Physical Therapists Say ‘Goodbye’ to Heating Pads?

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Clients routinely ask what they can do on their own for pain relief. My recommendation for everyone is exercise and yoga (for increased strength, balance, and flexibility), but I also recommend heat in some cases too. A heating pad, steam room, or hot bath can be great for your tissue.

Diathermy_machine_1933Muscles that are chronically tight often have limited blood supply as well. Heat applied to these muscles creates vasodilation (expansion of the blood vessels) and helps relax them, creating immediate pain relief for many. Heating pads are often used in chiropractic and physical therapy offices for this reason. However, the American Physical Therapy Association (APTA) has recently recommended that physical therapists limit the use of heating pads and other “passive physical agents” in their practices.

If the application of heat helps to reduce pain and increase flexibility and blood supply, then why is the APTA not in favor of it? Well, they’re not necessarily against using heat as method of treatment but more against the overuse of it. The following is an excerpt from the “Five Things Physical Therapists and Patients Should Question” they released:

Don’t employ passive physical agents except when necessary to facilitate participation in an active treatment program.

There is limited evidence for use of passive physical agents to obtain clinically important outcomes for musculoskeletal conditions. A carefully designed active treatment plan has a greater impact on pain, mobility, function and quality of life. While there is some evidence of short-term pain relief for certain physical agents, the addition of passive physical agents should be supported by evidence and used to facilitate an active treatment program. There is emerging evidence that passive physical agents can harm patients. Communicating to patients that passive, instead of active, management strategies are advisable exacerbates fears and anxiety that many patients have about being physically active when in pain, which can prolong recovery, increase costs and increase the risk of exposure to invasive and costly interventions such as injections or surgery.

So here’s the real issue that the statement above addresses quite diplomatically. Insurance companies reimburse physical therapists for the use of heat packs, which often provide immediate pain relief for patients. As a result, many physical therapists routinely use heat packs because it allows them to provide immediate pain relief while billing insurance companies AND work with other patients at the same time. All of this helps them to run a more profitable practice. The problem occurs when this drive for “efficiency” becomes more important than providing a successful treatment protocol. Even though patients often report pain relief from the application of heat, this is often temporary pain relief that is ultimately not in the best interest of the client. This use, or misuse, of heat packs can be a fine line and should be secondary to exercises that actively engage the patient.

According to the APTA, heat packs should only be employed when “supported by evidence and used to facilitate an active treatment program“. Essentiallly, the APTA is promoting an active treatment plan (exercises) over passive physical agents (such as heat packs). The use of passive physical agents are most useful when they provide enough pain relief to enable the patient to become more engaged in active exercises, which are ultimately more beneficial.

The list from the APTA also addresses concerns that passive physical agents promote a less physically active treatment plan, which can delay recovery and increase overall costs. The other 4 questionable practices listed echoed this sentiment, encouraging more activity from the patient.

In general, we’re healthier and happier when we use our bodies, and inactivity so quickly becomes the enemy of healing. Muscles and tissues become weak and develop adhesions. Other parts of our body compensate for the injury by taking on added responsibility, which has the potential to create long-term structural problems. Remaining active is crucial to recovery (as well as living healthy life) and treatment practices should support that.


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