Cold Therapy vs. Heat Therapy for Injuries: Which one?

It’s the age old question relating to sports injuries---“Should I apply heat therapy or cold therapy?” I’m actually surprised at the confusion surrounding this issue. The answer is almost always cold therapy. Heat therapy can actually be detrimental to tissue healing in many cases. To clarify specific issues surrounding this topic, I’ll discuss the appropriate application of both modalities here.
Sports injuries are the result of trauma to your tissue. It could be externally applied by a collision with an opponent or inanimate object. It can also occur independent of an outside source---such as when you role your ankle or twist your knee while changing directions. Trauma to your tissue sets off a physiologic process known as inflammation. As part of the inflammatory process, your body sends specialized cells and proteins to seal off the injured area, destroy damaged tissue and keep out bacteria. This can become problematic as, left unchecked, inflammation can destroy healthy tissue and create a bigger problem than you started with. To prevent this, it is crucial that you minimize inflammation as soon as possible.
Application of ice, more properly known as cryotherapy, decreases the temperature of injured tissue. This helps diminish pain, slow down muscle metabolism, and minimize muscle spasm. As a result---and here’s the key---the inflammatory process is decreased which aides in tissue recovery after trauma. Introduction of heat to the area will have the opposite effect. It increased blood flow to the area and can actually accelerate the inflammatory process in acute injuries. Therefore, any time there is an acute sport injury with swelling or inflammation present, heat is not appropriate.
The application of cold therapy treatment is different depending on the acuity of the sports injury in question. Ice applied right after the injury occurs reduces muscle metabolism and decreases the degree of tissue damage due to inflammation. Later, when the sports injury is in its sub-acute phase, the primary purpose of cold therapy is to relieve pain to help facilitate exercise and activity tolerance.
Hopefully, by now I’ve convinced you to use cold therapy with your acute or sub-acute sports injury. Mode and duration of cold therapy is important. Large, flexible gel ice packs that can surround the joint provide superior skin cooling effects when compared to rigid ice packs. Research articles recommend anywhere from 10-20 minutes 2-4 times a day up to 30-45 min every two hours. I typically suggest that more severe injuries and post-operative patients apply ice more frequently but for the average sports injury 10-20 minutes 2 times a day, especially after activity, is adequate for cold therapy.
Despite its lack of applicability to acute injuries, heat therapy is not without utility in treating certain types of injuries. Heat therapy can be applied for chronic issues such as muscle or joint stiffness or soreness. Heat therapy can also help relax muscles or decrease muscle spasms. In these cases, heat therapy is best applied before exercise to promote blood flow and prepare tissue for use.
Heating pads or hot packs are good heat therapy treaments but I recommend moist heat for maximum efficacy. Try using a hot, wet towel to wrap the area in question. Safely apply moist heat therapy for 15-20 minutes at a time and make sure that you have several layers between your skin and the heating source to avoid burns. Heat therapy should not be applied after exercise. Even with chronic injuries, ice is the better choice after activity.
Cold therapy and heat therapy both have useful applications when dealing with sports injury. Make sure you select the correct modality for your injury and always apply it safely. Cold temperatures can burn your skin just as easily as hot temperatures if not applied properly. If you develop a fever or your sports injury does not improve after a reasonable time, be sure to see your physician to rule out something more serious.

Article Summary:
Discover whether heat or cold therapy is the best treatment for your sports injury. Applying ice is the best approach directly after an injury occurs or after finishing your athletic activity. Heat is effective treatment for chronic pain or helping to promote blood flow before activity begins. Make sure to select the correct treatment for the situation to avoid detrimental effects.

Resource Box:
Trina Rowe is Doctor of Physical Therapy (DPT), a Sports Clinical Specialist (SCS) and a Certified Strength and Conditioning Specialist (CSCS). Trina is part of the physical therapy staff at the Santa Monica, CA Bauerfeind Performance Center. If you live in the Los Angeles area, you can visit the Bauerfeind Performance Center to receive expert advice on treating your sports injuries. Visit the Bauerfeind Performance Center Website for more information at http://raisingyourpotential.com.

Your Best Treatment for Tennis Elbow Pain

Tennis Elbow is a common sports injury---even among non-players.  It causes pain that limits your ability to play sports, or even do normal daily activities in some cases.  Despite the fact that Tennis Elbow is a common problem, very few of my clients really understand what it is or what the proper sports therapy is for this condition.

            Tennis elbow, known properly as lateral epicondylitis, is inflammation and pain of the lateral forearm near the elbow. In some cases, tearing of the muscle actually occurs from a sports injury. Lateral epicondylitis usually results from overuse of the extensor muscles that insert onto the lateral epicondyle.  A commonly implicated muscle is the extensor carpi radialis.       

            Despite the location of the pain being at the elbow, lateral epicondylitis is mostly influenced by what is going on at the wrist. The muscles that attach to the lateral epicondyle extend the wrist (like on a backswing in tennis) and assist with turning of the hand (like when turning a door knob).  They also function to stabilize the wrist during times when and external force is acting on the wrist but the wrist itself is not moving. 

            The first sports therapy treatment for Tennis Elbow pain you should perform is to rest the muscles of your forearm and ice the area to decrease inflammation. Identify the activity that brought the elbow pain on (it is usually a sports injury caused from a repetitive motion like a tennis swing---hence the name), and avoid that activity until the pain resolves.

The next treatment for Tennis Elbow you should perform is to stretch the muscles—gently. Extend your arm straight out in front of you and bend your wrist so that your fingers point straight down. Use your opposite hand to apply pressure and push the fingers of your extended arm toward your body. Hold for 30 seconds x 3 on each side. Don’t be overly aggressive the sports therapy in the beginning or you may further damage tissue that is already irritated.

            Long-term sports therapy of this issue is important to prevent return of  Tennis Elbow pain. Strengthening of forearm muscles can increase their tolerance to activity and make them less susceptible to sports injury. Consider wrist extension curls with a 1-2# weight or theraband resistance.

A Bauerfeind brace like the Epitrain can be another effective sports therapy treatment for Tennis Elbow.  The brace will support the joint and minimize impact of forces on the joint.  Also look at your swing form if you notice recurrent bouts of  elbow pain. It may be worthwhile to consult with a tennis pro who can evaluate your technique and suggest modifications that will improve your swing mechanics.

            Finally, don’t neglect the important role that your equipment plays in managing lateral epicondylitis and avoiding sports injury. I recommend that my patients who play tennis modify their racquet type, string type and string tension to decrease the amount of force transferred from the racquet to the arm.  Racquets with vibration dampening technology built in are a good foundation piece. Combine that with either natural gut or multifilament synthetic strings strung at the lower end of the tension range of your racquet to minimize impact forces on the arm and reduce the risk of sports injury. Avoid polyester strings at all costs if you are injured because though they perform well they are bad news for people with Tennis Elbow or shoulder pain.

For best results, take a multifaceted approach with treatment for tennis elbow.  Rest is important but you shouldn’t expect the problem to go a way permanently if you don’t treat the underlying causes of this sports injury. When in doubt, seek advice from a medical professional trained in sports therapy.

Article Summary: Dr. Trina Rowe describes the causes and symptoms of Tennis Elbow to help you reduce the risk of this common sports injury.  With proper sports therapy, medical aids and improved sports equipment, you can alleviate this painful condition.

Resource Box:
Trina Rowe is Doctor of Physical Therapy (DPT), a Sports Clinical Specialist (SCS) and a Certified Strength and Conditioning Specialist (CSCS). Trina is part of the physical therapy staff at the Santa Monica, CA Bauerfeind Performance Center.  Bauerfeind provides advanced sportstherapy and sports injury treatment for active clients in the Los Angeles area. Visit the Bauerfeind Performance Center Website for more information at http://raisingyourpotential.com.