♪ Bob and Brad, ♪
♪ the two most famous physical therapists on the internet. ♪
- Hi folks. I'm Bob Schrupp, physical therapist.
- Brad Heineck, physical therapist.
- And we are the most famous physical therapists
on the internet.
- In our opinion, of course, Bob.
- This is a question we get quite often Brad.
Yeah. I'm kind of surprised, after all this time
that there's still a lot of questions about
when you should use a cold pack versus a hot pack.
And it's really important to know this.
- It is because it can make a difference between
having your injury get worse or get better quick,
one way or another.
- There's some cases where it's not going to matter.
and we're going to go talk about those too,
but there's some cases where it really does matter.
- Sure. - So.
- Yeah. Like I said, this is a little controversial
from therapist to therapist, doctor to doctor,
chiropractor, et cetera. So we're going to set you straight.
- Little sidebar.
We've always got controversy Brad.
Okay. Let's, before we get any further,
let's talk about the people
that just came in to watch us here.
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- Yeah. He is running back and forth.
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All right, Brad, let's talk about, maybe...
What, do we want to start with like an acute injury?
- Right. What works as a hard...
Well, pretty much everyone agrees on this.
Say for example, you strain,
you slide into first base,
you sprain your ankle really bad. It's puffing up.
I don't think there's anybody that's going to say
put a hot pack on it.
- Right.
So an acute injury is a recent injury.
- Right. Put a cold pack on it, elevate it, compress it
get it up in the air, get that swelling under control.
And typically the rule of thumb is 0 to 48 hours.
From the time it happens, at least a couple of days
before you would change from cold to hot.
I personally go a little longer than that.
- Sure.
- But again, it's, it depends on the individual.
And this is the way, me speaking to my patients.
Or circumstance.
- Well, I think also Brad, what people may not
understand is like, let's say you just injured your back.
- Sure.
- There's swelling going on in that back too.
You may not see it.
- Right.
- So with a recent back injury I would do the same thing.
- Exactly.
- You know, if you just hurt your back
I would go for the next 24 to 48 hours,
I would be using cold.
- Sure.
- And then after that, you can decide.
- Right.
- But, so, on a hip injury, you know, any type of injury.
Shoulder injury.
If it's a recent injury start with the cold.
- Yeah. Any part of the body.
The one thing I, if we take a side step into backs,
I think the thing about back injuries is
people oftentimes continually re-injure their back
day after day after day just by sitting poorly.
So there's always a certain amount of swelling
and irritation to the back. So, with backs in particular,
I'd probably use cold packs more than heat.
- Yeah.
- But not always.
- So it's almost as a constant new injury.
- Right, I mean...
- So that's why the cold may feel better.
I think cold does penetrate deeper too. Doesn't it?
I was always taught that.
- Right.
- And I haven't read up on that recently,
so maybe you don't want to quote me on that.
- Right.
Exactly.
As far as things that you have to be careful about.
With cold,
if you got a cold pack, look at this cold pack right here.
It's frosty. Just came out the freezer.
Here, let's say I've injured my elbow.
I'm not going to put this cold pack directly on my skin.
This freezer could have been at 15 degrees.
You pull something out at 15 degrees,
put it directly on your skin, leave it there for 20 seconds.
You pull it off and you got frostbite on your skin.
- I think also if you're,
it is just like with heat and cold,
if you're on a bony surface
there's less protective adipose and skin.
- Right, right.
- And layers. So it's going to freeze easier.
- Exactly. So, in that case,
I usually just take a pillow case.
Because it works really well.
You know, you got to...
- Oh, that's a good idea.
- You got a bucket to throw it into,
and it's not going to fall through.
- Because sometimes we just take a paper towel
and put it down or something like that.
- Yeah, you need something to insulate it. Not a lot.
You know, if you put two or three towels it's too much,
but you need something.
And the same with heat.
Heat can, you can burn yourself with heat.
You know, I've had patients that put a hot
electric hot pack on their back
and then fell asleep with it.
- I hate to say how many times.
I mean, we've even had a, well, you know,
well we've normally in the clinic setting
we check it after five minutes.
We had one guy, we checked it after five minutes,
it was fine. And we kept asking him, is it fine?
Yeah, it's fine.
And then he took it off and it was a slight burn.
- Yeah.
- And he apologized, he goes,
you kept asking me and I said it was fine. So...
- Be careful with it.
- You have to be careful with it.
It's really easy to burn.
- I mean, these are the things that there's no question on.
And then probably the time.
There's a little variability on this,
but typically 15 to 20 minutes,
whether you got a cold pack or a hot pack
is going to do the job that it's going to do.
- You want to show a cold pack Brad?
Why don't we show maybe one way to use it for the back
and maybe for an ankle?
A lot of times what you ought to do is,
if possible, if there's an injury,
you do like to get it elevated too
because the elevation is going to help with
any edema or swelling that's developed.
We're a big fan of this leg wedge.
- Yep.
- This is good for,
actually it would be good for an ankle injury
and for a back injury.
- Right.
With the back, this doesn't elevate the back,
but it does really put it in a relaxed position.
So this is one of those situations where it doesn't elevate,
but it really does a nice job.
Lonnie, you want to throw a pillow there?
Just give it a toss. Be careful though.
Don't hit Bob in the head.
Yeah, that's good.
Thank you.
- Good arm there Lonnie. Good arm.
- So, we're going to demonstrate
I'm going to put this cold pack on my low back.
Bob's going to demonstrate
how to take care of an ankle sprain.
So we're getting two parts of the body at one time.
Again, he's elevated here. I can put the cold pack.
A lot of times people,
they sprain their ankle on the outside of the ankle.
So we can put the cold pack right there.
And then you can just take an ACE wrap
and you can go ahead and wrap around and put it in place.
And this is really feels good. Doesn't it Brad?
- Oh yeah. I'm in heaven right now.
I got a cold pack on my back. My ankle's getting chilled.
Just remember not to go too tight with the compression.
- Right. It doesn't need to be tight for this. I mean...
- A little snug is all, but if you get it too tight
you could actually cut the circulation off to your foot.
It can cause a problem.
- So, you know, and this reminds me, Brad.
A lot of times, right? People, after they hurt their back,
have you seen it where they feel like
they can't sleep in bed at night
and so they sleep in a recliner?
- Sure.
- And I always felt like some of the reason behind that
is they're trying to almost elevate the back a little bit.
You know what I mean?
- Yep. They could be.
- I don't understand it
because some of them they literally cannot sleep in bed.
I mean they just can't, it keeps them awake,
but they can sleep in a recliner.
- Yeah.
- All right. You want me to take this off Brad?
- Yeah, I suppose. Take it off, we've got work to do.
People are still waiting for our other nice hints
and tricks that we've learned over the last 30 years.
- Now, another form of, well
I guess we never gave one of those.
Sometimes for ice you can just take a styrofoam cup,
freeze the water in the cup, tear off the top of it.
And then you can quickly ice something down.
- Yeah. We got a video just last week we put up.
- Yeah.
That shows, that we demonstrate that very clearly.
How to do that.
What about with heat?
- What about it Brad?
- Same thing. Do you elevate?
You don't have to elevate with heat.
- No, you don't have to elevate with heat.
- Heat. You can go in any comfortable position.
You should be in a relaxed position where you can relax.
The thing with heat is it vasodilates,
increases circulation, helps relax the muscle,
which, you know, again makes it feel good.
- What I have found with heat, obviously, and just
anybody who has arthritis is going to understand this.
If you have arthritis and you're having pain,
generally heat's going to feel better.
I mean a lot of them - Right.
- just don't like the cold.
- Although, I do have a patient right now,
she's got severe arthritis in her knees
and she loves the cold.
- Does she really?
- Yeah. So, I guess.
- There's exception to every rule,
but if I were to be a betting man,
most clients with arthritis that are going to try it.
- I would agree.
For hot packs, therapists typically use a wet hot pack.
- Yeah. A moist hot pack.
- Moist heat. You can get a little more
of that heat conducting to the skin.
They just work better, they feel better.
You just got to be careful
because they don't feel warm at first.
- Right.
- About two or three minutes in, they can heat up
and then you got to use towels
and you may use four or five layers of towels
to insulate it. We keep our hot packs at 160 degrees.
That's pretty typical for a hydrocollator, what we use.
At home, if you use an electric one,
that's where... - Where you got to be safe.
- You need to be careful.
- The more you lean on a hot pack, the less the heat is,
you know, spread out through the body.
I mean, it stops it,
you know what I mean?
Compression - Right.
- will stop the blood from being distributed as well.
- Right, because...
- So you'll burn faster is what I'm trying to say.
If you're leaning on a hot pack
as opposed to having a hot pack on you,
it's going to cause...
- Right. So if you put the hot pack on a recliner and you...
- Lean on it.
- Versus laying on your stomach
and putting the hot pack on your back.
- It's going to get hotter quicker.
- Right.
So, you know, there's usually settings
on most electric hot packs or, you know, the pads.
And if you put it on high because you wanted it to heat
up quick and then you fall asleep and that hot gets too hot.
And then again, we talked about the skin burning situation.
- Right. And what I was taught, by the way Brad, in school,
and this was a hundred years ago, but
one is that moist heat versus radiant heat, which is a lamp.
- Right.
- Versus just regular heat, like from a heating pad.
- Yep.
- They're all the same.
- In what regards?
- In how pen...
Deep they penetrate. - How deep it goes
through the skin.
- Which they don't. They do not penetrate very deeply.
It's only a couple millimeters.
Versus, which we're going to talk about
a different option here, the radiant heat.
- Right.
- Or the far infrared heat.
- Infrared. Right, right.
So, should we get right into that?
- Yeah. Why don't get into that?
- Because here we've got the normal hot pack.
And again, heat lamps, you can use a heat lamp.
- Yeah. You can use heat lamps.
- It's not used in therapy like they used to be
20, 30 years ago.
- They were real popular back then.
- Yep.
- So this is far infrared
and the advantage of this is that it penetrates much deeper.
So where you normally have four, five millimeters
this can go up to 60 millimeters, which is
we think is 2.36 inches.
- It's over two inches which is a much deeper, you know,
many, at least five times deeper than the other.
- Oh yeah. Imagine this versus this.
- Right. - I mean, it just makes it...
- You're getting into the muscle for sure.
Or into the joint.
- This is made by Thermotex, we'll put a link below.
- And it is electric.
So, we talked about electric, be careful with electric
but this is different because there's,
it's only one setting.
- Right.
- And they say you can be on it for 45 minutes.
So, and actually I didn't believe them, so I tried it.
And I actually did fall asleep with it.
And I woke up later in the evening about 11,
you know, it had been a couple hours.
- They don't recommend it, but you can. It does, it happens.
- The point is, is that it didn't.
- It's safe.
- It was just a comfortable warmth.
- Right.
- It does not get that warm, but it does penetrate.
- One of the representatives from the company
actually talked about how she, during the winter,
she lives up, from Calgary.
- Yeah.
- And she puts it on just as a heating device in her office.
So she puts it in her chair so she can lean against.
- Right.
- Its got three hard panels.
This is a platinum one.
And the hard panel always goes to the body.
That's how it helps direct the far infrared
waves or rays or whatever they are.
And you can actually strap this in place.
It's got a long strap and a short strap.
And what you can do is
you can actually move around a little bit with this brand.
- Yeah. You can get an extension cord,
you go dancing with it.
(Bob and Brad laughing)
- But it's got a long cord.
It's got an eight foot cord.
Really good cord.
So what's really nice about this. So...
- Right.
- This is a really good option for
if you really want to get some deep penetrating heat.
- Right.
You know, unfortunately there's no options like that for
go laying in a snow bank, but we don't recommend that.
- What are another reason where we might use cold?
It seems like, Brad, that it,
it does reduce nerve conduction.
- Right, right.
And which relaxes a nerve.
And actually you can get a muscle to relax with cold.
- Right.
- And there's been studies done on this.
And I actually went to a in-service
by a gentleman who led one of these studies.
Although, it's not really widely spread done.
He did it with a lot of MS patients.
- Oh sure. - Really tight muscles.
And he put cold pack versus heat.
So once again, you got this flip-flop.
- So we're even talking about
if you have muscles that are spasming.
- Right.
- Or if you have spastic muscles,
is what you're saying.
- Right.
- This actually may calm things down.
- Exactly.
- And I've seen that where, you know, again
a lot of times muscles spasm right after back pain.
- Sure.
- And that's why a lot of times they like the cold too.
- So now we've got them thoroughly confused on.
- Right.
- But again, going back to when we talked about
the first 48 hours of an injury,
that's when things are pretty black and white.
- Right.
- After that.
- You can also mix them up, by the way.
You can do heat and then cold.
- A contrast bath.
- Yeah, a contrast bath.
- Which we do have a video on that.
- We should probably redo that one too.
- Yeah.
- Just a general rule thumb.
Generally, you kind of go five minutes in the hot,
one minute in the cold,
five minutes in the hot, one minute in the cold.
- And typically, the last one would be the cold.
- Right.
So,
all right.
- Wow, Bob, I'm getting all confused.
- All right.
Thanks everybody for sticking with us.