NOT use ice/heat therapy before/after a Physical Therapy Session
Is it normal to NOT use ice/heat therapy before/after a Physical Therapy Session?
I recently began physical therapy for a post-op lower lumbar discectomy (L5-S1). The first physical therapist said my condition was much better than they had anticipated (being only two months ago) and only prescribed one visit per week for four weeks. I have been to two of the four appointments thus far. The first, of course, being an evaluation and some streches. The second, was directed by a different PT who just happened to be on vacation the previous week. Both times, I was not offered heat/ice therapy before or after the exercises.
I’ve had previous PT for a shoulder injury, years ago, and at a different location. I remember being given heat therapy to start my session, and ice therapy to end them. Have things changed since then? Is hot/cold therapy only used in certian injuries? Should I politely remind my PT that I have not recieved either forms of therapy?
I know that is asking several questions at once, but I am just curious if I should bring this up my next visit, or just plan on icing it myself when I get home.
Best Answer
A discectomy is, in my opinion, a much different story, especially one that is two month old already. There really is little benefit it will have after microdiscectomy. However, I’d consider using it in someone who is having great difficulty regaining their range of motion (I’d use a heat pack before treatment) or in someone who has little tolerance for activity and they get flared up after PT. The only time I can think of where I used hot or cold after a back surgery is in a patient who had Lupus (an inflammatory condition) because she was still in much greater pain that I would have expected at her point and time.
The other thing to consider is that most insurance companies have stopped paying for hot/cold pack application. Very few patients are willing to foot the bill for this (charges usually running between $10-20). At my clinic, we stopped charging for them long ago because the billing caused more of a headache than anything else.
Lastly, let’s consider the evidence, while there is some evidence that hot/cold applications have a beneficial effect in the knee and the shoulder, it really hasn’t been proven for the back . From a clinical experience, I would say that unless there is another underlying medical condition, hot/cold are of very little benefit for this type of procedure.
You can certainly ask your therapist about it, but don’t expect your insurance company to pay for it. Most likely, your therapist will tell you it’s palliative at best (makes you feel good, but does nothing to help the healing process) and there is certainly nothing wrong with doing it. As you suggested, it might just be worth it to ice at home.
Best wishes in your recovery