september / october 2017 73
have you ever gotten in your car,
reached for your seat belt and tweaked
your neck? I have — and it’s basically
the lamest way ever to injure yourself.
To make matters worse, I tried to ignore
my injury out of sheer embarrassment.
The pain and inability to turn my head
in either direction likely would have
been diminished had I just put some
ice on it. Or should that be heat? I can
never remember, so I chose neither
and suffered for nearly a week, using a
fictitious story about lifting too hard at the
gym as my cover.
Whether you’ve pulled a muscle going about your normal every day activities,
tripped over a barbell and sprained your ankle or have back pain that flares up
seemingly out of nowhere, aches, pains and injuries are common. The key is how
you treat them, which often begins with an understanding of when to choose ice
versus heat the moment pain strikes.
“Ice has an anti-inflammatory effect by decreasing blood flow to an acutely
injured area,” says Naresh Rao, DO, FAOASM, an osteopathic sports medicine
physician who serves as the head physician for the USA men’s water polo team
and was on Team USA’s sports medicine team for the 2016 Summer Olympics.
“Ice is great for pain associated with inflammation and works best if the injury
is superficial enough to the skin so the cold can have an effect. Conversely, heat
has a muscle-relaxing effect by increasing blood flow to a chronically injured
area. Heat is great for stiff muscles and muscle spasms and can be used to help
increase flexibility in stiff or arthritic joints.”
In his book Step Up Your Game: The Revolutionary Program Elite Athletes Use
to Increase Performance and Achieve Total Health (Sports Publishing, 2016), Rao
states that his rule of thumb for the first 24 to 48 hours after an acute injury is to
use ice for 20 minutes on the hour along with some elevation and compression
(like an elastic bandage). The ice is thought to reduce inflammation that overly
ensues and reduce pain.
“I recommend heat for more chronic muscular tension or muscle spasm,” he
says. “Moist heat will actually help muscles relax. If you have a chronically tense
upper back, getting in the shower and using hot water with the beating action,
like a massage, can be very effective.”
As for the school of thought that advocates alternating heat and cold (i.e., con-
trast bath therapy), Rao says that while elite athletes follow this technique, the
research is not consistent in supporting its use.The Do’s and Don’ts of
Icing and Heating
There’s a bit more to treating an
injury than just slapping some
ice cubes or a heating pad on it. It
requires a bit of TLC, having the right
equipment on hand and quick action.Ice. Rao suggests using an ice
pack or frozen veggie bag that is
wrapped in a thin cloth or a few paper
towels because placing anything fro-
zen directly on the skin could cause
frostbite. Plan on 20-minute icing
sessions every hour within 24 to 48
hours of an acute injury. To keep the
ice in place, try wrapping plastic
wrap around the ice pack over the
injured area. Heat. There are two types of heat:
moist and dry. Moist heat can come in
the form of a hot shower, hot towel or
moist heating pad. If using a heating
pad, Rao says it is important for safety
reasons not to fall asleep with it —
this could lead to burning your skin or
even starting a fire. Again, you’ll want
to limit usage to 20 minutes at a time,
several times a day. Drugstores carry
adhesive heating pads that allow for
mobility while treating your injury.Precautions. If there is broken
skin, sign of infection or you are
not sure where the pain is coming
from (i.e., left shoulder pain with-
out an injury could be coming from
the heart), it’s best to seek medical
attention instead of self-treating.
Also, those with decreased sensation
because of nerve issues, like diabet-
ics who have peripheral neuropathy,
cannot perceive temperature well, so
they are at risk for cold or heat injury.
“I use a variety of treatments to
help patients get back on their feet
after injury using a whole-person
approach,” Rao says. “Injury is com-
mon, so don’t be discouraged when
it occurs.”“ICE HAS AN INFLAMMATORY EFFECT BY DECREASING
BLOOD FLOW TO AN ACUTELY INJURED AREA. HEAT HAS AMUSCLERELAXING EFFECT BY INCREASING BLOOD FLOW.”