Heat therapy

Heat therapy means warming a sore area from the outside. Clinicians call it superficial heat because it mainly warms the skin and the tissue just below.

Common options include an electric heating pad, a hot water bottle, a microwavable heat pack, a warm bath or shower, and stick-on heat wraps that warm up on their own once opened.

People use heat on the low back, the upper back and the neck. You can use it at home, and a physical therapist may also use it during a visit.

Warmth relaxes tight muscles and can ease muscle spasm.

Heat also widens blood vessels, which brings more blood flow to the area. It makes muscles and other soft tissues a little more flexible.

The soothing feeling of warmth may also quiet pain signals, though researchers do not fully understand how.

Heat does not heal the back or neck or change what is causing the pain. The hope is to ease pain and stiffness enough to make moving and stretching more comfortable.

Getting set up

Aim for gentle warmth that feels comfortable, never painful. With a heating pad, many clinicians suggest the low or medium setting.

Put a towel or a thin layer of clothing between your skin and a heating pad, hot pack or hot water bottle.

Many clinicians suggest about 15 to 20 minutes at a time with a heating pad or hot pack, with breaks in between. Stick-on heat wraps give lower, steady warmth over a longer time. Follow the package directions for how long to wear one and whether it can touch bare skin.

How it feels

Most people find gentle heat soothing.

Some people like heat before gentle stretching or exercise, because it can make moving feel easier.

Lift the pad and check your skin every so often. Stop if the skin looks bright red, blotchy or blistered, or if it starts to hurt.

A US guideline from the American College of Physicians lists superficial heat as one of the first treatments to try for low back pain of less than about three months. It rated the evidence for heat as moderate quality. [1]

In studies, heat wraps eased pain and disability a little over the first few days, compared with a placebo pill. A Cochrane review called this benefit small and short term. [2]

One study found that adding simple exercises to a heat wrap reduced pain more than the heat wrap alone. [2]

Most of this research is in recent back pain. Much less is known about heat for back pain that has lasted longer than three months. [2]

In one emergency room study of 60 adults with a recent neck or back strain, a heating pad and a cold pack gave similar, mild relief. Everyone also took ibuprofen (Advil, Motrin), so it is hard to tell how much the pad itself added. [5]

For neck pain, the evidence is thin. A 2026 review found only two small, low-quality studies of heat wraps for neck pain. Both reported less pain, but the evidence was too weak to say whether heat helps. A Canadian neck pain guideline advises clinicians not to offer heat treatments in the clinic, because studies did not show a benefit. [6] [7] [8]

Heat is cheap, easy to try at home, and low risk when used with care.

Common and mild

• Pink or red skin that fades after the heat comes off.
• Feeling too warm or sweaty, especially under a wrap worn for a long time.

Burns

• Heating pads and hot packs can burn the skin, sometimes badly enough to need hospital care. Many of these burns happen at home.
• The risk is higher with a high setting, long sessions, lying on top of the heat source, or falling asleep with it on. Never fall asleep on or under a heating pad that is turned on.
• Never use heat on top of a muscle rub or a pain-relief cream or ointment. Serious burns have been reported when these products are combined with a heat source.
• Do not put heat over a medicine patch, such as a prescription pain patch. Heat can make the body take in the medicine much faster.

Toasted skin

• Heat used often on the same spot for months can cause toasted skin syndrome (erythema ab igne): a lacy, net-like pattern of reddish brown marks. It usually does not hurt and often fades once the heat use stops, though not always.
• Very rarely, skin cancers have been reported in long-standing patches of toasted skin.

Who needs extra care

Tell your clinician before using heat if you have diabetes, nerve damage or numbness, poor circulation, multiple sclerosis, or a spinal cord injury. Reduced feeling makes it harder to notice a burn starting.

Anyone who cannot feel heat well or check their skin needs extra care too, such as older adults, people who have just had a numbing injection, or anyone who has taken a medicine that causes drowsiness.

Skip heat on a fresh injury that is swollen, since warmth can increase swelling.

Other downsides

Relief from heat is short-lived. It is usually one part of a plan that includes staying active, not a treatment on its own.

When to get help

Stop and call your care team if you notice a blister or skin that stays red or painful long after the heat is off. Get same-day care for a burn that looks deep, white or leathery.

See the warning signs.