HOT OR COLD?

HOT OR COLD?

By Brad Williamson BSc. (Physiotherapy) (Dist.) APAM

 

Confused as to whether or not ice or heat is right for your injury? Be confused no more! Let us fill you in on everything you need to know! 

Have you found yourself in this scenario before; you or a friend has sustained an injury, let’s say a sprained ankle or pulled a muscle, it’s painful, swollen and angry looking. You know that injuries of this sort benefit from ice or heat, but which one?

 

Well wonder no more! This article aims to un-muddy the waters of acute injury management so that you have the tools to optimally manage the next injury you see. This article pertains to musculoskeletal injuries, usually sustained through sporting endeavours, and is not necessarily applicable to more serious injuries. In such a case, medical help should be sought.

 

However, if one sustains an acute sporting injury that does not necessitate immediate medical attention then ICE is the weapon of choice. This is because upon sustaining an injury, the affected tissues are damaged to a certain extent. The response to this cellular damage is inflammation, a rapid cascade of chemical release and cellular signalling that produce five cardinal signs; pain, swelling, heat, redness and loss of function. Sound familiar?

Ice assists in reducing pain and swelling to a degree across the first 48 hours post-injury

Research demonstrates that application of ice assists in reducing pain associated with inflammation and can reduce swelling to a degree, although this is contentious(1). It also impacts the redness and heat by mitigating blood flow to the area although these elements of inflammation are usually of less concern.

 

To be most effective ice should be crushed in a wet flannel and applied to the affected area as this allows maximum cooling. In all cases actual ice, whether in a plastic bag or wet flannel, is preferable to gel ice packs as they tend to warm much faster. Once the ice is prepared it should be applied periodically in 20 minute bursts over the first 48 hours. It is important to remove the ice for periods and ensure there is a layer of tissue or flannel over the skin to prevent ice burns.

Apply ice for 20 minute periods across the first 48 hours

So, when does heat come into the picture? Heat is more effective in the later stages of an injury where muscle tightness, spasm and stiffness are the primary complaints. Heat is not recommended in the presence of inflammation as it may exacerbate the inflammatory process. Depending on the injury your physiotherapist will advise you as to the best exercises to perform after using your heat pack to lengthen muscles and loosen joints.

Wheat packs are a great way of applying heat therapy with most requiring between 1-2 minutes in the microwave, although be sure to follow the instructions on your particular heat pack. Again, it is important to protect the skin by leaving a thin layer of fabric between the skin and heat source. With heat therapy ‘more is more’, the research recommends continuous heat application (8 hours) for pain relief in chronic low back pain (2). So, don’t be afraid to make the heat pack your new best friend for a while!

I hope this quick write-up clears up any confusion out there about when to use which modality and allows you to get your recovery started the right way. With any injury it is important for prompt recovery and long-term health to be professionally assessed and treated, so if you or a friend has sustained such an injury book in today to ensure your recovery is 100%!

 

References

1. Bleakley C, McDonough S, MacAuley D. The Use of Ice in the Treatment of Acute Soft-Tissue Injury: A Systematic Review of Randomized Controlled Trials. 2004. ACSM; Vol32:(1). 

2. French, S. D., Cameron, M., Walker, B. F., Reggars, J. W. & Esterman, A. J. Superficial heat or cold for low back pain. Cochrane Database of Systemic Reviews, Issue 2. Art. No.: CD004750

The myth of the straight back

The myth of the straight back

By Brad Williamson BSc. (Physiotherapy) Dist.

The myth of the straight back

Are you sitting TOO straight?

How many times have you been told ‘sit up straight!’? I can guarantee it is a lot more than you have been told to slump! However, the current back pain and posture research does not favour the social infatuation of maintaining a ruler-straight spine in pursuit of a healthy back.

 

Whilst there are many unanswered questions pertaining to the cause and treatment of back pain, there is a general consensus that posture is not a one-size-fitsall scenario. So why is the myth of the straight back touted as healthy back behaviour? 

It is a combination of factors; the first being that a straight back while sitting is easier on the eye than a rounded back, an idea popularised in the 20th century. This is why you probably received this piece of ‘wisdom’ regularly from one of your elders!

Secondly, and most importantly, spinal mechanics are not widely understood. As a result many people believe that postures in which the low back to bends predispose the back to damage. This, however, is not supported by the scientific literature(1).

Human bodies are well constructed pieces of kit, refined over millions of years maintaining characteristics that benefit us and weeding out those that do not. Keeping this is in mind, it is no coincidence that the low back (lumbar spine) is highly mobile. This is because it is supposed to move! If it were supposed to be a rigid pole, we would not have the freedom of movement that it offers. Not only is the lumbar spine able to move, it needs to move. The vast majority of successful low back pain rehabilitation programs assist recovery through the use of movement and exercise. Motion is lotion ladies and gentlemen. 

As aforementioned posture is not a one-stop-shop, the optimum posture varies between individuals due to a whole host of factors. A sub-group of people with back pain develop said pain as a result of maintaining a straight spine at all times, this pattern is referred to as an active extensor pattern (1,2). Basically, by maintaining a straight back all day, everyday the muscles of the low back are constantly overactive. These muscles impart direct compression to the joints of the low back during activities that high levels of muscle activity and joint loading are not required. Having the low back musculature working constantly to keep the back straight at all times is akin to red-lining your car, after a while it will fatigue! 

To summarise, the purpose of this piece is to promote natural movement of the spine, utilising the full range of motion available to us and dispelling misconceptions about spinal mechanics. There are times however, when it is important to recruit the musculature to maintain a strong, neutral spine and this is when the back is being placed under external load. This does not mean that bending the back in other situations is unhealthy, I think we have explored that it is in fact built to bend!

If you have back pain it is important to be professionally assessed in order to identify the specific factors related to you and your pain. This allows for the development of an individualised treatment program facilitating your return to being pain free. So book in today to start your path back to being 100%!

 

References

1. Dankaerts W, O’Sullivan PB, Burnett A, Straker L. Differences in Sitting

Postures are Associated With Nonspecific Chronic Low Back Pain Disorders

When Patients Are Subclassified. Spine (Phila Pa 1976). 2006 Mar

15;31(6):698-704.

2. O’Sullivan PB. Diagnosis and classification of chronic low back pain disorders:

maladaptive movement and motor control impairments as underlying

mechanism. Man Ther. 2005 Nov;10(4):242-55.

Muscle strains; to stretch or not to stretch?

Muscle strains; to stretch or not to stretch?

By Brad Williamson, BSc. Physiotherapy (Dist.) APAM

Short answer is both! It’s all about timing, in the early stages it is advisable to avoid stretching as this will strain the injured fibres further, preventing the reparation process and thereby slow the initial healing process. As the strained fibres heal and return to sport is approaching adequate muscle flexibility and strength are vital to prevent a similar incident happening upon returning to competition. At this point your physiotherapist should assist you in regaining requisite flexibility, strength and confidence through appropriate exercises, stretches and hands-on techniques.

The approaches we use at Jenkins Physiotherapy are backed by research and our approach to muscle strains is no different. Researchers in Sweden almost halved the time to return to professional competition after a hamstring tear in professional footballers with a simple rehabilitation program, get started with us today to secure your spot on the pitch all season long!

If you have recently injured a muscle ensure you undertake appropriate acute injury measures including ice, rest, elevation, compression and have a thorough professional assessment so book now to facilitate rapid recovery and prevent further time off! 

References:

o   Askling CM, Tengvar M, Thorstensson A. Acute hamstring injuries in Swedish elite football; A prospective randomised controlled clinical trial comparing two rehabilitation protocols. Br J Sports Med 2013;47:953–959.