Ice or heat for lower back pain? What does the research say?

Cool it down with Ice or turn up the heat?

One of the most common approaches for clinicians and the public alike, to find pain relief for lower back pain, is to apply heat or cold therapeutics. These take the form of heat packs, hot water bottles, wheat bags as well as ice packs, ice gel packs etc. It’s one of those topics that everyone has an opinion on what works for them (and what will work for you).
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But what does the research have to say on this topic?

Unfortunately there is no high quality research on this subject. There is moderate level evidence to support the use of heat packs for short term symptom relief, and only low levels of evidence that shows minimal benefit from cold therapies for the treatment of lower back pain in acute (< 6 weeks ) and sub-acute patients. There appears to be a benefit of adding exercise to this approach which has ever increasing levels of support in the research.
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So what can we take away here?

Both heat and cold therapies are commonly used low risk interventions for lower back pain. Heat has moderate evidence demonstrating some benefit in pain reduction and this enhanced with adding exercises.

French, S. D., et al. (2006). "Superficial heat or cold for low back pain." Cochrane Database of Systematic Reviews(1).