Heat or Ice? When to use which?

February 17, 2010

When should you use heat or ice therapy? The answer is – it depends. In general, heat therapy is for chronic conditions and ice is useful in acute situations.

If you recently sustained an injury or aggravated an old injury, ice should be applied for a period of 15mins each time for the first 3 days. If you feel your muscles are feeling tight and stiff, a hot pack on the muscles will help to relieve the tightness.

This spectrum of acute to chronic looks at the duration since injury. If the injury is sustained within 36 hours, it is considered to be in the acute stage. At this stage the inflammation process is ongoing. Ice will help to bring down the inflammation and swelling so that the injury can heal better. Note that applying heat to this stage will increase the blood circulation, inflammation and hence swelling.

There are 2 common scenarios that cause pain, making you reach for that heat/ice pack. One of them is the acute injury (for example a fall, twisting movement or direct blow that is immediately painful) and the other is the chronic injury (happened over a period of time or from an acute injury that failed to heal). Each scenario requires a different approach to reducing your pain and speeding up your recovery.

Acute Injuries

It might be that you have just sprained your ankle playing soccer, shut your fingers in the car door or fractured your hand. All these are examples of acute injuries and will show the following signs:

Sharp, severe pain
Swelling
Redness
Increased warmth
Restricted joint movement
Unable to put weight through the structure (e.g. leg, ankle, wrist etc).

Flickr: Kyle May

For these types of injuries, we recommend managing the pain, inflammation, and swelling immediately with the use of ice. The ice cools the tissues, reduces tissue metabolic rate and constricts the blood vessels helping reduce further damage from occurring.

There are many ways of applying ice like using an ice pack; wrapping ice cubes in a wet towel or using a bag of frozen peas (sometimes that is the only thing on hand!). The cold agent should be in contact with the area for up to 20 minutes at a time and re-applied every 2-3 hours for around 3-5 days or until the swelling settles.

How does ice work?

1. Decreasing the pain

There are a few proposed theories regarding how ice decreases pain and it is possible that a combination of some of them can cause pain relief.

Decreased nerve transmission in pain fibres
Cold reduces the activity of free nerve endings
Cold raises the pain threshold
Cold causes a release in endorphins
Cold sensations over-ride the pain sensations

2. Reducing swelling

Ice cools the surface of the skin and its underlying tissues, causing narrowing of the blood vessels. This narrowing leads to a decrease in the amount of blood delivered to the area and subsequently reduces the amount of swelling. After a few minutes, the blood vessels re-open allowing blood to return to the area. The narrowing and opening repeat in cycles.

The decrease in swelling also allows more movement in the area and lessens the loss of function associated with the injury. Pain is also reduced as pressure from the swelling lessens. Chemicals that intensify the pain are released into the bloodstream when tissues are injured, thus the narrowing of the vessels help to minimize this release and pain.

3. Decreasing metabolic rate

Ice reduces the metabolic rate and oxygen requirements of the cells. Thus, even with the decreased blood flow and oxygen delivery that comes with narrowing of the vessels, the risk of cell death will be lessened. This prevents further injury.

Sub-acute phase

A few days following an acute injury, the pain and swelling may have decreased so much that there may be no sign of the original injury. However, the tissues are still in the process of recovery and will still benefit from modifying your activities (less vigorous) as well as using both ice and heat alternatively. This means to apply ice for 10 minutes, followed immediately by 10 minutes of heat.

How does this work?

Doing this will cause massive increases in blood flow to the area as the narrowing caused by cooling is reversed when heat is applied, resulting in an influx of blood to the damaged tissues. The increased blood flow to the area provides proteins, nutrients and oxygen for better healing. It also helps remove the products of inflammation and reduce residual swelling.
An important point to note is to ensure that inflammation has stopped before applying this technique. That means that the area should not be red, and should not be warm to touch.

Chronic Injuries

Flickr: Capture Queen

These are injuries resulting usually from overuse where some tissues are tight and inflexible causing aches. Examples include tennis elbow, golfer’s elbow, patella tendinitis and Achilles tendinopathy. Symptoms include pain when performing activities, a dull ache at rest and swelling. Occasionally, an acute injury is not allowed the time to heal properly and muscles spasm to protect it.

In order to treat these, heat should be used to help relax tight, aching muscles and joints, increase the extensibility of ligaments and tendons and promote blood flow to the area. Heat can also be used before exercise in chronic injuries to warm the muscles and increase flexibility.

Heat can be applied to the area in the form of heat packs, a warm damp towel, hot water bottles or heat rubs. If using a heat pack or hot water bottle, ensure a suitable layer of protection is placed over the skin to prevent burns. The heat should be applied for 15-20 minutes.

How does heat work?

Heat applied on the skin increases the temperature of the skin and the underlying tissues. This in turn opens up the blood vessels like your ateries, allowing more blood to flow into the area. This increase flow helps to remove waste products from cells and deliver more nutrients, relaxing tissues. The increased temperature of the blood also warms up surrounding tissues. Heat also has an effect of increasing flexibility of the soft tissues.

Both heat and ice are cheap, easy to use and effective ways of speeding up recovery when used correctly. Besides managing your injuries with these modalities, it may be a good idea to consult a physiotherapist in helping you rehabilitate and/or prevent the same injuries from occurring.

Written by MCR · Filed Under Treatment Option, Treatment Options | Comments

Tips to Run Pain Free

January 10, 2010

Recently our physiotherapist, Lenia, was featured in Shape magazine Jan 2010. Here is an excerpt from the article.

Shin splints are caused by weak shin muscles or faulty running biomechanics while plantar fasciitisis the result of tight calf muscles that reduce the foot's ability to absorb shock. Here are some tips to stay on track. Read more

Written by chyetuan.chng · Filed Under Exercises/Tools, Injury Prevention, Running, Sports Injury | Comments

Train Proprioception to Prevent Sprains

December 17, 2009

Hi, I hear from my personal trainer that i need to train my proprioception because of my ankle sprains. What is proprioception and how is it relevant to my ankle problem? – John Koh

What is Proprioception? Read more

Written by lenia.teo · Filed Under Ankle and Foot, Have A Question?, Injury Management, Injury Prevention, Sports Injury | Comments

Q angle and knee pain

November 25, 2009

What is Q angle?

The Q angle describes the angle of the knee from a frontal view. The Q angle gives an idea how the thigh muscles functions to move the knee and also how the knee cap (patella) tracks in the groove of the knee joint. A normal knee cap should move up and down within the groove with flexion and extension of the knee. When the Q angle is excessive, the knee cap tends to track out of alignment and hence causes wear and tear (degeneration) of the cartilage behind the knee cap.

What is the normal Q angle? The normal Q angle measured in standing is about 15 degrees and anything more than that is considered a risk factor for knee injuries. Ladies tend to have a wider Q angle due to their wider pelvis compared to their males.

Q-angle

How to measure Q angle? The Q angle is an intersection of two lines. First line joins the ASIS (bony protrusion in the front of the pelvis) to the middle of the patella. Second line runs from the protrusion on the top of the shin bone (tibial tuberosity) below the patella and upwards through the middle of the knee cap.

Common injuries related to a wide Q angle:

Iliotibial band friction syndrome (ITBFS)
Anterior knee pain or Patella Femoral Pain Syndrome (PFPS)
Anterior cruciate ligament injury (ACL)

Injuries because of an excessive Q angle can be categorised into 3 main reasons.

1. Muscle imbalance :

A large Q angle pulls the knee cap outwards due to the stronger lateral pull from the quadriceps and tight ITB. Coupled with a weakness of the inner aspect of the quadriceps (Vastus Medialis Oblique, VMO) the knee cap will track laterally instead of smoothly up and down within the knee groove. This maltracking causes the cartilage behind the knee to wear off or degenerate and hence the pain.

2. Biomechanical compensation:

An excessive Q angle can alter the movement pattern especially in the foot. The knee will tend to point inwards (valgus or knock-knee appearance) which encourages the foot to roll inwards (pronates). Over-pronation can lead to a number of injuries especially in runners.

3. Joint laxity/instability:

When the knee point inwards, the ligaments on the inner aspect of the knee gets overstretched and lax, therefore compromising the stability of the knee joint. The Anterior Cruciate Ligament (ACL) also undergoes a lot of stress in this position. Interestingly the larger Q angle in females has been attributed as a main reason why females are at a higher risk of sustaining an ACL injury.

How to manage a wide Q-angle?

You can reduce the risk of injuries by targeting the reasons above.

Muscle imbalance: Stretching on the ITB, strengthening the VMO and Glut medius to enable proper tracking of the knee cap.

Biomechanics: Get a customised orthotics to control excessive pronation and reduce the stress to the knee.

Joint Laxity/Stability: Balancing exercises to train knee proprioception and stability.

Written by lenia.teo · Filed Under Featured, Injury Prevention, Knee, Netball, Running, Soccer, Sports Injury, Women & Sports | Comments

Stretches for Swimmers

October 23, 2009

Muscle flexibility is very important in swimming as events are won by milliseconds. A flexible body will help to improve your swimming performance by achieving maximal propulsion from each stroke. Here are some recommended stretches that can be done to improve your flexibility. Read more

Written by chyetuan.chng · Filed Under Exercises/Tools, Injury Prevention, Sports Injury, Swimming | Comments

Ladies! Stronger Thighs, Lesser Knee Pain

September 30, 2009

Knee pain is one of the most common, if not the most common complain of pain in the elderly. In the USA, nearly 4 million sufferers of knee pain above the age of 45 are ladies.

Why are females more prone?

There are quite a number of reasons why ladies are more pre-disposed to developing knee pain. The reasons range from wider hips to increased Q-angle, tighter ilio-tibial band (ITB) to weaker physique. However, what is the most common cause of knee pain? The answer lies in the weakness of the quadriceps or thigh muscles. Read more

Written by Calvin Sim · Filed Under Injury Prevention, Knee, Knee (NonSport), Treatment Option, Uncategorized | Comments

What can i do for a hamstring “pull”

August 31, 2009

Pulling one’s hamstring is one of the most common soccer injuries and the most common cause is the lack of proper stretching before playing. When one says that they pull their hamstring, what it means is that one has strained or slightly torn their hamstring. Most soccer players think that by just resting for about 2-4 weeks without playing is all that is required to recover. However, this is not true. If you do nothing about the strain, you are at a higher risk of sustaining the same injury.
Read more

Written by Calvin Sim · Filed Under Exercises/Tools, Injury Prevention, Rugby, Running, Soccer, Sports Injury, Thigh, Treatment Option | Comments

TRX Suspension Training

August 9, 2009

Back2Sports was recently interviewed about TRX (Straits Times, 8 August 2009, ‘Traveling Gym’). We basically said that it is a great way to increase the intensity of your exercises but we strongly recommend close supervision during the early stages of training.

Written by chyetuan.chng · Filed Under Exercises/Tools, Injury Prevention | Comments

Warning! Is this how you stretch your hamstring?

August 5, 2009

Stretch A
click for larger view

Stretch A may aggravate your pain if you have a history of lower back nerve injury. When you bend from your hip with your knee straight the tension is at the back of your thigh, behind the knee. This focuses on the lower hamstrings and also pulls onto the sciatic nerve which originates from the lower back.

Written by chyetuan.chng · Filed Under Exercises/Tools, Injury Prevention, Knee, Sports Injury, Thigh | Comments

How to tell the difference between an ankle sprain and a fracture

July 27, 2009

This is a brief video on how to tell the difference between an ankle sprain and an ankle fracture. If you are thinking of taking an X-ray to confirm if it is a fracture, the Ottawa Ankle Rules has a guideline to check if you need an x-ray.