Oh My Sciatica! - By Brett Qualls, PT, DPT, OCS In my clinical practice, I…
-By: Brett Qualls, PT, DPT, OCS
“Do I use a hot or a cold pack?” That is a question that I get several times every day. The simple answer is: It depends! This should come as no real surprise, as there is very rarely one simple answer to all of life’s questions. There are certain situations that a hot pack is my first choice, but then there are others where I prefer a cold pack. While both heat and ice play an important role, by nature they have very different effects on the body. When we discuss use of hot or cold therapies, we lump this into a treatment category that we call thermotherapy.
Most people have a preconceived idea of what they want to use to ease their aches or pains. To be honest, most of the time people stick with whatever their mom or grandma had them do as a kid. Almost everyone goes for the hot pack. Many people will shy away from using a cold pack, until they see some of the inherent values of using ice. Below are a few very basic concepts when it comes to thermotherapy and how it is used in the rehabilitation world.
Applying heat helps muscles to relax, eases tension, improves flexibility, and helps to increase circulation. By applying a hot pack to a tight/tense muscle, you can help to ease tension and improve comfort in this area. While heat can play a role in decreasing tension, it can also cause a body part that is swollen to become more swollen by increasing circulation to the area.
Conditions that respond well to hot packs include: neck tension, chronic muscle injuries (48 hours after initial injury), muscle spasm, and joint stiffness.
Application of a cold pack helps to decrease inflammation, slow metabolism, decrease skin temperatures, and to ease achy-type pains. When treating a new or “acute” injury, ice will help to decrease the metabolism in the area which helps to decrease the extent of tissue damage. We also see ice help to slow the transmission of the nerve signals that carry the painful stimulus. With an old pain or “chronic” condition, ice helps to decrease inflammation and to ease pains.
Conditions that respond to cold packs include: arthritis, tendonitis, bursitis, new or “acute” injuries, and following most surgeries.
How to Use Thermotherapy
General best practice guidelines are to use either hot or cold packs for 10 to 20 minutes. Many people find benefit with alternating heat and cold therapies. I usually suggest starting with a hot pack and ending with a cold pack. By ending with the cold pack, you can minimize any increase in swelling that may have occurred as a side effect of using the heat. You want to take necessary precautions to not burn your skin with the hot or the cold pack. That’s right folks, you can certainly give yourself a cold burn, similar to frostbite. Usually you want to have at least 1 layer of fabric between your skin and the hot/cold pack. More layers are required if you are using a moist heat source. If you are looking a treating a condition, generally you will apply a hot or cold pack 3-4 times per day.
A general rule:
-If it is tight or tense: HOT PACK
-If it is achy or swollen: COLD PACK
When faced with a choice of hot vs cold, I almost always go with a cold pack. That is certainly my personal preference, but is also tends to make more sense for my aches and pains. While using hot or cold packs seems like a fairly simplistic treatment, it can help to ease what aches you!
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