Low back pain can place terrible limitations on daily life and the presence of sciatica too can make this even worse. While there are many avenues for treatment, medication and rehabilitation an often overlooked tool is contrast therapy. This is a natural way of intervening directly with the source of your lower back pain or sciatica. Contrast therapy is incredibly simple and involves the alternation of cold therapy and heat therapy applied directly to the source of an injury, this is important in many cases of lower back pain and sciatica and something we’ll cover later on. In short, the use of contrast therapy has long been known for its effectiveness in recovery enhancement and pain management so today we’ll be taking a deep dive into the topic of contrast therapy and how it can help you if you’re struggling with lower back pain or sciatica.
What is contrast therapy?
Also known as hot and cold therapy, this is a simple method of alternating the use of cold compress with a hot compress as a mechanism through which we can intervene directly in the area of injured tissue. The technique is simple, yet effective, so much so that it is frequently overlooked. By exposing the body to hot temperatures immediately followed by cold temperatures, the contrast stimulates significant changes in blood flow helping reduce inflammation. When it comes to lower back injuries, particularly flare ups that so frequently occur, the presence of this excessive inflammation is something that is particularly amenable to contrast therapy.
The role of heat therapy:
This is rather simple, by applying heat to an area of the body you are able to manipulate natural reflexes within the circulatory system. Blood flow will naturally increase through a process called vasodilation. This can also help relax stiffness in muscles as they function more effectively at higher temperatures with greater blood flow – just think how stiff everything is if you go out for a walk or run in the cold weather, compared to walking on a beach in the summer heat – everything moves easier, because everything is more fluid.
Common sources of heat therapy include water bottles and microwavable bags, as well as heating pads. There are also “whole body” sources of heat therapy such as warm baths, sauna and infra-red saunas. The latter, sauna & infra-red sauna offers benefits far beyond injury recovery.
The role of cold therapy
Often termed cryotherapy, it involves reducing the blood flow to an area which has a role in significantly reducing the inflammation and swelling present in the region. This occurs through a process called vasoconstriction, whereby the blood vessels tighten in order to restrict blood flow to an area, another example of this process naturally occurring is during physical activity, where the body will restrict blood flow to the digestive tract so as to funnel more resources to the muscles, heart and lungs fuelling the exercise process.
Common sources of cold therapy include flexible ice packs and frozen peas, as well as cryotherapy chambers and cold plunge pools or ice baths. The last three being options to deliver whole body cryotherapy, again much like the examples of sauna and infrared sauna above, these are known to deliver a wide range of additional health benefits.
Contrast bathing and inflammation in your lower back
The use of contrast therapy in lower back pain or for sciatica is specifically relevant. This is because of the peculiar nature of lower back injuries and their geography. Unlike other regions of the body, the ankle and knee for example. The regions we injure in the lower back are located within a finite bony space, think of this like an elevator. Ankles and knees on the other hand are bounded by soft borders, at least in part, like a balloon.
When we pump excessive “people” into an elevator, the boundaries do not stretch, they are fixed, and very quickly people will complain. Contrast this with the balloon, if we continue to add more air or water into the balloon, it will stretch relatively easily. Granted, it will still reach a limit, but it generally has much more ability to handle fluctuations in the amount of material contained within its borders.
Inflammation is good as the process drives with it more nutrition and fuel for the target region to undergo the recovery process, an active repairing process with considerable cellular activity being undertaken. The removal of dead and damaged tissue and the repair of existing tissue.
In the lower back however, this process must be managed, as we have the finite space available. When too much inflammation is diverted to the region of the spine that is injured, pressure builds in the “elevator” and the nerves that are in these locations will let you know about it!
Most people who have an injury or reinjury to their lower back suffer with the consequences of excessive inflammation in this confined space creating a constant source of aggravation for their lower back pain. This is made worse in cases where we have stenosis of the spine as the available space is smaller than it otherwise should be, therefore the tolerance for excessive levels of inflammation is lesser. Such conditions include:
Although inflammation is a good process, considering this simple truth, those with lower back pain should be acutely aware of the benefits that something like contrast therapy can bring to managing their lower back inflammation.
Contrast therapy for sciatica
Sciatica is a tricky one as so many people who suffer from even severe cases of sciatica are unaware of the location of the source of this pain. Contrast therapy only works on the region to which it is applied, therefore if you apply this therapy to the leg, where the sicaitc pain is located you will render the benefits of contrast therapy useless.
If you’re struggling with sciatica, or even simple referral pain in the buttocks or hip region, know that the source of this pain will be coming from the lower lumbar spine where the roots of the sciatic nerve are being irritated. Even if you have no specific lower back pain to speak of right now, applying your contrast therapy to the lower back is important – otherwise it will not help you one bit!
Benefits of contrast therapy for low back pain
There are three main benefits that contrast therapy offers you if you’re struggling with back pain, with a fourth additional benefit which we’ll cover separately.
- Reduce inflammation: By alternating the hot and cold therapies you’re able to better manage the inflammation process in your lower back in a focussed manner.
- Improve circulation: The process of vasodilation and vasoconstriction helps create a pumping mechanism improving blood flow to and through the local region promoting a faster recovery.
- Pain relief: Many people who utilise this method of contrast therapy, report a reduction in their lower back pain following the practice.
The fourth benefit is more profound. Inflammation is a good process, one that will be occurring through the body in small degrees to facilitate the general process of your body’s maintenance of it’s health and wellbeing, and let’s face it as we age, we are frequently carrying old injuries or “tweaks” that are still not as strong or good as they should be. Being forced to take oral anti-inflammatory medications to manage a specific problem, inflammation in the lower back, means we are exposing our whole body to the effects of this medication (and the side effects that come with all medications). Put simply, utilising contrast therapy means we can avoid needing to rely on medications that can have undesirable secondary effects.
Implementing contrast therapy: step-by-step application
The great thing about contrast therapy is that it is easy and more or less free to do for everyone. All you need is a freezer and a microwave or kettle. We recommend for those with lower back the following routine:
- Apply heat to the lower back for 3-5 minutes
- Apply cold to the lower back for 3-5 minutes
- Repeat 3 times through.
This is a simple approach that will take you 20-30 minutes to complete. You could do this as many times throughout the day as you like. We recommend to members of Back In Shape that they do this after doing the towel decompression stretch, in the morning, middle of the day, and evening if possible. Having said this, if you’re in the midst of a flare up of your back pain or sciatica, more frequent application can be helpful. If you want to see exactly what to do then check out the recent video on a step-by-step guide to contrast therapy for back pain.
The downsides of contrast therapy:
There are always downsides with anything, and we’d be wrong if we didn’t cover the main flaw with contrast therapy. This is that it is inconvenient and can be messy. Having to alternate between the freezer and microwave or kettle to switch between hot and cold can be off putting for all but those in the most discomfort. Inconvenience means that most will not regularly utilise this great option and therefore if it’s not done, it can’t help.
The second downside could well be seen as a “user error” either having the ice too cold or the heat too hot could result in some discomfort or pain on the skin which, although easily avoided, could be an unwelcome error and certainly one worth pointing out.
When it comes to any tool, we know from experience that the fewer barriers to utilisation, the more likely adoption is to take place so consistent application continues.
Another way to deliver the benefits of contrast therapy: Recoverytherm cube
As with our approach to back pain for our patients, we’re always looking for a better way, a route where technology can deliver benefits more effectively and in a safer way. This is where the RecoveryTherm Cube by Therabody comes in. We recently reviewed this device and did a full video: RecoveryTherm Cube Review: Pro’s & Con’s For Back Pain Relief.
This device has two clear advantages in so much that it combats the two downsides above. Firstly, it has known temperatures, minimum and maximum, 8 degrees and 42 degrees celsius respectively, secondarily it is as easy as turning it on, strapping it on and forgetting it. This eliminates the difficulty, inconvenience and messiness associated with contrast therapy using ice packs and hot water bottles.
Whole body contrast therapy: Saunas and Ice Baths
Although not specific to the lower back, nowadays you’re hearing more and more on the benefits of contrast therapy from prominent academic and medical figures. Individual PhD’s and MD’s such as Dr Andrew Huberman, Dr Rhonda Patrick and Dr Peter Attia, have all spoken at length about the science behind the use of saunas, and ice baths at length on various podcasts and videos. Although it is a tangent, for those interested in such benefits of this mechanism of contrast bathing or sauna and ice baths individually, it is worth looking into.
Could contrast therapy help your back pain or sciatica?
Hopefully by this point you should have come to a resounding yes.
However, expectation is important. Remember that contrast therapy helps manage inflammation and pain, it is not magic. It does not eliminate the requirement for you to provide your body with the necessary resources to heal and regenerate by way of good nutrition.
It certainly does not eliminate the need for you to be mindful of how you conduct yourself and use your body on a daily basis, making modifications and adjustments for a more back health friendly way of living.
Finally, it definitely does not mean that you no longer need to devote a relatively small amount of time 3 to 5 times a week to resistance based exercises. This is the only way you will provide the necessary stimulation to your body to trigger adaptive changes, restore health and develop resilience in your lower back for the long term.