Heat Vs. Cold (Ice) Pack? Avoid This Common Mistake. Infrared Heat?

hi folks I'm Bob Shrum physical

therapist Brad hi NIC physical therapy

almost famous physical therapist on the

internet in our opinion of course Bob

this is a question we get quite often

Brad yeah I'm kind of surprised you know

after all this time that there's still a

lot of questions about whether 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 there some cases where it's not

going to matter and we're gonna go talk

about those two but I have some cases

where it really does matter sure so yeah

yeah like I said this is a little

controversial from therapist to

therapist doctor to doctor chiropractor

etc so we're gonna set you straight a

little sidebar we've always got

controversy Brandi yeah okay that's

before we get any further let's talk

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so all right Brad let's talk about maybe

what we want to start with like an acute

injury right what works as a heart and

pretty much everyone agrees on this say

for example you strain your you slide in

the first-base you sprained your ankle

really bad it's puffing up there's I

don't think there's anybody that's gonna

say put a hot pack on it right there's

on acute injury is a recent injury right

so 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 zero to

48 hours from the time that 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 read what people may not understand

like let's say you just injured your

back sure there's swelling going on in

that back - you may not see it right so

with with a recent back injury I would

do the same

exactly you know if you just hurt your

back I would go it for the next 24 to 48

hours and I would be using cold sure and

then after that you can decide right but

but so I don't hip injury you know any

any type of injury shoulder injury it's

a recent injury start with the cold yeah

any part of the body the one thing if we

take a sidestep into backs I think the

thing about back injuries is people

oftentimes continually re injure their

back 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 that I

probably use cold packs more than Heat

yeah but not always so it's 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 always always taught that

right I haven't read up on that recently

so maybe you don't want to quote me on

that but all right so 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 frost you

just came out of the freezer here I've

this I've injured my elbow I'm not gonna

put those 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 and

leave it there for 20 seconds you pull

it off and you got frostbite on your

skin I think also if you're it's just

like we heat and cold if you're on a

boney surface there's less protective

adipose and skin right layers so it's

gonna freeze easier exactly so in that

case I usually just take the pillowcase

because it works really well you know

you got oh that's a good idea

you got a bucket to throw it into it is

I'm gonna fall through sometimes we just

take a paper towel and put it down 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 same with heat heat can you can burn

yourself with heat you know I've had

patients that put a hot electric hot

back on their back

and fell asleep what I hate to say how

many times I mean we've even had a boy

you know well we've you're normally in

the clinic study we check it after five

minutes we had one guy we checked it

after five minutes it was fine and I've

kept ask him is it fine it's fine

and he took it off and it was it was a

slight burn yeah and he apologized goes

you kept asking me and I said it was

fine so be careful you have to be

careful with it it's really easy to burn

right these are things that there's no

question on and then probably the time

there's a little variability on this but

typically fifteen to twenty minutes

whether you got a cold pack or a hot

pack is gonna do the job that if you

want to show a cold pack bread why don't

we show me one way to use it for the

back and sure for an ankle a lot of

times what we want to do is if you if

possible if there's an injury you do

like to get it elevated to because the

elevation is going to help with the any

edema or swelling that's developed we're

a big fan of this leg wedge yep

it's this is good for actually would be

good for an ankle injury and for a back

injury right what with a 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 line you want to throw a pillow

over there just just give it a toss be

careful though don't hit Bob in the head

yeah that's good thank you

put on arm there Lonnie good arm so

we're gonna demonstrate I'm gonna put

this cold pack on my low back Bob's

gonna demonstrate ankle how to take care

of an ankle sprain so we're getting to

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 and wrap around

and put it in place and this is really

feels good doesn't it Brett oh yeah I'm

in heaven right now I got a cold pack on

my back Mike my ankles 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 after

your foot is a problem so you know what

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 oh I don't

understand it because some homes they

literally cannot sleep in in in bed no I

mean they just can't it would keep some

weight but they can sleep in a recliner

yeah so all right when we take this off

Brad yeah I suppose they cannot forget

work to do people are still waiting for

their other nice hints and tricks that

we've learned over the last thirty years

now another form of well I guess we

never even get 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've got a

video just last week we put up that that

shows and we demonstrate that very

clearly how to do that what about with

heat what about a brand same thing do

you elevate you don't have to Ella no

you don't have to elevate with you you

can go any comfortable position you

should be relaxed position where you can


the thing with heat is it basil dilates

increases circulation helps relax the

muscle which you know again makes it

feel good so I have found with heat

obviously and this anybody who has

arthritis is gonna understand us if you

have arthritis and you're having pain

generally heats gonna feel better yeah I

mean a lot of them 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 a cold she really

yeah so there's exception every rule but

if I were to you know be a Betty man I

mean most times Arthur I just think

you're in the trial would agree for hot

packs therapists typically use a wet hot

pack yeah a moist on waste heat you can

get a little more that heat conducting

to the skin they just work better they

feel better you just gonna be careful

because they don't feel warm at first

right two or three minutes and they can

heat up and then you gotta 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 hydroxylate ER what we use

at home if you use an electric one

that's where you gotta 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 I mean the

compression right stop the blood from

being distributed okay ray because

you'll burn faster so I'm trying to say

if you look if you're if you're leaning

on a hot pack as opposed to having a hot

pack on you that's it's it's gonna cause

right put the hot pack on recline or

newly lean on it versus laying on your

stomach and put that right on your back

it's gonna it's gonna get hot or quicker

right so right so you know there's

usually settings on most electric hot

packs or that you know the pads and if

you put it on high because he wanted to

heat up quick and then you fall asleep

and a hat gets too hot and then again we

talked about the skin burning situation

right and I was taught by the way in

Brandon 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 they're all the same in

what regards in a pennant Depot how they

race through the skin which they don't

do not penetrate very deeply right only

a couple millimeters

versus which we're going to talk about a

different option here the radiant heat

right are the far infrared ray great so

I should we get right yeah while we get

this here we've got the normal hot pack

and again heat lamps

you can use a heat you can use heat lamp

it's not used in therapy like they used

to be thirty years ago a popular back

then yeah so this is far infrared and

the advantage of this is that it

penetrates much deeper so where you

normally have four or five millimeters

this can go up to sixty millimeter which

is we think is two point three six

inches it's over two inches witches are

much deeper you know minute at least

five times deeper than the other imagine

this versus this right it just means

getting into the muscle fiber or into

the joint this is made by thermo Tex

will put a length of law and it is

electric so we talked about electric be

careful electric but this is different

because there's no it's only one setting

right and I and they say you can be on

it for 45 minutes so naturally I didn't

believe him so I tried it and I actually

did fall asleep with it and I woke up

later in the evening about eleven you


a couple I don't recommend it but but

you can the point is is that it didn't

say it was just a comfortable warm right

it does not get that warm but it does

penetrate one of the representatives

from the company act she talked about

how she during the winter she lives up I

mean they're from Calgary and she puts

it on just as a heating device in her

office so she she puts it in a chair so

she can lean against it's got three hard

panels this is the Platinum one and the

hard panel always goes to the body

that's how it helps direct the far

infrared waves are 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 with a little bit

with this Brad yeah you could get an

extension cord you go dancing yeah but

it's got a long cord it's got an 8 foot

cord really good cord so what's really

nice about this so alright this is a

really good option for if you really

want to get some deep penetrating Heap

right you know unfortunately there's no

options like that before right go Elena

snowbank but we don't recommend that

what what are another reason where we

might use cold it seems like Brad that

it does reduce nerve conduction right

right and it relaxes the nerve and

actually you can get a muscle to relax

with cold there's been studies done on

this and actually went to a in-service

by a gentleman who led one of these

studies although it's not really widely

widely spread done he did it with a lot

of MS patients oh sure they tight

muscles and they 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 muscles yeah is

what you're saying right this actually

may calm things down exactly so and I've

seen that where you know again a lot of

times muscle spasm right after back pain

sure and that's why a lot of times like

the cold tool so now we've got them

thoroughly confused on right but again

going back we talked about the first 48

hours of 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 contrast wrap


which we do have a video I mean we

should probably do that one too you know

just a general rule of thumb generally

you kind of go five minutes in the hot

one minute Nicole five minutes to the

hot one minute Nicole typically the last

one would be the cold right so all right

I'm getting all confused all right

thanks everybody for sticking with us