Is ICE or HEAT better for my severe back pain?

Great Question!

The answer to this question depends on the stage of healing that your body is going through. In the acute stage of healing, when inflammation is setting in (usually at the time of onset to 72 hours), it is best to use ice on the injured site due to the inflammation. The ice will help to reduce the inflammation and also aids in masking the pain from the injured site.  If your pain is constantly being exacerbated or irritated by certain movements or activities, this resets that 72 hour time frame and ice should be reapplied during this time.  Ice treatment may be applied for 20 minutes at a time with one hour between applications.  Always make sure to have a cloth between the ice pack and your skin.

Most of the patients that initially seek treatment in my office tell me that they have been using heat to reduce the pain and inflammation. This actually acts against the idea of reducing inflammation. The heat will bring more blood and body fluids to the site causing the inflammation to become worse. You have to be careful at this stage of healing because if the inflammation gets really bad there is a possibility of additional damage to the area. The cryotherapy (ice therapy) will help to reduce the inflammation.  As our providers often say “When in doubt, use ice!”

The next part of the question is about heat. While heat seems to “feel good” at first, it is best to leave the heat until after the inflammatory stage of healing. After the inflammation has subsided the heat will aid in healing since it attracts blood and healing enzymes to the injured site.  Many patients inappropriately apply heat, only to notice that their symptoms worsen or do not improve.  Because they typically wouldn’t notice a worsening of their symptoms for hours or even a day or two after applying heat, patients may not relate the worsening of their symptoms to the heat.  If you have been applying heat and your symptoms have not been improving, try switching to ice.

I hope I was able to help answer your question and I look forward to answering more questions in our next blog post.

Magic’s Dwight Howard has been diagnosed with a herniated disc

This past week it was announced that Magic’s Dwight Howard had been diagnosed with a herniated disc in his lower back. In the last few games he has played, you could tell he was in pain. Dwight Howard was trying to play through the pain and hoping it would go away. As with most serious disc conditions, a herniated disc does not just heal without some sort of limited activities.

I created a method called the NDS Method, which helps people with bulging discs, herniated discs, and degenerative disc disease. I created this method out of necessity for helping people avoid back surgery. Over 72% of people who go in for back surgery must go in for another surgery. I don’t want that to happen to you and I know you don’t want that to happen to you either.

I have sent Dwight Howard an email and also sent him an express letter explaining the NDS Method procedure in detail. I look forward to hearing back from him and being able to help him recover quickly.

For more details on the exclusive NDS Method, visit

The most common causes of sciatica (pain down the legs)

When discussing sciatica it is important to understand the underlying medical cause of the sciatica-143x300 sciatica symptoms in order to find effective treatment.
6 Most Common Causes of Sciatica

There are 6 lower back problems that are the most common causes of sciatica:

Lumbar herniated disc
A herniated disc occurs when the soft inner core of the disc (nucleus pulposus) leaks out, or herniates, through the fibrous outer core (annulus) and irritates the contiguous nerve root. A herniated disc is sometimes referred to as a slipped disc, ruptured disc, bulging disc, protruding disc, or a pinched nerve, and sciatica is the most common symptom of a lumbar herniated disc.

Degenerative disc disease
While disc degeneration is a natural process that occurs with aging, for some people one or more degenerated discs in the lower back can also irritate a nerve root and cause sciatica. Degenerative disc disease is diagnosed when a weakened disc results in excessive micro-motion at that spinal level, and inflammatory proteins from inside the disc become exposed and irritate the area (including the nerve roots).

Isthmic spondylolisthesis
This condition occurs when a small stress fracture allows one vertebral body to slip forward on another (e.g. the L5 vertebra slips over the S1 vertebra). With a combination of disc space collapse, the fracture, and the vertebral body slipping forward, the nerve can get pinched and cause sciatica.

Lumbar spinal stenosis
This condition commonly causes sciatica due to a narrowing of the spinal canal. Lumbar spinal stenosis is related to natural aging in the spine and is relatively common in adults over age 60. The condition typically results from a combination of one or more of the following: enlarged facet joints, overgrowth of soft tissue, and a bulging disc placing pressure on the nerve roots, causing sciatica pain.

Piriformis syndrome
The sciatic nerve can get irritated as it runs under the piriformis muscle in the buttock. If the piriformis muscle irritates or pinches a nerve root that comprises the sciatic nerve, it can cause sciatica-type pain. This is not a true radiculopathy (the clinical definition of sciatica), but the leg pain can feel the same as sciatica caused by a nerve irritation.

Sacroiliac joint dysfunction
Irritation of the sacroiliac joint – located at the bottom of the spine – can also irritate the L5 nerve, which lies on top of the sacroiliac joint, causing sciatica-type pain. The leg pain can feel the same as sciatica caused by a nerve irritation.

More Causes of Sciatica

In addition to the most common causes, a number of other conditions can cause sciatica, including:

  • Pregnancy. The changes that the body goes through during pregnancy, including weight gain, a shift on one’s center of gravity, and hormonal changes, can cause sciatica during pregnancy.
  • Scar tissue. If scar tissue compresses the nerve root, it can cause sciatica.
  • Muscle strain. In some cases, inflammation related to a muscle strain can put pressure on a nerve root and cause sciatica.
  • Spinal tumor. In rare cases, a spinal tumor can impinge on a nerve root in the lower back and cause sciatica symptoms.
  • Infection. While rare, an infection that occurs in the low back can affect the nerve root and cause sciatica.

It is important to know the underlying clinical diagnosis of the cause of sciatica, as treatments will often differ depending on the cause. For example, specific sciatica exercises, which are almost always a part of a treatment program, will be different depending on the underlying cause of the symptoms.

Article written by: Stephen H. Hochschuler, MD