We have posted at least 3 well done studies on the effectiveness of Heat-Wrap therapy (Therma-care & others) done since their inception in early 2000. These studies suggest efficacy. When compared to placebo they show consistent benefit at 5 days (moderate-quality evidence). At 1 and 4 days they are apparently more effective than acetaminophen (but what isn’t!?). The same results were found with other nSAIDS including IB though high-quality studies were limited. Both pain and disability in a cohort of nearly 300 people found by the fourth day the heat-wrap had greater benefits as it did on day one. When a heat wrap is used for 3 consecutive days plus “education” (minimizing catastrophe/victimization potential) and teaching sensible “lifestyle accommodation” tactics, significant reductions in disability and improvements in pain relief were noted on the first day and the fourth. A Harvard study suggested dramatic improvement vs “other” interventions in the first 5 days with the use of heat-wraps. When compared with McKenzie protocols there were no significant differences in pain relief or function noted.
We have promoted this simple, cost effective treatment for nearly 10 years and continue to be impressed on how they seem to allow relief and ADL tolerance often better than ice or pills (ice is difficult to apply throughout a day if no freezer is available as well as the difficulty with skin irritation). However we all recognize that nothing is 100% and there are non-heat responders and conditions which simply will require some “ice time”. It’s important to note that in LBP IF the muscles are a source heat makes sense…IF the disc or joints are it also makes sense since “inflammation” of these structures is unlikely increased via skin surface heat.
A several year systematic review on ankle sprains also recently suggested aggressive ice therapy promoted more recurrences and disability.