hot pack or hot shower, this would expand
the tissues, increase the blood flow and
increase bleeding and swelling in the area
– the opposite of what you want to happen!
The same principle applies with regard
massaging an injury: do not get an injured
area massaged in the first 24 to 48 hours,
as this will have the same effect as heat
and increase the problem. Apply the ice for
at least 25-30 minutes at a time and repeat
every two to three hours for between one
and three days, as directed by your physio.
Do not leave the ice on for more than 45
minutes at a time.
The use of anti-inflammatories in the first
three days is also to be avoided: you should
only use normal painkillers, as you need the
inflammation process. However, after the first
three days anti-inflammatories can be used
if the inflammation is not reducing of its own
accord and the swelling is still causing pain.
It’s been a few days since my
injury, and the pain is less. Can I
use heat now?
Yes. However, the best way to do this is use
heat and ice alternately. When you go from
ice to heat and then back again, it helps
‘flush’ the tissues, remove waste products
from the injury and promote healing. Think of
squeezing a sponge and letting it fill up with
water, then squeezing it again and repeating
this process. Professional athletes use this
idea to help improve their recovery rate. After
72 hours, the swelling and bleeding process
will have stopped, so you won’t increase the
damage with heat.
After the alternating ice treatments, wait
until the tissues warm up to normal body
temperature before applying the heat for the
same amount of time. Let the tissues cool
down naturally. Then repeat the ice/heat
process as many times as you can.
During the onset of injury, the body swells the
area quickly to immobilise the damaged area so
it can repair – and stop you using it!
Using ice and heat effectively can be very
time consuming, so not many people – apart
from professional athletes – do it.
After exercising I feel pain from an
old injury. What should I use?
As tempting as the idea of applying heat is,
the best treatment in this instance is actually
ice. If you suffer recurrent pain (not just muscle
fatigue) after exercise, it’s usually a sign of
inflammation and aggravation of the tissues.
Ice is still the better option here because, even
though inflammation is an essential part of
the recovery and repair process by the body,
you don’t want to increase it with more heat
and blood flow than you need. Ice in this case
would be the best at controlling pain levels and
help desensitise the area. Apply the ice for at
least 25 to 30 minutes at a time and repeat
every two to three hours if possible.
I have pain and muscle spasm
in my neck and shoulders, and a
headache. Is heat the best?
In this case heat, in the form of a wheat
bag or a microwavable hot pack, is the best
option as it increases blood flow to the area,
helping reduce tight muscles and activate
trigger points in the muscles in the neck,
trapezius and spine. The hot shower option
(with which many of us are familiar) is also
very relieving. The same applies for the lower
back and mid back (thoracic). Using heat on
these areas helps soothe muscle pain and
neural tension in the spine, and relaxes
muscle spasm and tightness. Massage
therapists use hot stones on the back and
spinal muscles for this very reason. Massage
therapy works in the same way as heat, so
if you can get to a massage therapist or
physiotherapist you will get even more relief
(and the problem addressed as well).
I get really tight muscles in my
legs and lower back from time to
time. Should I use heat before I
train or play sport?
If you do a proper warm up, heat is not usually
necessary, as the blood flow and neural
activity generated by the active warm up does
the trick. However, for very tight muscles or
problem areas (from old injuries) that need
extra warming up, heat is the best option
here, as the goal is to reduce the muscle
tension and increase your blood flow so the
tissues are more easily stretched. You don’t
want to stretch cold muscles before exercise.
Apply the heat pack or wheat bag for 25 to
30 minutes before the active warm up, then
make sure you stretch the tight muscles.
Using only heat before training is a
‘passive’ warm up and not as effective as an
‘active’ one. However, doing a passive warm
up of heat and massage, then an active warm
up or a light jog or cycle before stretching, is
the most effective option before training or
sport. This is the principle that professional
sports-people use before their games: heat,
massage, warm up, stretch, perform!
Tim Keeley, B.Phty, Cred.MDT,
APAM
With over 20 years’
experience in physiotherapy
and the fitness industry, Tim
is Principal Physiotherapist
and Director of Physio
Fitness, a clinic based in Sydney’s Bondi Junction.
An internationally credentialed McKenzie
Credentialed Spinal Physiotherapist, he specialises
in sports, fitness and training injuries.
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