A HEATED TOPIC ABOUT COLD THERAPY

Redfern Physio • Jul 22, 2019

I want you to think back to the last injury you had. Did you have an initial impulse to put an ice pack on it? Or did you prepare a heat pack in the microwave? Well, different types of injuries require different types of management.

We all know that both cold and hot therapy can help treat many injuries. They are both quick, drug-free, inexpensive and easy self-treatment options. But do you know when it’s appropriate to use a cold or hot pack to treat a problem? Here I will explain when you should use hot or cold treatments.

Firstly, how does it work?

  • In the initial stages following an injury the immune system responds with an inflammatory response which sees an increase of blood flow to the area. This causes a rush of white blood cells, antibodies, proteins and other fluids to the injury site. This increase in swelling and inflammation causes the pain. Too much swelling will slow down the healing, be uncomfortable and also limit joint range of motion.
  • Ice reduces tissue temperature by slowing down metabolic activity around the injured area and as a result, decreases tissue damage. This will also lessen the pain by numbing the nerve endings involved.
  • Heat increases the surfaces temperature of the skin, which stimulates your sensory receptors and as a result, blocks the pain signals being sent to the brain. Heat also makes your muscle tissue more elastic, which releases tension and increases blood flow. Therefore providing oxygen and more nutrients to the painful area to aid in the healing process and restore range of movement.

 

How do you know which one to choose?

 

 

Cold Therapy:

 

  • Think ‘acute’ sports injuries. These include sprained ankles, torn muscles/ligaments and bruises. When an acute injury occurs they become red, swollen and hot due to damaged muscle tissues.
  • Get it on fast! Ice is most effective immediately following an injury and loses its affect significantly after approximately 48hours. The sooner you get it on; there is a greater chance of reducing swelling and minimising inflammation.
  • What form of ice? Ice therapy includes raw ice, gel packs (used with a towel to reduce intensity), ice baths or the trusty bag of peas. The most effective method is the use of crushed ice in a bag applied to the injury site.
  • You can purchase gel packs that turn into ice in your freezer or, to make things quick and easy on the sideline of a game, use instant ice packs, which are designed to turn cold instantly with a simple squeeze.
  • A commercial device such as a Game Ready is commonly used in an outpatient setting. It provides intermittent compression whilst delivering cryotherapy (cold therapy) to the injury site. This is the best way to deliver cold and compression therapy to an injured site and is used commonly by the world’s best athletes. Redfern Physiotherapy is equipped with its very own Game Ready machine to help manage your acute injuries!
  • Did you know? Ice has been shown to be more effective than gels (a common item in a sports parents freezer) at reducing skin surface temperature. It has the ability to absorb more heat as it goes through a state of physical change – melting from ice to water.

 

Hot Therapy:

 

  • Think ‘chronic’ sports injuries. Is best used for consistent pain (pain lasting from weeks to months), stiffness, muscle spasms, whiplash, arthritis and to loosen and relax tired muscles. However, it should not be used directly after exercise.
  • No Exceptions! Refrain from using heat for at least 48-72 hours after a new injury has occurred. If swelling or redness to the skin occurs following an injury then do not apply heat.
  • Signs of a chronic injury include a dull ache when at rest or pain when performing an activity.
  • Ways to heat it up? Heat therapy includes wheat packs, hot water bottles, a sauna or hot bath. Deep Heat and Tiger Balm are often used to provide a neurological distraction due to their warming sensation on the skin only.
  • Did you know? The continuous application of low-level heat eased low back pain better than two common over the counter painkillers.

 

Friendly reminders:

 

  • How long? Whether hot or cold, be sure to keep exposure to 20 minutes per session. You should wait at least 1 hour between treatments (starting when you take off the ice until you reapply the ice).
  • Protect your skin from burns by wrapping packs in a towel or cloth before applying.
  • What a mess! A Ziploc bag is a great solution for keeping ice therapy mess-free! No bag or cloth to use? Perform an ice massage by constantly moving the ice around the area of discomfort.
  • The Price is right! A common acronym to remember what steps to take in the initial stages of an acute injury is
    • Protect = Protection from further damage
    • Rest = rest to avoid prolonged irritation
    • Ice = To control pain, bleeding and edema (swelling)
    • Compression = For support and to control edema
    • Elevation = Place the injury site above the heart to drain fluid away from the area.

As a general rule of thumb, you should use heat on stiff, aching and chronic injuries and ice on acute or new injuries that occur suddenly. Remember! Ice and heat provide symptom relief but are not going to treat the underlying issue. To find out how to recover from your acute or chronic injury, book an appointment with our team of physiotherapists to help you follow a customized rehabilitation management plan.

By Eddie Farrah 03 Aug, 2023
Hamstring injuries are a common injury among athletes, particularly those involved in sports that require sudden changes of direction, explosive acceleration, and high-speed running. Rehabilitation after a hamstring injury can be a challenging process, and it is essential to understand the special considerations involved in the rehabilitation process to ensure optimal outcomes. The latest evidence has shown hamstring injuries require assessment and treatment of multiple areas of the body such as lumbopelvic control, posterior chain strength and stability and hamstring strength in a fatigued state. Due to the complex nature of hamstring injuries and their relationship with the aforementioned areas, they have a high recurrence rate. In this blog, we will discuss the special considerations for hamstring rehabilitation. The Importance of Early Intervention One of the most critical special considerations for hamstring rehabilitation is the importance of early intervention. Delaying rehabilitation can prolong the recovery time and increase the risk of re-injury. Therefore, it is essential to initiate rehabilitation as soon as possible after the injury. Gradual Progression Another important consideration for hamstring rehabilitation is the need for gradual progression. It is crucial to progress rehabilitation exercises slowly and steadily, focusing on regaining strength, flexibility, and mobility while avoiding overloading the hamstring muscles. Eccentric Exercises Eccentric exercises are particularly effective for hamstring rehabilitation. These exercises involve lengthening the muscle while it is under tension, which helps to promote muscle fibre remodelling and healing. Eccentric exercises can also help to improve muscle strength and reduce the likelihood of recurrence. Sports-Specific Rehabilitation Rehabilitation exercises should be tailored to the specific requirements of the athlete's sport. For example, athletes involved in sports that require high-speed running may benefit from incorporating high-speed running drills into their rehabilitation program. This approach can help to improve neuromuscular control, endurance, and power. How Can High-Speed Running Help with Hamstring Rehabilitation? The use of high-speed running as a rehabilitation strategy for hamstring injuries is based on the principle of progressive loading. High-speed running involves significant eccentric loading of the hamstring muscles, which can help to stimulate muscle fibre remodeling and improve muscle strength and endurance. Evidence for High-Speed Running for Hamstring Rehabilitation Several studies have explored the use of high-speed running as a rehabilitation strategy for hamstring injuries, with promising results. A systematic review published in the British Journal of Sports Medicine evaluated the effectiveness of high-speed running in the rehabilitation of hamstring injuries. The review analysed seven studies with a total of 301 participants. The review found that high-speed running was effective in improving hamstring strength, running performance, and reducing the risk of re-injury. The review also found that high-speed running did not increase pain or re-injury risk compared to traditional rehabilitation programs. Another study published in the Journal of Orthopaedic and Sports Physical Therapy evaluated the effectiveness of high-speed running in the rehabilitation of elite soccer players with hamstring injuries. The study found that high-speed running was effective in reducing the time to return to play, improving hamstring strength, and reducing the risk of re-injury. The Role of Manual Therapy Manual therapy can also be beneficial for hamstring rehabilitation. Soft tissue mobilisation techniques, such as soft tissue release, can help to improve blood flow, reduce muscle tension, and promote tissue healing. Joint mobilisation techniques around the lumbar spine and pelvis can also help to improve joint mobility, reducing the risk of further injury. This is integral as we work on ensuring the lumbopelvic region is working efficiently to allow the hamstrings to rehabilitate to their full potential. Psychological Considerations Recovering from a hamstring injury can be a frustrating and challenging process, and psychological considerations should also be taken into account during rehabilitation. It is common for people to experience the highs and lows of rehab & may benefit from working with a sports psychologist to help them cope with the emotional and psychological challenges of rehabilitation and stay motivated throughout the process. This is also integral for return to sport considerations as it can be a daunting experience after injury. Concerns of re-injury or not being able to perform at their pre-injury level is often felt and thus it is important for people to feel confident and mentally prepared to return to sport following a hamstring injury. Conclusion Hamstring rehabilitation requires special considerations to ensure optimal outcomes. Early intervention, gradual progression, eccentric exercises, sports-specific rehabilitation, manual therapy, and psychological considerations are all essential elements of an effective rehabilitation program. It is essential to work with a physiotherapist to develop a personalised rehabilitation program tailored to the athletes specific needs and goals.
11 Jul, 2023
Application and benefits during rehab. Blood flow restriction (BFR) training involves restricting the blood flow to working muscles during exercise, resulting in hypoxia in the muscle tissue. It can be applied to both resistance and aerobic exercise; however, the purpose of this blog is to have a look at the potential benefits of using BFR during resistance-based exercise in rehab. BFR resistance training has been shown to help increase muscle size and strength in young, old and load compromised populations (including post ACL replacement surgery and people suffering from OA). The greatest benefits of BFR training have been shown to occur during low-load resistance exercise, with some studies showing that muscle hypertrophy and strength adaptions using BFR are significantly greater than those achieved with low load resistance exercise alone. Benefits of BFR during rehab After sustaining an injury or having surgery, people will often struggle tolerating heavy loads through the affected area, which can cause an increase in pain during activity, reduce function and impact rehab and recovery timeframes. During rehab for any type of injury, it is important to load and strengthen the muscles around the injured or painful structure, however pain (and injury) can often prevent a person from being able to perform the required exercises (or tolerate the required load during exercise) to actually achieve this increase in strength, which can often lead to slow progression during rehab. This is where BFR training can be beneficial. BFR training can be used to get the most out of low-load resistance training for load compromised people who can’t tolerate heavy-load training during the early stages of rehab. Applying BFR training to rehab As mentioned above, BFR training can be a useful tool when trying to maximise the impact of low-load exercise during rehab. This can often be beneficial when pain/injury is impacting the ability to appropriately load the injured area in order to elicit a change in symptoms. A good example of this presentation in the clinic is during rehab following a patella dislocation or subluxation. The sensitivity and reduced capacity to load the patellofemoral joint after this type of injury can make it hard to perform quadriceps strengthening exercises with adequate load to elicit a meaningful change in strength, which can lead to the development of compensatory strategies and slow progression during rehab. BFR can be used to help overcome this hurdle. Have a look at our Instagram here to see an example of a rehab session using BFR for a client who suffered a patella dislocation. There are many other types of pain/injury that could benefit from the use of BFR at certain stages of rehab, such as managing OA pain and when recovering from ACL replacement surgery. Overall, BFR can be a useful tool to use during certain stages of rehab; but just like all aspects of rehab there is no ‘one size fits all’ approach, so get in contact in you would like to discuss if BFR could be useful for you. Reference for information Hughes L, Paton B, Rosenblatt B, Gissane C, Patterson SD. Blood flow restriction training in clinical musculoskeletal rehabilitation: a systematic review and meta-analysis. Br J Sports Med. 2017 Jul;51(13):1003-1011. doi: 10.1136/bjsports-2016-097071. Epub 2017 Mar 4. PMID: 28259850.
04 Jun, 2023
Hamstring injuries are a common injury among athletes, particularly those involved in sports that require sudden changes of direction, explosive acceleration, and high-speed running. Rehabilitation after a hamstring injury can be a challenging process, and it is essential to understand the special considerations involved in the rehabilitation process to ensure optimal outcomes. The latest evidence has shown hamstring injuries require assessment and treatment of multiple areas of the body such as lumbopelvic control, posterior chain strength and stability and hamstring strength in a fatigued state. Due to the complex nature of hamstring injuries and their relationship with the aforementioned areas, they have a high recurrence rate. In this blog, we will discuss the special considerations for hamstring rehabilitation. The Importance of Early Intervention One of the most critical special considerations for hamstring rehabilitation is the importance of early intervention. Delaying rehabilitation can prolong the recovery time and increase the risk of re-injury. Therefore, it is essential to initiate rehabilitation as soon as possible after the injury. Gradual Progression Another important consideration for hamstring rehabilitation is the need for gradual progression. It is crucial to progress rehabilitation exercises slowly and steadily, focusing on regaining strength, flexibility, and mobility while avoiding overloading the hamstring muscles. Eccentric Exercises Eccentric exercises are particularly effective for hamstring rehabilitation. These exercises involve lengthening the muscle while it is under tension, which helps to promote muscle fibre remodelling and healing. Eccentric exercises can also help to improve muscle strength and reduce the likelihood of recurrence. Sports-Specific Rehabilitation Rehabilitation exercises should be tailored to the specific requirements of the athlete's sport. For example, athletes involved in sports that require high-speed running may benefit from incorporating high-speed running drills into their rehabilitation program. This approach can help to improve neuromuscular control, endurance, and power. How Can High-Speed Running Help with Hamstring Rehabilitation? The use of high-speed running as a rehabilitation strategy for hamstring injuries is based on the principle of progressive loading. High-speed running involves significant eccentric loading of the hamstring muscles, which can help to stimulate muscle fibre remodeling and improve muscle strength and endurance. Evidence for High-Speed Running for Hamstring Rehabilitation Several studies have explored the use of high-speed running as a rehabilitation strategy for hamstring injuries, with promising results. A systematic review published in the British Journal of Sports Medicine evaluated the effectiveness of high-speed running in the rehabilitation of hamstring injuries. The review analysed seven studies with a total of 301 participants. The review found that high-speed running was effective in improving hamstring strength, running performance, and reducing the risk of re-injury. The review also found that high-speed running did not increase pain or re-injury risk compared to traditional rehabilitation programs. Another study published in the Journal of Orthopaedic and Sports Physical Therapy evaluated the effectiveness of high-speed running in the rehabilitation of elite soccer players with hamstring injuries. The study found that high-speed running was effective in reducing the time to return to play, improving hamstring strength, and reducing the risk of re-injury. The Role of Manual Therapy Manual therapy can also be beneficial for hamstring rehabilitation. Soft tissue mobilisation techniques, such as soft tissue release, can help to improve blood flow, reduce muscle tension, and promote tissue healing. Joint mobilisation techniques around the lumbar spine and pelvis can also help to improve joint mobility, reducing the risk of further injury. This is integral as we work on ensuring the lumbopelvic region is working efficiently to allow the hamstrings to rehabilitate to their full potential. Psychological Considerations Recovering from a hamstring injury can be a frustrating and challenging process, and psychological considerations should also be taken into account during rehabilitation. It is common for people to experience the highs and lows of rehab & may benefit from working with a sports psychologist to help them cope with the emotional and psychological challenges of rehabilitation and stay motivated throughout the process. This is also integral for return to sport considerations as it can be a daunting experience after injury. Concerns of re-injury or not being able to perform at their pre-injury level is often felt and thus it is important for people to feel confident and mentally prepared to return to sport following a hamstring injury. Conclusion Hamstring rehabilitation requires special considerations to ensure optimal outcomes. Early intervention, gradual progression, eccentric exercises, sports-specific rehabilitation, manual therapy, and psychological considerations are all essential elements of an effective rehabilitation program. It is essential to work with a physiotherapist to develop a personalised rehabilitation program tailored to the athletes specific needs and goals.
21 Feb, 2023
Injuring your ACL can be overwhelming, often you will be deliberating whether or not to get surgery while coming to terms with the long rehab process ahead. This blog will shed a bit of light on something that everyone should be doing after sustaining an ACL injury; Prehab. What is ACL Prehab? ACL Prehab is what is done between tearing your ACL and having surgery/performing rehab. It is the term used for the exercises and training that needs to be performed after sustaining an ACL injury and should be performed even if you are considering not having surgery. What does ACL Prehab involve? Prehab involves a block of supervised exercise sessions with a focus on lower body strengthening (particularly the quadriceps and hamstrings), knee mobility and stability/motor control. The timeframes and specific types of exercise will vary between different people, but the goal of prehab remains the same; maximise the chance of returning to your pre-injury level of activity and staying there. Why is Prehab so important? Performing a 5-week block of prehab training has been shown to increase the chance of returning to your pre-injury level of sport following an ACL replacement, it has also been shown to significantly improve knee function after ACL injury, regardless of whether you decide to have surgery or not (Eitzen et al, 2010). Prehab also provides a great opportunity to perform some strength and hop testing, which will be used later in rehab. This testing will provide a good comparison for leg strength and function prior to returning to sport, doing this has been shown to help reduce the risk of reinjury by up to 75% (Capin et al, 2019). The take home message. A short block of Prehab has been shown to have a great impact on knee function after ACL injury and will increase the chances of having a good recovery and returning to your chosen sport or activity, regardless of whether or not you require surgery. Everyone who suffers an ACL injury should perform some amount of Prehab; if you have recently injured your ACL and would like to have a chat about Prehab, then get in touch….
By Redfern Physio 12 Aug, 2022
If you suffer from IBS (Irritable Bowel Syndrome), there’s a high chance that you have heard of the low FODMAP diet – you may have even started one and feel better! The low FODMAP diet is broken down into three phases: elimination, reintroduction and personalisation. Understanding these three stages and working through them with a dietitian is key to getting the most out of the diet and controlling your symptoms long-term. What is IBS? IBS is a collection of unpleasant symptoms such as abdominal cramping, pain, bloating, diarrhoea and/or constipation. Unfortunately, it affects around one in five Australians at some point. Its cause is often unknown but, in some cases, it can be triggered by gastro or food poisoning. Psychological stress and genetics have also been implicated in the development of IBS. FODMAPs explained The low FODMAP diet was a breakthrough for IBS suffers. FODMAPs, stand for Fermentable, Oligosaccharides, Disaccharides, Monosaccharides and Polyols. FODMAPs are a type of carbohydrate found in certain foods that are poorly absorbed in those with IBS. They then act as a food source to bacteria and ferment in the gut causing all those troubling IBS symptoms mentioned. The 3 Phase of a Low FODMAP Diet The low FODMAP diet should not be a lifelong diet. Rather it is an investigative tool to work out your IBS triggers so you can make better informed food choices to help you live more comfortably. Phase 1: Elimination To be commenced under the supervision of a dietitian, this phase involves eliminating all high FODMAP foods from the diet for a period of 2-6 weeks. Many begin to feel better as early as a few days into the elimination phase, but for some, it can take a few weeks. So, don’t be discouraged! The better you stick to this phase the more accurate the results. Your dietitian will help determine how long you spend in this phase, but it should never be long-term, no matter have great you feel. Phase 2: Reintroductions (or challenge steps) This phase involves reintroducing high FODMAP foods back into the diet in a methodical way to determine which trigger symptoms and which do not. It is the most informative phase of the diet and can often produce surprising results! As each FODMAP is reintroduced it is important that your background diet remains low in FODMAPs to ensure an accurate result. A dietitian is crucial during this phase to help interpret your responses. This phase can take 6-8 weeks to complete.  Phase 3: Personalization The last phase of the low FODMAP diet involves establishing your longer-term, personalised FODMAP diet. Initially this will involve reintroducing FODMAPs that were well tolerated and avoiding those that triggered your symptoms. Determining your thresholds of those FODMAPs that did trigger symptoms is the final step and important to expand the variety of your diet and allow as much food freedom as possible. Thresholds can change over time too, so if there are FODMAPs you didn’t tolerate well during the challenge steps, try again in a few months and see if anything has changed. As you can see, the low FODMAP diet is an involved multiphase diet. The end goal is to eat as freely as possible without triggering IBS symptoms. If you are suffering from IBS, or have started a low FOMDAP diet but are not sure what is next, you can book an appointment with our dietitian Fiona here .
By Redfern Physio 04 Jul, 2022
Last year, I injured my shoulder in COVID-19 lockdown whilst completing a bench press at the gym. Having an injured shoulder caused me to be frustrated and anxious as I was unable to continue with my training program. Being on the ‘other side of the fence’ dealing with an injury highlighted some aspects of recovery which I feel are worth reminding you about! Shoulder injuries are very common and often are incorrectly prescribed with “rest” and other passive management tools such as cortisone injection to treat the pain and inflammation. However, the root cause of the shoulder pain is often not assessed and treated appropriately, and this predisposes you to getting persistent shoulder pain or a GRUMPY shoulder! Do any of these common shoulder complaints relate to you? I get pain in my shoulder: when I reach out into awkward rotated positions behind me. ‘I have difficulty putting on shirts/clothes overhead or grabbing the seat belt in the car.’ after completing a task (cleaning/gardening/painting) for over an hour (or even less). ‘I avoid doing these tasks because of the pain.’ during certain exercises in the gym. ‘I am frustrated as this stops me working out/ going to the gym and building strength.’ when sleeping on my side through the night. ‘I’ve tried sleeping on my back, but I can’t fall asleep and wake when I roll onto that side.’ My best advice is that you need to listen to your shoulder. Ignoring the pain can lead to persistent symptoms, further weakness and breakdown of tissue, and therefore chronic pain. Many of our clients we see at Redfern Physio have a Grumpy Shoulder for several weeks or months before they present to our practice. This chronic overload of the shoulder usually causes pain which we labelled as “rotator cuff related shoulder pain”. This incorporates the following: Rotator cuff tendinopathy or tendinitis Partial / Full thickness tears of the rotator cuff muscles Subacromial bursitis Subacromial or rotator cuff impingement syndrome Often it is not “just the shoulder” causing pain, but an overload in the muscles around the shoulder blade, mid-back and neck. A thorough physiotherapy assessment will aim to assess the compensatory movement patterns that have caused pain into the shoulder. What’s our message here? If you experience pain in your shoulder whilst gardening, don’t expect it to improve if you continue to ‘push through’. If you hurt your shoulder at the gym, you will need a minimum of period of reduced intensity of that activity as well as a period of physiotherapy and rehab to get you back to lifting at your best. You must pace yourself back to your normal activities over a period of time, usually several weeks. I had the most benefit after a physio assessment, which gave me a clear diagnosis with a physiotherapy management plan to work with me on my weakness and reduce my fear of reinjury. I am now able to train without any pain. Next time you come into the clinic, make sure you ask about my story with my shoulder injury! For detailed advice and an individual management program contact our team at Redfern Physio on 8068 5158, or book now by clicking Book an appointment
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