- Hi, I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And together we are the most
famous physical therapists on the internet.
- In our opinion, of course, Bob.
- Brad, what is the one most
the common questions that we get
all the time from patients?
- Do I use hot packs or cold packs on my injury?
- Exactly.
Should I use hot or cold?
And today we're just gonna give a brief discussion
of this of when you should use heat
and when you should use ice, ice, baby too cold.
All right.
Let's start off with heat, Brad.
What are conditions in which you might want to use heat?
- If you've got tight muscles
and you want to get them loosened up,
but they're not tender to the touch or red or sore.
- Sure. If you're preparing for an activity.
- Right.
- Obviously, with ice, you know,
if you have a sprain or a strain
and there's some swelling,
or there may be some slight bleeding into the tissue,
you're gonna not want to use heat in that instance,
cause the heat will actually make the bleeding worse.
So, after a sprain or strain,
I think most people know that, don't they?
Right after an ankle sprain,
you put ice on it.
- Right.
- The thing is though,
what they don't know is that after a back injury,
a back strain, especially, if it's a new one
that you put ice on it,
cause it's the same thing that's going on,
you're getting swelling.
- Right.
- And so, the general rule of thumb is
for the first 72 hours
or first three days,
you want to use ice on
what we call an acute injury,
an injury that just happened.
- Right.
- So, what's another instance
in which you might want to use heat though, Brad?
- Arthritis.
- Yeah.
Arthritis is a big one.
I think we see a lot of our patients.
- Yeah.
- They just don't like that ice, yeah.
- Yeah, typically that cold
on an arthritic joint is uncomfortable.
- It makes it more stiff too
- Right.
It makes people not happy with the therapist.
- Yeah.
And we don't like that.
And you want it for relaxation.
Heat is really good.
It also helps flush out chemicals.
- Sure.
You know, like what's that lactate?
- Yep.
You wanna get that out of there.
And so that heat can help the circulation.
- Yep.
I would say heat is better for chronic diseases too,
chronic issues.
- Sure.
- Things have been going on a long time.
- Right.
- The one instance in which
I think the 72 rule does not apply
is when you have had a knee replacement.
And after three days you still may be icing.
- Oh right.
- We see people that are icing weeks.
- Weeks.
You bet.
- Exactly.
In fact, you know, a lot of them are even hesitant
even when I'm a month later going,
"Oh, we should try some heat on it."
They're, "really? I I still want to stick with the ice."
But at that point, quite often the heat
can help the mobility.
And even if there is a little bit of swelling there yet.
I even like to use the heat sometimes.
- Right, right.
- So.
- That's one of those iffy areas.
But you know, by that time,
you pretty much know your ice.
You know what your knee's gonna take.
- Right.
- You've working with it for over a month.
- So, the other thing where I might use ice is
on a chronic reoccurring injury,
like shin splints.
- Sure.
- My son had a little bit of that
and it really felt good after he would run
and he'd slap those ice packs on him.
- Sure.
- And I think it really made it,
it stopped it from getting worse.
- Right, right.
- It seemed like it kept it under control.
- Right.
- So, generally again, if it's
just recently happened a current acute,
you know, that there's probably some swelling
and maybe even some bleeding
you're gonna use it with the ice.
- Right.
- To be honest with you,
ice is never really wrong.
Isn't that true, Brad?
- Correct.
You really cannot go wrong with a cold pack.
It may not help,
but it's not gonna hurt.
- Right.
- Where with a hot pack
if you've got something inflamed
and it's tender
and you put that hot pack on there,
it might feel good when you have it on there,
but after you take it off,
the swelling gets worse.
- Will get worse.
Exactly.
- And you know, I've heard people say,
"I put the hot pack on
and afterwards it hurt more."
Versus they put the cold pack on.
It's uncomfortable at first,
but after you take it off,
for the next few hours,
it feels better.
- It felt good.
I've seen in places where ice packs,
people like it on their back,
even though it's a chronic injury.
- Sure.
- They always use ice packs.
- Right.
- So, the other thing is you can do both.
- Sure.
- That's a treatment too,
where we do basically a ratio of four to one.
You'll put like,
let's say we do contrast baths.
And we have a video for that.
Where you put a sink full of very warm water
and a sink of very cold water.
And you put your hands in there
for four minutes in the warm water.
Then one minute in the cold.
Four minutes in the warm.
And what's that doing?
It's exercising the arteries.
- Right.
One vaso dilates
so, the heat gets things opened up
and the cold squeezes it.
So, you get more blood flow.
- That restriction.
- The fluid goes gets in and out.
And that's what you want to get things moving.
- It's a fountain.
- In there, right.
And you always end up with the cold.
- End up with the cold.
- Right.
- That's right.
- We've got some cold packs here, right here.
Here's about a nice size one for your back.
If you're gonna put one on your back.
we've got a nice small here,
great for the elbow.
Great for the knee.
- And these are the hot packs that we use.
It actually, uses a machine
that we put them in.
And that basically keeps them at 160 degrees.
- Right.
And they're soaked in water.
So, they're actually have some moist hot pack.
- Right.
- Probably not gonna have one of those at home,
because it costs a little bit of money for the machine.
It's typically in the clinic.
- Right.
- So, at home you can buy one of the hot packs
that you you know, you can put in the microwave.
You can buy those at the pharmacy store.
- Some people just take a moist towel.
- Yeah.
- That's what they do with the nursing home a lot.
Just heat up a towel and put it on there.
The heat doesn't stay there real long,
but it does enough.
- Right, right.
- To help heat it up a little bit.
- Yep, yeah.
- Get a little relief.
Just look at our videos for hot and cold packs,
which reminds me, Bob,
maybe we should make,
I just got another idea for a video,
but I'm not gonna tell them, okay?
- All right.
You're gonna have to stay tuned to find out.
Take care of everybody.
- Now, I don't know, Bob,
this is about the right size.
We're talking about that broken heart theory.
- Oh, yeah.
- You can lay that right there
and just lay like that for a while.
- There we go.
- You got that broken heart.
It might help.
- A heart. All right, thanks.