Heat vs Cold Therapy for Chiropractic Injury Recovery
00:00welcome to the next episode of Mike Depp welcome to the next episode of Mike Depp with CYO today's episode's going to with CYO today's episode's going to with CYO today's episode's going to cover the age old debate on using Heat cover the age old debate on using Heat cover the age old debate on using Heat versus ice therapy uh you're going to versus ice therapy uh you're going to versus ice therapy uh you're going to have Tim and myself for this episode and have Tim and myself for this episode and have Tim and myself for this episode and I'm going to have to explain why I had I'm going to have to explain why I had I'm going to have to explain why I had to call him in for this episode uh and to call him in for this episode uh and to call him in for this episode uh and really the reason is because this topic really the reason is because this topic really the reason is because this topic is well above my pay grade and ratings is well above my pay grade and ratings is well above my pay grade and ratings were Dr that's probably what it was um were Dr that's probably what it was um were Dr that's probably what it was um just as a reminder if you haven't yet just as a reminder if you haven't yet just as a reminder if you haven't yet hit the follow button and share this hit the follow button and share this hit the follow button and share this episode with a friend it does help us episode with a friend it does help us episode with a friend it does help us reach more evidence-based DCS like reach more evidence-based DCS like reach more evidence-based DCS like yourself really around the world um and yourself really around the world um and yourself really around the world um and I think this is one of those topics that I think this is one of those topics that I think this is one of those topics that you're going to want to hear and we're you're going to want to hear and we're you're going to want to hear and we're going to keep this uh short and sweet going to keep this uh short and sweet going to keep this uh short and sweet however this is a topic that I really do however this is a topic that I really do however this is a topic that I really do believe I hear about at least on a daily believe I hear about at least on a daily believe I hear about at least on a daily basis and the solution sound simple basis and the solution sound simple basis and the solution sound simple however we're going to examine the facts however we're going to examine the facts however we're going to examine the facts and not just the opinions on how to and not just the opinions on how to and not just the opinions on how to explain ice therapy and when to use it explain ice therapy and when to use it explain ice therapy and when to use it as compared to heat therapy now we're
01:00as compared to heat therapy now we're as compared to heat therapy now we're going to set the record straight on this going to set the record straight on this going to set the record straight on this old wives tale so sit back put your old wives tale so sit back put your old wives tale so sit back put your trade tables up uh seats in an upright trade tables up uh seats in an upright trade tables up uh seats in an upright position there is going to be some position there is going to be some position there is going to be some turbulence during this episode uh turbulence during this episode uh turbulence during this episode uh sometimes in your head sometimes through sometimes in your head sometimes through sometimes in your head sometimes through our discussion uh but really we're going our discussion uh but really we're going our discussion uh but really we're going to prepare ourselves to kind of change to prepare ourselves to kind of change to prepare ourselves to kind of change what science has told us in the past and what science has told us in the past and what science has told us in the past and also learn from it and how we're going also learn from it and how we're going also learn from it and how we're going to move forward um you know as far as to move forward um you know as far as to move forward um you know as far as our education and also how we educate our education and also how we educate our education and also how we educate our patients of course with the common our patients of course with the common our patients of course with the common goal of the patients needs first so so goal of the patients needs first so so goal of the patients needs first so so topic of debate for today Heat versus topic of debate for today Heat versus topic of debate for today Heat versus cold therapy which is best for muscular cold therapy which is best for muscular cold therapy which is best for muscular skeletal injuries and as you know we try skeletal injuries and as you know we try skeletal injuries and as you know we try to stay in that realm we're not going to to stay in that realm we're not going to to stay in that realm we're not going to uh dive out into the other things that uh dive out into the other things that uh dive out into the other things that possibly are useful for heat and cool possibly are useful for heat and cool possibly are useful for heat and cool therapy and we may dive into a couple therapy and we may dive into a couple therapy and we may dive into a couple little conditions however really with a little conditions however really with a little conditions however really with a an isolated focus on muscle skeletal an isolated focus on muscle skeletal an isolated focus on muscle skeletal injuries uh this is actually a Blog that injuries uh this is actually a Blog that injuries uh this is actually a Blog that uh Dr Burman um created and posted in uh Dr Burman um created and posted in uh Dr Burman um created and posted in November 2024 it provided not only our November 2024 it provided not only our November 2024 it provided not only our subscribers but also myself I learned a
02:00subscribers but also myself I learned a subscribers but also myself I learned a lot from this uh this blog and it gave lot from this uh this blog and it gave lot from this uh this blog and it gave me some evidence-based guidelines on me some evidence-based guidelines on me some evidence-based guidelines on heat and ice therapy and when we can use heat and ice therapy and when we can use heat and ice therapy and when we can use both uh to be the most beneficial for both uh to be the most beneficial for both uh to be the most beneficial for where that patient lives you know where where that patient lives you know where where that patient lives you know where are they in their their healing cycle um are they in their their healing cycle um are they in their their healing cycle um I would love to take credit for this I would love to take credit for this I would love to take credit for this blog in fact I'm going to use some of blog in fact I'm going to use some of blog in fact I'm going to use some of the infographics and this information in the infographics and this information in the infographics and this information in several of my presentations for next several of my presentations for next several of my presentations for next year uh but the title of the blog is year uh but the title of the blog is year uh but the title of the blog is when to use ice uh versus heat from when to use ice uh versus heat from when to use ice uh versus heat from musco gutal injuries if you want to take musco gutal injuries if you want to take musco gutal injuries if you want to take a look at it if you're a subscriber it's a look at it if you're a subscriber it's a look at it if you're a subscriber it's on the home page page obviously you know on the home page page obviously you know on the home page page obviously you know where to find it if you're not a where to find it if you're not a where to find it if you're not a subscriber uh that's okay uh cyro.com on subscriber uh that's okay uh cyro.com on subscriber uh that's okay uh cyro.com on the top nav bar you see a resources tab the top nav bar you see a resources tab the top nav bar you see a resources tab um if you dive into the blog section you um if you dive into the blog section you um if you dive into the blog section you can find this blog and of course we have can find this blog and of course we have can find this blog and of course we have our webinars and we have our podcast and our webinars and we have our podcast and our webinars and we have our podcast and and everything else on that that one and everything else on that that one and everything else on that that one section a really nice introduction uh section a really nice introduction uh section a really nice introduction uh where's where's the snarkiness it's where's where's the snarkiness it's where's where's the snarkiness it's coming don't worry oh that's that's good coming don't worry oh that's that's good coming don't worry oh that's that's good to know this was a fun blog uh because to know this was a fun blog uh because to know this was a fun blog uh because it changed the way I practice and that's it changed the way I practice and that's it changed the way I practice and that's what it's all about evolving saying what what it's all about evolving saying what what it's all about evolving saying what can we do differently to help get our can we do differently to help get our can we do differently to help get our patients better more quickly and
03:00patients better more quickly and patients better more quickly and especially tools that we can teach them especially tools that we can teach them especially tools that we can teach them this is essential patient education um this is essential patient education um this is essential patient education um and certainly heat and cold is one of and certainly heat and cold is one of and certainly heat and cold is one of those fundamental things that plays a those fundamental things that plays a those fundamental things that plays a valuable role in Pro managing pain valuable role in Pro managing pain valuable role in Pro managing pain promoting healing but those mechanisms promoting healing but those mechanisms promoting healing but those mechanisms between Heat versus Ice differ radically between Heat versus Ice differ radically between Heat versus Ice differ radically so selecting the right one makes all the so selecting the right one makes all the so selecting the right one makes all the difference the good news is we're going difference the good news is we're going difference the good news is we're going to dive deep into those today all right to dive deep into those today all right to dive deep into those today all right so first things first let's put a an so first things first let's put a an so first things first let's put a an outline on today's podcast you know what outline on today's podcast you know what outline on today's podcast you know what is cold therapy and then we'll dive into is cold therapy and then we'll dive into is cold therapy and then we'll dive into what is heat therapy uh to start things what is heat therapy uh to start things what is heat therapy uh to start things off let's go through the mechanism of off let's go through the mechanism of off let's go through the mechanism of action for cold therapy and then we'll action for cold therapy and then we'll action for cold therapy and then we'll go right into the benefits of cold go right into the benefits of cold go right into the benefits of cold therapy yeah perfect we all understand therapy yeah perfect we all understand therapy yeah perfect we all understand that cold therapy causes Vaso that cold therapy causes Vaso that cold therapy causes Vaso constriction where vessels are going to constriction where vessels are going to constriction where vessels are going to narrow down which means the vessels that narrow down which means the vessels that narrow down which means the vessels that supply the nerves are also going to be supply the nerves are also going to be supply the nerves are also going to be uh narrowed down that means the no uh narrowed down that means the no uh narrowed down that means the no acceptors are going to be suppressed and acceptors are going to be suppressed and acceptors are going to be suppressed and also muscle excitability is going to be also muscle excitability is going to be also muscle excitability is going to be suppressed so we get pain relief from it suppressed so we get pain relief from it suppressed so we get pain relief from it we get a decrease in the muscle spasm by we get a decrease in the muscle spasm by we get a decrease in the muscle spasm by that vasal constriction and we certainly that vasal constriction and we certainly that vasal constriction and we certainly get decreased swelling we're going to get decreased swelling we're going to get decreased swelling we're going to minim miniz the fluid buildup in that
04:00minim miniz the fluid buildup in that minim miniz the fluid buildup in that injured area through that vasil injured area through that vasil injured area through that vasil constriction of the arterials and the constriction of the arterials and the constriction of the arterials and the capillaries to control swelling the capillaries to control swelling the capillaries to control swelling the other thing that's happening in that other thing that's happening in that other thing that's happening in that controlling of swelling is there's going controlling of swelling is there's going controlling of swelling is there's going to be less lucaites and granulocytes and to be less lucaites and granulocytes and to be less lucaites and granulocytes and macrofagos those key immune cell macrofagos those key immune cell macrofagos those key immune cell mediators so a decrease in the mediators so a decrease in the mediators so a decrease in the inflammation and this is where we inflammation and this is where we inflammation and this is where we thought that in the past maybe this thought that in the past maybe this thought that in the past maybe this would help to control subsequent tissue would help to control subsequent tissue would help to control subsequent tissue damage from the pressure and those damage from the pressure and those damage from the pressure and those inflammatory products so we would inflammatory products so we would inflammatory products so we would suppress that for prolonged periods of suppress that for prolonged periods of suppress that for prolonged periods of time with ice and that belief was mainly time with ice and that belief was mainly time with ice and that belief was mainly predicated upon animal models and we've predicated upon animal models and we've predicated upon animal models and we've since learned that maybe not that using since learned that maybe not that using since learned that maybe not that using ice Beyond 6 to 12 hours may not be the ice Beyond 6 to 12 hours may not be the ice Beyond 6 to 12 hours may not be the ideal situation in fact it may cause ideal situation in fact it may cause ideal situation in fact it may cause more tissue damage in the long run even more tissue damage in the long run even more tissue damage in the long run even a critical review published last year a critical review published last year a critical review published last year this year 2024 in the British medical this year 2024 in the British medical this year 2024 in the British medical journal said that there is no conclusive journal said that there is no conclusive journal said that there is no conclusive evidence from Human studies that evidence from Human studies that evidence from Human studies that cryotherapy limits secondary injury or cryotherapy limits secondary injury or cryotherapy limits secondary injury or promotes tissue regeneration in fact promotes tissue regeneration in fact promotes tissue regeneration in fact it's probably just the opposite so so if
05:00it's probably just the opposite so so if it's probably just the opposite so so if I understand you correctly uh we should I understand you correctly uh we should I understand you correctly uh we should really use ice in the first 6 to 12 really use ice in the first 6 to 12 really use ice in the first 6 to 12 hours we're going to use it to relieve hours we're going to use it to relieve hours we're going to use it to relieve pain reduce swelling and to slow down pain reduce swelling and to slow down pain reduce swelling and to slow down the cellular inflammatory response but the cellular inflammatory response but the cellular inflammatory response but if I had to sum this up into one if I had to sum this up into one if I had to sum this up into one sentence it would be um cold causes sentence it would be um cold causes sentence it would be um cold causes shrinkage is that shrinkage is that shrinkage is that right let's let's use that as a headline right let's let's use that as a headline right let's let's use that as a headline that'll be that'll be we can name the that'll be that'll be we can name the that'll be that'll be we can name the podcast that that could be the case um podcast that that could be the case um podcast that that could be the case um so keeping those things in mind um so keeping those things in mind um so keeping those things in mind um when should I tell a patient to consider when should I tell a patient to consider when should I tell a patient to consider cryotherapy I mean Are there specific cryotherapy I mean Are there specific cryotherapy I mean Are there specific utilities uh specific conditions that utilities uh specific conditions that utilities uh specific conditions that really do respond well to ice yeah really do respond well to ice yeah really do respond well to ice yeah absolutely that ice is still valuable in absolutely that ice is still valuable in absolutely that ice is still valuable in that first 6 to 12 hours after an injury that first 6 to 12 hours after an injury that first 6 to 12 hours after an injury especially something like a sprain or a especially something like a sprain or a especially something like a sprain or a strain or a contusion where we may want strain or a contusion where we may want strain or a contusion where we may want to control that inflammation and control to control that inflammation and control to control that inflammation and control being the key word optimize not suppress being the key word optimize not suppress being the key word optimize not suppress or completely eliminate inflammation or completely eliminate inflammation or completely eliminate inflammation we're trying to optimize inflammation so we're trying to optimize inflammation so we're trying to optimize inflammation so 6 to 12 hours is good the other thing
06:006 to 12 hours is good the other thing 6 to 12 hours is good the other thing that ice works well for that's proven by that ice works well for that's proven by that ice works well for that's proven by tons of literature is U migraine tons of literature is U migraine tons of literature is U migraine headaches whether we put a cold pack on headaches whether we put a cold pack on headaches whether we put a cold pack on the neck which is beneficial to the the neck which is beneficial to the the neck which is beneficial to the muscles as well as the crowded artery or muscles as well as the crowded artery or muscles as well as the crowded artery or if we put that ice on the head through a if we put that ice on the head through a if we put that ice on the head through a cold gel headband or a wrap that cold gel headband or a wrap that cold gel headband or a wrap that definitely helps our patients with definitely helps our patients with definitely helps our patients with migraines and there aren't a lot of migraines and there aren't a lot of migraines and there aren't a lot of things that help once the migraine is things that help once the migraine is things that help once the migraine is triggered there aren't a lot of things triggered there aren't a lot of things triggered there aren't a lot of things that help but ice is one of those things that help but ice is one of those things that help but ice is one of those things that can help to suppress the symptoms that can help to suppress the symptoms that can help to suppress the symptoms the other thing is that some types of the other thing is that some types of the other thing is that some types of arthritis is benefit from Ice now arthritis is benefit from Ice now arthritis is benefit from Ice now typical osteoarthritis wouldn't but an typical osteoarthritis wouldn't but an typical osteoarthritis wouldn't but an acute rheumatologic flare up if somebody acute rheumatologic flare up if somebody acute rheumatologic flare up if somebody has a rheumatoid arthritis or sertic has a rheumatoid arthritis or sertic has a rheumatoid arthritis or sertic arthritis ice therapy helps to limit arthritis ice therapy helps to limit arthritis ice therapy helps to limit that that uh body trying to resorb its that that uh body trying to resorb its that that uh body trying to resorb its own cartilage cells that autoimmune own cartilage cells that autoimmune own cartilage cells that autoimmune response and all the vascularity so response and all the vascularity so response and all the vascularity so suppressing that is good uh especially suppressing that is good uh especially suppressing that is good uh especially in conditions like gout that's the one in conditions like gout that's the one in conditions like gout that's the one that has the most research ice that that has the most research ice that that has the most research ice that gouty toe and moving Upstream just a gouty toe and moving Upstream just a gouty toe and moving Upstream just a little bit to the knee if somebody has a little bit to the knee if somebody has a little bit to the knee if somebody has a knee replacement cold compression knee replacement cold compression knee replacement cold compression therapy after knee replacement
07:00therapy after knee replacement therapy after knee replacement does improve recovery outcomes but does improve recovery outcomes but does improve recovery outcomes but outside of that the evidence is pretty outside of that the evidence is pretty outside of that the evidence is pretty limited for ice helping things what limited for ice helping things what limited for ice helping things what about a good bourbon great evidence about a good bourbon great evidence about a good bourbon great evidence there yes I I missed that number five uh there yes I I missed that number five uh there yes I I missed that number five uh so let me get this straight you know so so let me get this straight you know so so let me get this straight you know so realistically coming out of school uh realistically coming out of school uh realistically coming out of school uh being a past athlete I I do emphasize being a past athlete I I do emphasize being a past athlete I I do emphasize past athlete um I always learn about the past athlete um I always learn about the past athlete um I always learn about the rice principle and that's one thing that rice principle and that's one thing that rice principle and that's one thing that is still uh relayed to just athletes now is still uh relayed to just athletes now is still uh relayed to just athletes now and the rice principle was was the rest and the rice principle was was the rest and the rice principle was was the rest ice compress Elevate and this was not ice compress Elevate and this was not ice compress Elevate and this was not just when the injury happened this was just when the injury happened this was just when the injury happened this was you know for the next several days after you know for the next several days after you know for the next several days after an acute injury one of the interesting an acute injury one of the interesting an acute injury one of the interesting things you brought up in your blog things you brought up in your blog things you brought up in your blog though is that the uh the investigator though is that the uh the investigator though is that the uh the investigator who found the rice principal who who found the rice principal who who found the rice principal who published that work Dr mkin has actually published that work Dr mkin has actually published that work Dr mkin has actually since revised his stance on this and since revised his stance on this and since revised his stance on this and that ice should actually be used that ice should actually be used that ice should actually be used cautiously post injury he had a more cautiously post injury he had a more cautiously post injury he had a more recent article that said when it comes recent article that said when it comes recent article that said when it comes to ice therapy we really should be doing to ice therapy we really should be doing to ice therapy we really should be doing exactly what we just brought up in the exactly what we just brought up in the exactly what we just brought up in the aftermath of any kind of injury really 6
08:00aftermath of any kind of injury really 6 aftermath of any kind of injury really 6 to 12 hours and and after that we're to 12 hours and and after that we're to 12 hours and and after that we're actually going to hinder recovery by actually going to hinder recovery by actually going to hinder recovery by delaying tissue repair um and actually delaying tissue repair um and actually delaying tissue repair um and actually increase Scar Tissue formation of that increase Scar Tissue formation of that increase Scar Tissue formation of that area so that's one of those things that area so that's one of those things that area so that's one of those things that um I always find um uh refreshing um and um I always find um uh refreshing um and um I always find um uh refreshing um and not that Dr mkin wanted to be wrong but not that Dr mkin wanted to be wrong but not that Dr mkin wanted to be wrong but um he continued to investigate he um he continued to investigate he um he continued to investigate he continued to be curious about his past continued to be curious about his past continued to be curious about his past finding and that now he's able to come finding and that now he's able to come finding and that now he's able to come up with a um a new possibility to help up with a um a new possibility to help up with a um a new possibility to help these people post recovery and that's these people post recovery and that's these people post recovery and that's when we kind of we dive into the the when we kind of we dive into the the when we kind of we dive into the the peace and love approach which emphasizes peace and love approach which emphasizes peace and love approach which emphasizes that early protection uh elevation avoid that early protection uh elevation avoid that early protection uh elevation avoid anti-inflammatories to to will limit anti-inflammatories to to will limit anti-inflammatories to to will limit that inflammatory response uh still use that inflammatory response uh still use that inflammatory response uh still use compression and then of course education compression and then of course education compression and then of course education on how to um you know to how to get that on how to um you know to how to get that on how to um you know to how to get that tissue to heal and then once that um tissue to heal and then once that um tissue to heal and then once that um acute injury has started to subside now acute injury has started to subside now acute injury has started to subside now we're going to follow that up with some we're going to follow that up with some we're going to follow that up with some um controlled loading you know some some um controlled loading you know some some um controlled loading you know some some controlled exercise a little bit of
09:00controlled exercise a little bit of controlled exercise a little bit of optimism um and then some some different optimism um and then some some different optimism um and then some some different movements to uh start to vascularize the movements to uh start to vascularize the movements to uh start to vascularize the tissue and exercise so let's let's take tissue and exercise so let's let's take tissue and exercise so let's let's take a little bit deeper of a dive into the a little bit deeper of a dive into the a little bit deeper of a dive into the peace and love um because that's peace and love um because that's peace and love um because that's something that we all want to start to something that we all want to start to something that we all want to start to educate our uh patients on so Dr B why educate our uh patients on so Dr B why educate our uh patients on so Dr B why don't you take the peace part and I'll don't you take the peace part and I'll don't you take the peace part and I'll take the love part um somehow that's take the love part um somehow that's take the love part um somehow that's going to get stitched into uh a going to get stitched into uh a going to get stitched into uh a marketing message I'm worried what marketing message I'm worried what marketing message I'm worried what they're going to come up with after that they're going to come up with after that they're going to come up with after that that that's a Mee good good work again that that's a Mee good good work again that that's a Mee good good work again I'll take uh I'll take the right after I'll take uh I'll take the right after I'll take uh I'll take the right after the injury so that's peace uh comes in the injury so that's peace uh comes in the injury so that's peace uh comes in so we still want to protect things so we still want to protect things so we still want to protect things remember when rice went to to price and remember when rice went to to price and remember when rice went to to price and then went to prices protection is still then went to prices protection is still then went to prices protection is still one of those things that after something one of those things that after something one of those things that after something has been strained or contused we really has been strained or contused we really has been strained or contused we really don't want it to be further irritated so don't want it to be further irritated so don't want it to be further irritated so we're going to protect it by limiting we're going to protect it by limiting we're going to protect it by limiting movement that doesn't mean stopping movement that doesn't mean stopping movement that doesn't mean stopping movement that means limiting movement or movement that means limiting movement or movement that means limiting movement or making sure that we we're getting making sure that we we're getting making sure that we we're getting movement that uh doesn't damage that movement that uh doesn't damage that movement that uh doesn't damage that tissue elevation is still a key that we tissue elevation is still a key that we tissue elevation is still a key that we would like to get those waste products would like to get those waste products would like to get those waste products back out of there so getting the injured
10:00back out of there so getting the injured back out of there so getting the injured area up above the other areas is still a area up above the other areas is still a area up above the other areas is still a good thing but as opposed to Rice which good thing but as opposed to Rice which good thing but as opposed to Rice which said ice to limit inflammation now we said ice to limit inflammation now we said ice to limit inflammation now we want to avoid anti-inflammatories and in want to avoid anti-inflammatories and in want to avoid anti-inflammatories and in the peace and love that that's detailed the peace and love that that's detailed the peace and love that that's detailed in most of the literature the in most of the literature the in most of the literature the anti-inflammatories that we're talking anti-inflammatories that we're talking anti-inflammatories that we're talking about are chemicals over-the-counter about are chemicals over-the-counter about are chemicals over-the-counter painkillers anti-inflammatories using painkillers anti-inflammatories using painkillers anti-inflammatories using those we know suppresses uh tonogenesis those we know suppresses uh tonogenesis those we know suppresses uh tonogenesis it's going to limit the amount of it's going to limit the amount of it's going to limit the amount of healing so don't use those right away healing so don't use those right away healing so don't use those right away unless instructed by your doctor there's unless instructed by your doctor there's unless instructed by your doctor there's a really good reason swelling is a a really good reason swelling is a a really good reason swelling is a natural reaction it's part of the body's natural reaction it's part of the body's natural reaction it's part of the body's healing process and stopping it or healing process and stopping it or healing process and stopping it or dramatically suppressing it actually dramatically suppressing it actually dramatically suppressing it actually delays recovery so that's the big one delays recovery so that's the big one delays recovery so that's the big one let's avoid anti-inflammatories one let's avoid anti-inflammatories one let's avoid anti-inflammatories one thing that did get to stick around is thing that did get to stick around is thing that did get to stick around is compression that putting a wrap around compression that putting a wrap around compression that putting a wrap around it limits the swelling it optimizes the it limits the swelling it optimizes the it limits the swelling it optimizes the swelling limits the bleeding inside the swelling limits the bleeding inside the swelling limits the bleeding inside the tissues and it may help with healing and tissues and it may help with healing and tissues and it may help with healing and finally education that patients need to finally education that patients need to finally education that patients need to understand why they're doing these understand why they're doing these understand why they're doing these things not just that you're telling them things not just that you're telling them things not just that you're telling them to but educating them about the injury
11:00to but educating them about the injury to but educating them about the injury and focusing on an active recovery and focusing on an active recovery and focusing on an active recovery especially preparing that that patient especially preparing that that patient especially preparing that that patient for the phase that comes next a couple for the phase that comes next a couple for the phase that comes next a couple of days after injury where we move into of days after injury where we move into of days after injury where we move into love and that's where I guess I come in love and that's where I guess I come in love and that's where I guess I come in um I think that this is where things uh um I think that this is where things uh um I think that this is where things uh what we would normally call the rehab what we would normally call the rehab what we would normally call the rehab phase we want to calm things down first phase we want to calm things down first phase we want to calm things down first and we want to build things back up so and we want to build things back up so and we want to build things back up so the first part would be loading uh the first part would be loading uh the first part would be loading uh loading isn't necessarily putting loading isn't necessarily putting loading isn't necessarily putting someone under load meaning with weights someone under load meaning with weights someone under load meaning with weights it could just be start to move that it could just be start to move that it could just be start to move that tissue or actually just put weight on tissue or actually just put weight on tissue or actually just put weight on that tissue again so something to think that tissue again so something to think that tissue again so something to think about that doesn't mean we need to you about that doesn't mean we need to you about that doesn't mean we need to you know start to use resistance bands and know start to use resistance bands and know start to use resistance bands and weights associated with uh the tissue weights associated with uh the tissue weights associated with uh the tissue but we do want to start to load that but we do want to start to load that but we do want to start to load that tissue to build it back up to that same tissue to build it back up to that same tissue to build it back up to that same strength or capacity um optimism is the strength or capacity um optimism is the strength or capacity um optimism is the next piece stay positive there's one next piece stay positive there's one next piece stay positive there's one thing that uh continually surprised me thing that uh continually surprised me thing that uh continually surprised me is that the optimism uh the plan set is that the optimism uh the plan set is that the optimism uh the plan set forth the confidence you have as a forth the confidence you have as a forth the confidence you have as a provider makes a huge impact on how that provider makes a huge impact on how that provider makes a huge impact on how that patient recovers we we all know tissue
12:00patient recovers we we all know tissue patient recovers we we all know tissue heals our job is to continually be there heals our job is to continually be there heals our job is to continually be there to help support our patients uh and to help support our patients uh and to help support our patients uh and making sure that we don't use negative making sure that we don't use negative making sure that we don't use negative words as compared to the positive words words as compared to the positive words words as compared to the positive words that are going to help that patient that are going to help that patient that are going to help that patient recover quickly uh vascularization this recover quickly uh vascularization this recover quickly uh vascularization this is one of those things like I I'm a big is one of those things like I I'm a big is one of those things like I I'm a big Walker um I I love when I can get my Walker um I I love when I can get my Walker um I I love when I can get my patients out and walking and just to get patients out and walking and just to get patients out and walking and just to get the blood moving uh there is a big the blood moving uh there is a big the blood moving uh there is a big difference between hurt and harm when it difference between hurt and harm when it difference between hurt and harm when it comes to this is that if something truly comes to this is that if something truly comes to this is that if something truly hurts above a 4 out 10 and a sharp pain hurts above a 4 out 10 and a sharp pain hurts above a 4 out 10 and a sharp pain or shooting pain that's harm you're or shooting pain that's harm you're or shooting pain that's harm you're doing too much too fast but when doing too much too fast but when doing too much too fast but when something is a achy or more just kind of something is a achy or more just kind of something is a achy or more just kind of hurts we can move through those hurts we can move through those hurts we can move through those movements uh if it's just uncomfortable movements uh if it's just uncomfortable movements uh if it's just uncomfortable we want to make sure we get that person we want to make sure we get that person we want to make sure we get that person up and and out and not just laying up and and out and not just laying up and and out and not just laying around the C on the couch and then around the C on the couch and then around the C on the couch and then finally exercise is the the E part of finally exercise is the the E part of finally exercise is the the E part of love that we want to build someone back love that we want to build someone back love that we want to build someone back up to where they were pre-injury so let up to where they were pre-injury so let up to where they were pre-injury so let pain be your guide you know if it hurts pain be your guide you know if it hurts pain be your guide you know if it hurts too much we don't want to get them back too much we don't want to get them back too much we don't want to get them back in too fast however we want to make sure in too fast however we want to make sure in too fast however we want to make sure we can get them back in their activity we can get them back in their activity we can get them back in their activity and avoid any kind of compensatory and avoid any kind of compensatory and avoid any kind of compensatory movements um and in our evaluation
13:00movements um and in our evaluation movements um and in our evaluation before we you know drop them back into before we you know drop them back into before we you know drop them back into their sport so let's go into the heat their sport so let's go into the heat their sport so let's go into the heat discussion um anything else you want to discussion um anything else you want to discussion um anything else you want to cover as far as ice before we we we cover as far as ice before we we we cover as far as ice before we we we drive into that um a couple of things drive into that um a couple of things drive into that um a couple of things yeah if you'd like to learn more about yeah if you'd like to learn more about yeah if you'd like to learn more about peace and love you can download the peace and love you can download the peace and love you can download the infographic just visit Cairo up or check infographic just visit Cairo up or check infographic just visit Cairo up or check out the blog um and you'll be able to out the blog um and you'll be able to out the blog um and you'll be able to download that in the forums library and download that in the forums library and download that in the forums library and I think this the the last thing before I think this the the last thing before I think this the the last thing before diving whoa whoa whoa whoa wait one more diving whoa whoa whoa whoa wait one more diving whoa whoa whoa whoa wait one more one more thing I actually I have one one more thing I actually I have one one more thing I actually I have one more question um more question um more question um we just talk well we just talked about we just talk well we just talked about we just talk well we just talked about ice but I guess probably the number one ice but I guess probably the number one ice but I guess probably the number one thing that I hear from a a patient is thing that I hear from a a patient is thing that I hear from a a patient is how long to apply it so we didn't cover how long to apply it so we didn't cover how long to apply it so we didn't cover that so how long should you apply ice that so how long should you apply ice that so how long should you apply ice War a while um so it depends on the War a while um so it depends on the War a while um so it depends on the temperature that ice could be anything temperature that ice could be anything temperature that ice could be anything or Cooling and vasil constriction could or Cooling and vasil constriction could or Cooling and vasil constriction could occur anything between cool water as you occur anything between cool water as you occur anything between cool water as you mentioned and 0 deg celsus that if you mentioned and 0 deg celsus that if you mentioned and 0 deg celsus that if you have an instant ice pack that's going to have an instant ice pack that's going to have an instant ice pack that's going to be very cold in fact potentially be very cold in fact potentially be very cold in fact potentially dangerously cold that we need some dangerously cold that we need some dangerously cold that we need some insulation insulation insulation and insulation is going to be the key to
14:00and insulation is going to be the key to and insulation is going to be the key to how long we apply that that if somebody how long we apply that that if somebody how long we apply that that if somebody has um a lot of tissue between the area has um a lot of tissue between the area has um a lot of tissue between the area that that you're icing it may take a that that you're icing it may take a that that you're icing it may take a little longer to cool that tissue if little longer to cool that tissue if little longer to cool that tissue if you're putting insulation garments in you're putting insulation garments in you're putting insulation garments in between there which we should depending between there which we should depending between there which we should depending on the thickness of those it may take on the thickness of those it may take on the thickness of those it may take longer but generally 10 to 20 minutes longer but generally 10 to 20 minutes longer but generally 10 to 20 minutes and really what's going to happen is the and really what's going to happen is the and really what's going to happen is the patient is going to go through a a patient is going to go through a a patient is going to go through a a series of Sensations that we refer to as series of Sensations that we refer to as series of Sensations that we refer to as the acronym SE band cold burning aching the acronym SE band cold burning aching the acronym SE band cold burning aching and numb meaning that first you're going and numb meaning that first you're going and numb meaning that first you're going to feel cold when you put an ice back on to feel cold when you put an ice back on to feel cold when you put an ice back on then it's going to start to burn and then it's going to start to burn and then it's going to start to burn and then it's going to ache and finally it's then it's going to ache and finally it's then it's going to ache and finally it's going to turn numb it's time to take the going to turn numb it's time to take the going to turn numb it's time to take the ice back off when it becomes numb and ice back off when it becomes numb and ice back off when it becomes numb and this is something if you haven't this is something if you haven't this is something if you haven't experienced those Sensations yourself experienced those Sensations yourself experienced those Sensations yourself get up as long as you're able to put get up as long as you're able to put get up as long as you're able to put your your foot or hand in cold water put your your foot or hand in cold water put your your foot or hand in cold water put your foot in a bucket of cold water and your foot in a bucket of cold water and your foot in a bucket of cold water and you'll see those of ice water you'll see you'll see those of ice water you'll see you'll see those of ice water you'll see those Sensations come about exactly as those Sensations come about exactly as those Sensations come about exactly as the Sean acronym and also the the Sean acronym and also the the Sean acronym and also the interesting point is when patients say interesting point is when patients say interesting point is when patients say this is totally off Off Script but when this is totally off Off Script but when this is totally off Off Script but when a patient says they have a high pain a patient says they have a high pain a patient says they have a high pain threshold number one you know they don't
15:00threshold number one you know they don't threshold number one you know they don't they have the lowest pain threshold they have the lowest pain threshold they have the lowest pain threshold because people who have high pain because people who have high pain because people who have high pain thresholds don't realize they have high thresholds don't realize they have high thresholds don't realize they have high pain thresholds but the one indicator of pain thresholds but the one indicator of pain thresholds but the one indicator of your pain threshold is how long you can your pain threshold is how long you can your pain threshold is how long you can keep your foot in a bucket of ice water keep your foot in a bucket of ice water keep your foot in a bucket of ice water some people can run it all the way to some people can run it all the way to some people can run it all the way to numb and then of course you could keep numb and then of course you could keep numb and then of course you could keep it there infam once it's numb but many it there infam once it's numb but many it there infam once it's numb but many people are pulling it out at cold or people are pulling it out at cold or people are pulling it out at cold or burning or especially aching so if you burning or especially aching so if you burning or especially aching so if you want to see who has the highest pain want to see who has the highest pain want to see who has the highest pain threshold in your office find some cold threshold in your office find some cold threshold in your office find some cold water stick your feet in and first water stick your feet in and first water stick your feet in and first person out has the lowest pain threshold person out has the lowest pain threshold person out has the lowest pain threshold I'll tell you what um that's one of the I'll tell you what um that's one of the I'll tell you what um that's one of the things that I've done with uh with things that I've done with uh with things that I've done with uh with student athletes and essentially my kids student athletes and essentially my kids student athletes and essentially my kids is that I'll get you know like seers is that I'll get you know like seers is that I'll get you know like seers disease or some Achilles copath and disease or some Achilles copath and disease or some Achilles copath and dropping that extremity into cold well dropping that extremity into cold well dropping that extremity into cold well it does a great job of quickly cooling it does a great job of quickly cooling it does a great job of quickly cooling that tissue so something we can of that tissue so something we can of that tissue so something we can of course use um but from what I heard you course use um but from what I heard you course use um but from what I heard you know it takes 10 to 20 minutes to make know it takes 10 to 20 minutes to make know it takes 10 to 20 minutes to make the magic happen is that is that about the magic happen is that is that about the magic happen is that is that about right exactly uh so as far as heat goes right exactly uh so as far as heat goes right exactly uh so as far as heat goes so I guess we can drive into heat so I guess we can drive into heat so I guess we can drive into heat because Heat's actually the bigger part because Heat's actually the bigger part because Heat's actually the bigger part of this discussion of this discussion of this discussion let's go through the same flow that we
16:00let's go through the same flow that we let's go through the same flow that we did with cold so what is the mechanism did with cold so what is the mechanism did with cold so what is the mechanism of action of heat and then how does this of action of heat and then how does this of action of heat and then how does this actually work on this cellular level actually work on this cellular level actually work on this cellular level yeah great question just the opposite of yeah great question just the opposite of yeah great question just the opposite of ice that heat is going to cause vasod ice that heat is going to cause vasod ice that heat is going to cause vasod dilation so we're going to increase the dilation so we're going to increase the dilation so we're going to increase the blood flow to the area and that has blood flow to the area and that has blood flow to the area and that has several benefits that there's some pain several benefits that there's some pain several benefits that there's some pain relief um and and we don't think of heat relief um and and we don't think of heat relief um and and we don't think of heat often as a pain relieving process but it often as a pain relieving process but it often as a pain relieving process but it absolutely does because it's going to absolutely does because it's going to absolutely does because it's going to stimulate the thermo receptors and stimulate the thermo receptors and stimulate the thermo receptors and that's going to then suppress or or or that's going to then suppress or or or that's going to then suppress or or or dampen the effect of the uh in the dampen the effect of the uh in the dampen the effect of the uh in the proprioceptors as well and it's going to proprioceptors as well and it's going to proprioceptors as well and it's going to dampen the effect of the pain sensor so dampen the effect of the pain sensor so dampen the effect of the pain sensor so the no susceptive input is going to be the no susceptive input is going to be the no susceptive input is going to be suppressed because you've increased the suppressed because you've increased the suppressed because you've increased the sensation of the Theros spors and the sensation of the Theros spors and the sensation of the Theros spors and the proprioceptors from that process we're proprioceptors from that process we're proprioceptors from that process we're going to also increase the big thing is going to also increase the big thing is going to also increase the big thing is increasing blood flow and Metabolism increasing blood flow and Metabolism increasing blood flow and Metabolism delivering more oxygen and nutrients to delivering more oxygen and nutrients to delivering more oxygen and nutrients to the tissues that supports muscle the tissues that supports muscle the tissues that supports muscle function and strength and Mobility it's function and strength and Mobility it's function and strength and Mobility it's really helpful in those Subacute and really helpful in those Subacute and really helpful in those Subacute and chronic muscular scutal conditions to
17:00chronic muscular scutal conditions to chronic muscular scutal conditions to improve tissue elasticity and muscle improve tissue elasticity and muscle improve tissue elasticity and muscle flexibility and oxygenation as well as flexibility and oxygenation as well as flexibility and oxygenation as well as the connective tissue elasticity is just the connective tissue elasticity is just the connective tissue elasticity is just going to decrease the stiffness in the going to decrease the stiffness in the going to decrease the stiffness in the area so heat absolutely has a pain area so heat absolutely has a pain area so heat absolutely has a pain relieving effect as well as an relieving effect as well as an relieving effect as well as an enhancement by providing nutrients that enhancement by providing nutrients that enhancement by providing nutrients that are needed so ice slows things down heat are needed so ice slows things down heat are needed so ice slows things down heat speeds things back up um so you know speeds things back up um so you know speeds things back up um so you know knowing those things as far as on the knowing those things as far as on the knowing those things as far as on the physiological um idea of what those physiological um idea of what those physiological um idea of what those things do can we be somewhat black and things do can we be somewhat black and things do can we be somewhat black and white as far as that goes as far as time white as far as that goes as far as time white as far as that goes as far as time so can I kind of stick to you know so can I kind of stick to you know so can I kind of stick to you know things 6 to 12 hours that's ice and then things 6 to 12 hours that's ice and then things 6 to 12 hours that's ice and then uh heat after I mean is it that simple uh heat after I mean is it that simple uh heat after I mean is it that simple or should we be kind of mirroring these or should we be kind of mirroring these or should we be kind of mirroring these or matching these with diagnosis or matching these with diagnosis or matching these with diagnosis absolutely matching them with diagnosis absolutely matching them with diagnosis absolutely matching them with diagnosis would be helpful we know there are would be helpful we know there are would be helpful we know there are certain things that that ice is better certain things that that ice is better certain things that that ice is better for we also have to to basically ask for we also have to to basically ask for we also have to to basically ask ourself what do I want to do with this ourself what do I want to do with this ourself what do I want to do with this this blood flow at this moment in time this blood flow at this moment in time this blood flow at this moment in time do I want to suppress it a little bit do
18:00do I want to suppress it a little bit do do I want to suppress it a little bit do I want to optimize it and does that I want to optimize it and does that I want to optimize it and does that optimization mean getting a little more optimization mean getting a little more optimization mean getting a little more blood to the area and most of the time blood to the area and most of the time blood to the area and most of the time it's getting more blood to the area it's getting more blood to the area it's getting more blood to the area especially for the number one thing that especially for the number one thing that especially for the number one thing that we treat that's lower back pain that we treat that's lower back pain that we treat that's lower back pain that heat therapy has a ton of evidence heat therapy has a ton of evidence heat therapy has a ton of evidence that's saying when it comes to acute or that's saying when it comes to acute or that's saying when it comes to acute or Subacute or chronic non-specific low Subacute or chronic non-specific low Subacute or chronic non-specific low back pain heat is the way to go back pain heat is the way to go back pain heat is the way to go including the anals of internal medicine including the anals of internal medicine including the anals of internal medicine that said let's use heat therapy it that said let's use heat therapy it that said let's use heat therapy it provides some short-term relief from provides some short-term relief from provides some short-term relief from pain and the disability uh and when you pain and the disability uh and when you pain and the disability uh and when you combine it with other treatments those combine it with other treatments those combine it with other treatments those treatments become more effective you treatments become more effective you treatments become more effective you know just to interject again cuz I'm I'm know just to interject again cuz I'm I'm know just to interject again cuz I'm I'm pretty good at that you are an injector pretty good at that you are an injector pretty good at that you are an injector that was that the February study in 2017 that was that the February study in 2017 that was that the February study in 2017 the Valentine's Day study you know one the Valentine's Day study you know one the Valentine's Day study you know one of those for those of you who remember of those for those of you who remember of those for those of you who remember the anal of internal medicine in 2017 the anal of internal medicine in 2017 the anal of internal medicine in 2017 said for uh acute Subacute chronic low said for uh acute Subacute chronic low said for uh acute Subacute chronic low back pain that we should be in by we back pain that we should be in by we back pain that we should be in by we this is anal of internal medicine this this is anal of internal medicine this this is anal of internal medicine this is across the board Physicians uh we is across the board Physicians uh we is across the board Physicians uh we should be considering uh using should be considering uh using should be considering uh using acupuncture spinal manipulation heat and
19:00acupuncture spinal manipulation heat and acupuncture spinal manipulation heat and massage and you know that's that's the massage and you know that's that's the massage and you know that's that's the standard of care for those types of standard of care for those types of standard of care for those types of lower back pain however did anyone else lower back pain however did anyone else lower back pain however did anyone else see a surge of patients from their see a surge of patients from their see a surge of patients from their primary care doctors just flooding into primary care doctors just flooding into primary care doctors just flooding into Chiropractic opposes because you know we Chiropractic opposes because you know we Chiropractic opposes because you know we get those standards of care but not get those standards of care but not get those standards of care but not everybody follows that uh everybody has everybody follows that uh everybody has everybody follows that uh everybody has their ideas on how to accomplish you their ideas on how to accomplish you their ideas on how to accomplish you know treating lower back pain and they know treating lower back pain and they know treating lower back pain and they don't want to change your habits so don't want to change your habits so don't want to change your habits so here's my question what are you going to here's my question what are you going to here's my question what are you going to do you know in in light of this do you know in in light of this do you know in in light of this information that we should not be using information that we should not be using information that we should not be using ice past 12 hours are you still going to ice past 12 hours are you still going to ice past 12 hours are you still going to be using ice in your clinic for these be using ice in your clinic for these be using ice in your clinic for these patients for three visits for uh three patients for three visits for uh three patients for three visits for uh three visits a week for the next 12 weeks or visits a week for the next 12 weeks or visits a week for the next 12 weeks or can we uh consider using ice at the very can we uh consider using ice at the very can we uh consider using ice at the very beginning and then going to heat after beginning and then going to heat after beginning and then going to heat after so how are you going to change your so how are you going to change your so how are you going to change your practice with this new information well practice with this new information well practice with this new information well what a great point that um it's hard to what a great point that um it's hard to what a great point that um it's hard to do you get used to doing something you do you get used to doing something you do you get used to doing something you stay in that it tends to work for you stay in that it tends to work for you stay in that it tends to work for you but you don't have the evidence to say but you don't have the evidence to say
20:00but you don't have the evidence to say you know it's anecdotal evidence when it you know it's anecdotal evidence when it you know it's anecdotal evidence when it comes to the real scientific evidence comes to the real scientific evidence comes to the real scientific evidence yeah we probably should be using heat yeah we probably should be using heat yeah we probably should be using heat and we look at MDS saying why aren't you and we look at MDS saying why aren't you and we look at MDS saying why aren't you following the guideline by referring to following the guideline by referring to following the guideline by referring to me now but there's a few fingers me now but there's a few fingers me now but there's a few fingers pointing back at us saying well why pointing back at us saying well why pointing back at us saying well why aren't we following the guideline and aren't we following the guideline and aren't we following the guideline and using heat now for lower back pain and using heat now for lower back pain and using heat now for lower back pain and really any uh mechanical type problem really any uh mechanical type problem really any uh mechanical type problem that's not in the very early acute that's not in the very early acute that's not in the very early acute stages once we get into the Subacute and stages once we get into the Subacute and stages once we get into the Subacute and chronic certainly uh for any any chronic certainly uh for any any chronic certainly uh for any any mechanical no susceptive condition like mechanical no susceptive condition like mechanical no susceptive condition like a tendonosis or osteoarthritis once that a tendonosis or osteoarthritis once that a tendonosis or osteoarthritis once that very acute phase is fast for the first very acute phase is fast for the first very acute phase is fast for the first few hours those sprains and strains will few hours those sprains and strains will few hours those sprains and strains will absolutely appreciate heat we also find absolutely appreciate heat we also find absolutely appreciate heat we also find heat uh works well for exercise types of heat uh works well for exercise types of heat uh works well for exercise types of things that it works well before things that it works well before things that it works well before exercise it enhances physical function exercise it enhances physical function exercise it enhances physical function and range of motion flexibility and range of motion flexibility and range of motion flexibility decreases muscle stiffness which reduces decreases muscle stiffness which reduces decreases muscle stiffness which reduces the rate of strain that low-level heat the rate of strain that low-level heat the rate of strain that low-level heat therapy a few hours before intense therapy a few hours before intense therapy a few hours before intense exercise will improve movement and exercise will improve movement and exercise will improve movement and prevent damage during activity ity and prevent damage during activity ity and prevent damage during activity ity and then post exercise it's a little bit of
21:00then post exercise it's a little bit of then post exercise it's a little bit of a coin toss there's a number of studies a coin toss there's a number of studies a coin toss there's a number of studies that say you should ice for delayed to that say you should ice for delayed to that say you should ice for delayed to Onset muscle soreness Doms and other Onset muscle soreness Doms and other Onset muscle soreness Doms and other studies said that you should use heat studies said that you should use heat studies said that you should use heat but really I think the more conclusive but really I think the more conclusive but really I think the more conclusive study a review of 50 studies said that study a review of 50 studies said that study a review of 50 studies said that heat provides the more effective relief heat provides the more effective relief heat provides the more effective relief in the first 24 hours post exercise and in the first 24 hours post exercise and in the first 24 hours post exercise and then the one other thing um is that most then the one other thing um is that most then the one other thing um is that most experts there was a consensus panel that experts there was a consensus panel that experts there was a consensus panel that came up saying when should we use heat came up saying when should we use heat came up saying when should we use heat and that's where a lot of this and that's where a lot of this and that's where a lot of this information came from an international information came from an international information came from an international uh group of experts and four out of five uh group of experts and four out of five uh group of experts and four out of five of them said that heat would be very of them said that heat would be very of them said that heat would be very beneficial for dis Manara as well so not beneficial for dis Manara as well so not beneficial for dis Manara as well so not just the mechanical things we treat but just the mechanical things we treat but just the mechanical things we treat but anytime we want to improve blood flow to anytime we want to improve blood flow to anytime we want to improve blood flow to an area so same kind of question that we an area so same kind of question that we an area so same kind of question that we had for Ice uh when should we use I me had for Ice uh when should we use I me had for Ice uh when should we use I me not when but um how long should we use not when but um how long should we use not when but um how long should we use heat therapy um you know what's what's heat therapy um you know what's what's heat therapy um you know what's what's the safe temperature range and for how the safe temperature range and for how the safe temperature range and for how long yeah this one's a lot more long yeah this one's a lot more long yeah this one's a lot more conclusive it's it's your hot tub so 40° conclusive it's it's your hot tub so 40° conclusive it's it's your hot tub so 40° celi 104 105° celi 104 105° celi 104 105° um it would be the optimal temperatures
22:00um it would be the optimal temperatures um it would be the optimal temperatures it's safe for most of our patients for it's safe for most of our patients for it's safe for most of our patients for superficial heat therapy uh if you want superficial heat therapy uh if you want superficial heat therapy uh if you want to increase tissue temperature that's to increase tissue temperature that's to increase tissue temperature that's going to increase vascularization and going to increase vascularization and going to increase vascularization and depending upon how much you warm that depending upon how much you warm that depending upon how much you warm that tissue determines how much tissue determines how much tissue determines how much vascularization so if you take something vascularization so if you take something vascularization so if you take something to uh the you know below 100° range to uh the you know below 100° range to uh the you know below 100° range below 38° Centigrade you're going to below 38° Centigrade you're going to below 38° Centigrade you're going to have a 27% increase in blood flow if you have a 27% increase in blood flow if you have a 27% increase in blood flow if you take it to to uh 40° which is about 105 take it to to uh 40° which is about 105 take it to to uh 40° which is about 105 you're going to have a 77% Improvement you're going to have a 77% Improvement you're going to have a 77% Improvement in blood flow in the trapezius muscles in blood flow in the trapezius muscles in blood flow in the trapezius muscles where the study was done so that's where the study was done so that's where the study was done so that's optimal and if you really bump it up to optimal and if you really bump it up to optimal and if you really bump it up to 42° uh celius then it's going to be 144 42° uh celius then it's going to be 144 42° uh celius then it's going to be 144 uh% increase in blood flow so it's going uh% increase in blood flow so it's going uh% increase in blood flow so it's going to uh depend upon the thickness of the to uh depend upon the thickness of the to uh depend upon the thickness of the tissue as far as the speed so if you if tissue as far as the speed so if you if tissue as far as the speed so if you if you have a thick tissue with a lot of you have a thick tissue with a lot of you have a thick tissue with a lot of insulation it's going to take longer insulation it's going to take longer insulation it's going to take longer fact 2 cm of subcutaneous fat can take
23:00fact 2 cm of subcutaneous fat can take fact 2 cm of subcutaneous fat can take up to 30 minutes to get the desired up to 30 minutes to get the desired up to 30 minutes to get the desired therapeutic effect so most of the time therapeutic effect so most of the time therapeutic effect so most of the time we say 10 to 20 but if you're on we say 10 to 20 but if you're on we say 10 to 20 but if you're on something that's heavily insulated it's something that's heavily insulated it's something that's heavily insulated it's going to take even longer so for those going to take even longer so for those going to take even longer so for those of you who want to stick around to the of you who want to stick around to the of you who want to stick around to the end of the podcast we will be covering end of the podcast we will be covering end of the podcast we will be covering the conversion from Celsius to uh the conversion from Celsius to uh the conversion from Celsius to uh Fahrenheit uh we'll go over the math Fahrenheit uh we'll go over the math Fahrenheit uh we'll go over the math behind that just if you want to uh bring behind that just if you want to uh bring behind that just if you want to uh bring some numbers to all those some numbers to all those some numbers to all those calculations yeah it's always uh I've calculations yeah it's always uh I've calculations yeah it's always uh I've got a sister who lives in Switzerland got a sister who lives in Switzerland got a sister who lives in Switzerland and she's always you know telling me and she's always you know telling me and she's always you know telling me that temperature I'm like what what does that temperature I'm like what what does that temperature I'm like what what does that even mean uh it's always that even mean uh it's always that even mean uh it's always interesting when you go from our system interesting when you go from our system interesting when you go from our system to the metric system and how much that to the metric system and how much that to the metric system and how much that makes sense anyway uh that's an opinion makes sense anyway uh that's an opinion makes sense anyway uh that's an opinion not a fact uh let's go through uh if you not a fact uh let's go through uh if you not a fact uh let's go through uh if you do have any thoughts on this and I think do have any thoughts on this and I think do have any thoughts on this and I think there are going to be thoughts on this there are going to be thoughts on this there are going to be thoughts on this uh because normally um I get the uh because normally um I get the uh because normally um I get the thoughts I get the feedback from all thoughts I get the feedback from all thoughts I get the feedback from all these podcasts but for this one I am these podcasts but for this one I am these podcasts but for this one I am going to pass it over to Tim so if you going to pass it over to Tim so if you going to pass it over to Tim so if you have any questions opinions or thoughts have any questions opinions or thoughts have any questions opinions or thoughts on Heat versus ice be sure to email Tim
24:00on Heat versus ice be sure to email Tim on Heat versus ice be sure to email Tim tiim C tiim C tiim C o.com he's giving me a look right now o.com he's giving me a look right now o.com he's giving me a look right now but no realistically uh we do like the but no realistically uh we do like the but no realistically uh we do like the feedback um I got some feedback from the feedback um I got some feedback from the feedback um I got some feedback from the last podcast and um it was it was last podcast and um it was it was last podcast and um it was it was towards the eggs and bacon comment that towards the eggs and bacon comment that towards the eggs and bacon comment that I make and I really do appreciate those I make and I really do appreciate those I make and I really do appreciate those things there's so many people that you things there's so many people that you things there's so many people that you know try to pigeon hole us for making a know try to pigeon hole us for making a know try to pigeon hole us for making a comment versus uh you know you know for comment versus uh you know you know for comment versus uh you know you know for the Heat versus ice we're just giving the Heat versus ice we're just giving the Heat versus ice we're just giving you the evidence and we're providing you the evidence and we're providing you the evidence and we're providing some some some context around it that an some some some context around it that an some some some context around it that an evidencebased chiropractor could use um evidencebased chiropractor could use um evidencebased chiropractor could use um whenever we get feedback though that whenever we get feedback though that whenever we get feedback though that fuels the next podcast the next webinar fuels the next podcast the next webinar fuels the next podcast the next webinar so we really do appreciate it um now so we really do appreciate it um now so we really do appreciate it um now let's drive into uh more of the fun let's drive into uh more of the fun let's drive into uh more of the fun aspect of the podcast and I have two aspect of the podcast and I have two aspect of the podcast and I have two questions I'm going to ask them to Tim I questions I'm going to ask them to Tim I questions I'm going to ask them to Tim I have not prepared him at all which makes have not prepared him at all which makes have not prepared him at all which makes it even better um so the two questions it even better um so the two questions it even better um so the two questions uh I'll give you the first one first I uh I'll give you the first one first I uh I'll give you the first one first I don't want to give you time to think don't want to give you time to think don't want to give you time to think about the second one and then I'll give about the second one and then I'll give about the second one and then I'll give you my answer which I have put some
25:00you my answer which I have put some you my answer which I have put some thought into so sorry about that um uh thought into so sorry about that um uh thought into so sorry about that um uh the first one is this one what is one the first one is this one what is one the first one is this one what is one thing now this is professional not thing now this is professional not thing now this is professional not personal it's not that we don't care personal it's not that we don't care personal it's not that we don't care about your personal life but we don't um about your personal life but we don't um about your personal life but we don't um what's the one thing professionally that what's the one thing professionally that what's the one thing professionally that surprise you this year surprise you this year surprise you this year 2024 professionally uh off the cuff as 2024 professionally uh off the cuff as 2024 professionally uh off the cuff as I'm looking through the door at our I'm looking through the door at our I'm looking through the door at our office it would be our team that um as office it would be our team that um as office it would be our team that um as our as our business continues to grow we our as our business continues to grow we our as our business continues to grow we we we've put a lot of time and effort we we've put a lot of time and effort we we've put a lot of time and effort into developing additional resources uh into developing additional resources uh into developing additional resources uh that our team is still so dedicated that that our team is still so dedicated that that our team is still so dedicated that we've got some of the greatest people in we've got some of the greatest people in we've got some of the greatest people in the world and those of you who have the world and those of you who have the world and those of you who have interacted with them certainly interacted with them certainly interacted with them certainly understand that from Becky and sales and understand that from Becky and sales and understand that from Becky and sales and and Kurt moving through Adrien and the and Kurt moving through Adrien and the and Kurt moving through Adrien and the entire onboarding team um they're entire onboarding team um they're entire onboarding team um they're they're tremendous our product team I they're tremendous our product team I they're tremendous our product team I think that's what would surprise me that think that's what would surprise me that think that's what would surprise me that we have a group of people that who we have a group of people that who we have a group of people that who aren't chiropractors who are still aren't chiropractors who are still aren't chiropractors who are still willing to dedicate their lives and willing to dedicate their lives and willing to dedicate their lives and Beyond what they would ever be expected Beyond what they would ever be expected Beyond what they would ever be expected to give to make our profession
26:00to give to make our profession to give to make our profession better yeah um that was my answer I would I would Echo that um in answer I would I would Echo that um in our first year of having the EHR out in our first year of having the EHR out in our first year of having the EHR out in our beta group I have been and we had our beta group I have been and we had our beta group I have been and we had how many beta clinics did we have you how many beta clinics did we have you how many beta clinics did we have you know before we released it uh eight know before we released it uh eight know before we released it uh eight eight so we had we had some diverse eight so we had we had some diverse eight so we had we had some diverse clinics that were using it to begin with clinics that were using it to begin with clinics that were using it to begin with um but the variation in scheduling in um but the variation in scheduling in um but the variation in scheduling in services in Billing services in Billing services in Billing in uh creative coding uh creative in uh creative coding uh creative in uh creative coding uh creative business practices um are all different business practices um are all different business practices um are all different and I I knew we were going to get into and I I knew we were going to get into and I I knew we were going to get into some um clinically diverse situations some um clinically diverse situations some um clinically diverse situations just by nature of the Chiropractic just by nature of the Chiropractic just by nature of the Chiropractic profession I had no idea how diverse our profession I had no idea how diverse our profession I had no idea how diverse our business ecosystem was though I really business ecosystem was though I really business ecosystem was though I really didn't 100% honestly um and you know didn't 100% honestly um and you know didn't 100% honestly um and you know some people would be like well you know some people would be like well you know some people would be like well you know that makes it tough and you you can't that makes it tough and you you can't that makes it tough and you you can't scale a product if everybody's doing scale a product if everybody's doing scale a product if everybody's doing like a different practice um I I just I
27:00like a different practice um I I just I like a different practice um I I just I I I would disagree with that um because I I would disagree with that um because I I would disagree with that um because I think what we're going to learn is I think what we're going to learn is I think what we're going to learn is what works from certain clinics what works from certain clinics what works from certain clinics clinically and business-wise and then clinically and business-wise and then clinically and business-wise and then we're going to be able to provide a we're going to be able to provide a we're going to be able to provide a scalable model for those younger scalable model for those younger scalable model for those younger chiropractors and to show them chiropractors and to show them chiropractors and to show them clinically and accounting Le accounting clinically and accounting Le accounting clinically and accounting Le accounting Le yeah Absol that sounds like Works um Le yeah Absol that sounds like Works um Le yeah Absol that sounds like Works um and to show chiropractors how to and to show chiropractors how to and to show chiropractors how to whatever model they want to choose how whatever model they want to choose how whatever model they want to choose how to make it work for them in the future to make it work for them in the future to make it work for them in the future um so I'm pretty excited for that um um so I'm pretty excited for that um um so I'm pretty excited for that um next one um what are you looking forward next one um what are you looking forward next one um what are you looking forward to next year so 2025 what happens to next year so 2025 what happens to next year so 2025 what happens professionally um for ferus for you or professionally um for ferus for you or professionally um for ferus for you or for CYO however however you want to for CYO however however you want to for CYO however however you want to answer answer answer it um well the new partner search I it um well the new partner search I it um well the new partner search I think would be the big one that's going think would be the big one that's going think would be the big one that's going to be exciting um am I to be exciting um am I to be exciting um am I leaving I would say next year obviously leaving I would say next year obviously leaving I would say next year obviously the thing that dominates really uh every the thing that dominates really uh every the thing that dominates really uh every second of our day is the EHR that our
28:00second of our day is the EHR that our second of our day is the EHR that our our profession has such value and such our profession has such value and such our profession has such value and such Merit and it's not being shouted from Merit and it's not being shouted from Merit and it's not being shouted from the rooftops it's not being appreciated the rooftops it's not being appreciated the rooftops it's not being appreciated the way that it should um I think that the way that it should um I think that the way that it should um I think that we as a profession can truly work we as a profession can truly work we as a profession can truly work together better to harvest data to move together better to harvest data to move together better to harvest data to move that data to decision makers to make our that data to decision makers to make our that data to decision makers to make our profession truly that undeniable best profession truly that undeniable best profession truly that undeniable best choice and I don't think that can be choice and I don't think that can be choice and I don't think that can be done without an EHR that's made by done without an EHR that's made by done without an EHR that's made by chiropractors for chiropractors with an chiropractors for chiropractors with an chiropractors for chiropractors with an evidence-based standpoint and inspired evidence-based standpoint and inspired evidence-based standpoint and inspired and created by those chiropractors in and created by those chiropractors in and created by those chiropractors in that Network and so I'm most excited to that Network and so I'm most excited to that Network and so I'm most excited to see what we as a group are going to see what we as a group are going to see what we as a group are going to accomplish next year to advance our accomplish next year to advance our accomplish next year to advance our profession I think it's going to be a profession I think it's going to be a profession I think it's going to be a GameChanger we're going to break down GameChanger we're going to break down GameChanger we're going to break down some walls the things that we just some walls the things that we just some walls the things that we just talked about why don't MDS refer it's talked about why don't MDS refer it's talked about why don't MDS refer it's because of their personal experience because of their personal experience because of their personal experience that they we see each other's failures that they we see each other's failures that they we see each other's failures we're going to be able to change that we're going to be able to change that we're going to be able to change that process and I couldn't be more excited process and I couldn't be more excited process and I couldn't be more excited about being part of that and being part about being part of that and being part about being part of that and being part of the network that that serves us yeah
29:00of the network that that serves us yeah of the network that that serves us yeah learning from the data is probably my learning from the data is probably my learning from the data is probably my number one um so I'm going to have to I number one um so I'm going to have to I number one um so I'm going to have to I will have to change my answer for this will have to change my answer for this will have to change my answer for this one because you you took my answer uh one because you you took my answer uh one because you you took my answer uh legitimately on that one um 2025 legitimately on that one um 2025 legitimately on that one um 2025 probably the events that I have probably the events that I have probably the events that I have scheduled um I know your events um so scheduled um I know your events um so scheduled um I know your events um so I'm sure you're excited but I and I I'm sure you're excited but I and I I'm sure you're excited but I and I can't speak to yours um I have been an can't speak to yours um I have been an can't speak to yours um I have been an anti-m mastermind person uh since the anti-m mastermind person uh since the anti-m mastermind person uh since the since since I've been in practice since since I've been in practice since since I've been in practice there's been so many masterminds and there's been so many masterminds and there's been so many masterminds and I've always seen them as money grabs and I've always seen them as money grabs and I've always seen them as money grabs and uh kind of exposing people who uh don't uh kind of exposing people who uh don't uh kind of exposing people who uh don't have the information um however um a have the information um however um a have the information um however um a good friend of mine Kevin Christie um good friend of mine Kevin Christie um good friend of mine Kevin Christie um has one coming up and I have just been has one coming up and I have just been has one coming up and I have just been following him for a long time we both following him for a long time we both following him for a long time we both have a similar background in MPI and um have a similar background in MPI and um have a similar background in MPI and um I get to to go into and to do a I get to to go into and to do a I get to to go into and to do a presentation for his group uh just very presentation for his group uh just very presentation for his group uh just very excited to be in uh like-minded people excited to be in uh like-minded people excited to be in uh like-minded people and just to provide my perspective not and just to provide my perspective not and just to provide my perspective not to provide knowledge not to provide um to provide knowledge not to provide um to provide knowledge not to provide um you know the way to do this so the seven you know the way to do this so the seven you know the way to do this so the seven ways to fix all shoulder pain is to
30:00ways to fix all shoulder pain is to ways to fix all shoulder pain is to provide 15 years of perspective and and provide 15 years of perspective and and provide 15 years of perspective and and how I can help them and then man I'll how I can help them and then man I'll how I can help them and then man I'll tell you what uh Parker in March uh you tell you what uh Parker in March uh you tell you what uh Parker in March uh you and I are both going to be at that's a and I are both going to be at that's a and I are both going to be at that's a changing mindset as being in school changing mindset as being in school changing mindset as being in school compared to what they are now uh if you compared to what they are now uh if you compared to what they are now uh if you haven't been to Parker event uh haven't been to Parker event uh haven't been to Parker event uh regardless of your philosophy regardless regardless of your philosophy regardless regardless of your philosophy regardless of where you practice regardless of of where you practice regardless of of where you practice regardless of whatever it is you do you should see it whatever it is you do you should see it whatever it is you do you should see it um it's one of those things that I um it's one of those things that I um it's one of those things that I really like because U they give uh Tim really like because U they give uh Tim really like because U they give uh Tim and I we're not speaking together and I we're not speaking together and I we're not speaking together fortunately um however one of their BW fortunately um however one of their BW fortunately um however one of their BW they get to they give us free reign they they get to they give us free reign they they get to they give us free reign they just give us a stage what do you want to just give us a stage what do you want to just give us a stage what do you want to talk about and I really do appreciate talk about and I really do appreciate talk about and I really do appreciate that that that platform yeah absolutely I I would Echo platform yeah absolutely I I would Echo platform yeah absolutely I I would Echo those as well uh so we're looking those as well uh so we're looking those as well uh so we're looking forward to great things in the years forward to great things in the years forward to great things in the years that follow we're proud to be part of that follow we're proud to be part of that follow we're proud to be part of your team we're proud uh that we can be your team we're proud uh that we can be your team we're proud uh that we can be serving each other and if you haven't serving each other and if you haven't serving each other and if you haven't already if you enjoyed this episode we already if you enjoyed this episode we already if you enjoyed this episode we would encourage you to share it with a would encourage you to share it with a would encourage you to share it with a friend if you learned something new I friend if you learned something new I friend if you learned something new I bet your friend would en enjoy learning
31:00bet your friend would en enjoy learning bet your friend would en enjoy learning something new as well um and let us know something new as well um and let us know something new as well um and let us know what we can talk about in the future to what we can talk about in the future to what we can talk about in the future to make this even more valuable it's about make this even more valuable it's about make this even more valuable it's about pushing our profession forward and you pushing our profession forward and you pushing our profession forward and you can help us spread that word by hitting can help us spread that word by hitting can help us spread that word by hitting the follow button thanks for listening start off 2025 strong listening start off 2025 strong utilizing the best deal kup has ever utilizing the best deal kup has ever utilizing the best deal kup has ever offered $50 off a month for the entire offered $50 off a month for the entire offered $50 off a month for the entire year for 202 $25 you're going to at $50 year for 202 $25 you're going to at $50 year for 202 $25 you're going to at $50 off any plan that means for as low as off any plan that means for as low as off any plan that means for as low as $99 a month you're going to be able to $99 a month you're going to be able to $99 a month you're going to be able to utilize all the new functionality and utilize all the new functionality and utilize all the new functionality and features within Kyo up these features features within Kyo up these features features within Kyo up these features are going to allow you to streamline are going to allow you to streamline are going to allow you to streamline patient care and revolutionize your patient care and revolutionize your patient care and revolutionize your practice with new marketing practices practice with new marketing practices practice with new marketing practices and also new things you can do for your and also new things you can do for your and also new things you can do for your patients to get better outcomes let's patients to get better outcomes let's patients to get better outcomes let's make 2025 a game changer for you and make 2025 a game changer for you and make 2025 a game changer for you and your clinic and join the thousands of your clinic and join the thousands of your clinic and join the thousands of chiropractors around the world that chiropractors around the world that chiropractors around the world that already use KIRO can't wait to have you already use KIRO can't wait to have you already use KIRO can't wait to have you on board