be entirely correct to think of or treat non-specific back pain as an injury like an ankle sprain. Contrary to how most ankle sprains occur, most flare-ups of back pain are not brought on by an acute insult that would be traumatic enough to tear the thick muscles of the back.

While the size and number of related studies have been small, the preponderance of scientific data actually supports the use of heat wraps for non-specific low back pain. This was the conclusion of Jürgen Freiwald of the Bergische University in Germany and his seven university colleagues from across Germany, Italy, and Portugal. In the current study, they provided a narrative review of the peer-reviewed studies. Based on the current evidence, they conclude that, in non-specific back pain, heat wraps provide pain relief, improve muscular strength, and increase flexibility. One of the studies they reviewed found that therapeutic exercise plus heat wraps worked better than either therapy alone.

The researchers offer a word of caution: “Before using heat therapy to treat [back pain], it is important to rule out any serious systemic disease.”

Some of the 11 studies they reviewed had endpoints at 1, 2, and 4 days, but others had endpoints at 1, 2, and 12 weeks. Criticisms of the shorter studies were that they could not rule out the pro-inflammatory argument. The theoretical increase in stiffness and soreness from pro-inflammatory treatment may only become evident in the following 24 to 48 hours. The longer studies may provide evidence against the pro-inflammatory hypothesis, but this conclusion is vulnerable to reversal by more robust studies.

Conclusion

Under the advice of a healthcare professional, the evidence supports the use of heat wraps as part of a treatment plan for non-specific back pain. Clinical judgement and experience of the physiotherapist should be considered in individualised treatment planning. When used, heat wraps would only be one part of an overall treatment plan that should include active, supervised exercise therapy delivered as promptly as possible.

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References

Freiwald J, Magni A, Fanlo-Mazas P, Paulino E, Sequeira de Medeiros L, Moretti B, Schleip R, Solarino G. A role for superficial heat therapy in the management of non-specific, mild-to-moderate low back pain in current clinical practice: A narrative review. Life. 2021 Aug 2;11(8):780.
Gianola S, Bargeri S, Del Castillo G, Corbetta D, Turolla A, Andreano A, Moja L, Castellini G. Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis. British Journal of Sports Medicine. 2022 Jan 1;56(1):41-50.