Therapeutic Application of Hot Packs

Hot Packs are a way of transferring heat to the patient by conduction. 

We want to apply hot packs to relieve painful musculoskeletal disorders, bursitis or tendinitis in the chronic stages, arthritis and joint pain, as well as subacute and chronic traumatic and inflammatory conditions. 

Hot packs are also used prior to electrical stimulation and other treatments.

Hot packs come in a variety of styles and sizes and the correct one should be selected for the body area to be treated.  Some sizes and styles you may find are listed below.

A) Myofacial  
B) 10" x 24"
C) 10" x 18"
D) Standard
E) Half size
F) Oversize
G) Knee/Shoulder
H) Cervical



Hot packs need to be cared for appropriately in order to deliver a quality treatment.  The temperature in the Hydrocollator should be between 165 and 170 degrees F.  New packs must be soaked for 24 hours before placing them in the Hydrocollator and they should be left in the unit for at least 5 minutes before using.

Packs must be completely submerged in water while in the hydrocollator and should be cleaned or replaced as needed.  The hydrocollator should also be cleaned as needed or once a month with alcohol.  The outside can be cleaned with mineral oil and alcohol.

Remember to have tongs handy for removal of the hot packs as well as towels or pack covers to cover the packs and dry the client. 

Before applying the hot packs we must check for any contraindications, such as:

  1. Impaired Sensation
  2. Impaired Circulation
  3. Dermatological Conditions
  4. Open Wounds
  5. Acute Inflammatory Conditions that may be aggrevated by heat
  6. Fever which may also be elevated further by heating
  7. Malignancies which may matastasize due to increased blood flow
  8. Active Bleeding - sort of a duh!
  9. Cardiac Insufficiency - Heart may not be able to handle additional stress produced by heat
  10. Extremely old adults and children <4 years old.  They have unreliable thermoregulatory systems
  11. Clients devitalized by x-ray therapy

Additional precautions that should be lloked for are Existing Edema which may be aggrevated by heating and clients who are confused or obtunded.

Hot Pack Treatment

Here's some steps for administering a Hot Pack Treatment:

  • Prepare materials, equipment, and area - Remember you'll need the hot packs, towels or pack covers for the hot packs, plastic sheeting to hold in the heat, a timer, a thermometer to check water temperature in the hydrocollator, pillows to aid in positioning, and sheets to properly drape the client.
  • Wash your hands!
  • You can position the client now or explain the procedure to the client and then position the client.  Be aware of any contraindications in case you need to use an alternate position.  When explaining the procedure to the client be sure to let them know that they should feel a warm, comfortable sensation.  They should not feel an increase in pain, hot spots, dizziness or throbbing.  Also note if they are having any difficulty breathing or feelings of nausea. 
    • If client feels any of these things the treatment should be stopped by removing the hot packs.  You can increase the number of layers used until heat can be tolerated without uncomfortable feelings.
  • Check for any contraindications.
  • Visually inspect the area to be treated.
    • Ensure area is free from infections, lesions, or other precautionary conditions
    • Palpate the area to be sure it is free from inadequate circulation and sensation or other precautionary conditions
  • Select hot pack from hydrocollator appropriate for the treatment to be given. 
    • Make sure the water temp is between 165 and 170 degrees F.  If it is below that temperature the treatment should be postponed until water reaches correct temp.  If it is too high try leaving the lid open for a little bit so it can cool a little.
    • Remember to lift the hot pack out with tongs by the little handle thingies.
    • Allow excess water to drain from the pack.
  • Wrap hot pack in no less than 6 layers of toweling, remember that the pack covers are equal to 4 layers (I think???)
  • Apply the hot pack to the area to be treated and cover the heat pack with a plastic sheeting.
  • Provide a bell for the client in case the pack becomes too hot.  Inform the client to remove the pack if it becomes too hot during the treatment.
  • Set timer for prescribed time and monitor the client during the treatment.  Usually 20 minutes.
  • Remove the hot pack when the treatment is done, remembering to leave the draping over the client while you clean the area and return the hot pack to the hydrocollator.  Let them remain in the treatment position as they can become light headed and dizzy after the treatment.
  • Dry the treated area and inspect for quality of treatment.  A light to moderate erythema should be observed.
  • Document treatment appropriately