COLD HOT THERAPY

So, when would you use heat and ice therapy?

And in fact, usually what is best is a mixture of heat and ice therapy. Actually vice versa. First ice cold therapy followed by moist heat.

For example,

PATELLO FEMORAL PAIN

Normally the kneecap slides neatly up and down in the trochlear groove but if it is forcibly shoved against the sides of the groove the cartilage will be injured. It's lined with super very smooth cartilage - in fact the thickest hyaline cartilage in the body because the forces on the kneecap are enormous.

Yes, that's a cartilage defect in the femoral condyle that you've probably spotted too. It's the beginning of osteoarthritis of the knee, that which awaits all obese folk, especially women because of something called the Q-angle that we won't go into today. Apologies for going on and on and on and on about obesity. It will cause you pain, lots of it.

Aside: Pain in the pocket book too. Obesity and diabetes are directly related. "After adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than what expenditures would be in the absence of diabetes."

Imagine your annual medical costs over a five year period are say $100,000. For a diabetic, it's $230,000. And most diabetes is caused by obesity. Oddly, when the diabetes really sets in, you'll suddenly lose weight, a lot of it. It's not a reason to be pleased. Frequent urination and thirst are the signs.

STAIRS

Every step, every time you jump, stand up from a chair, go up or down hill, the quadriceps contracts and the enormous forces are directed via the patellar to the tibia enabling you to straighten the knee going upstairs, and stop it bending too much when walking downstairs.

Patello-Femoral arthralgia

• Vastus Medialis
• Vastus Lateralis

If one or the other is weak, then the kneecap tracks to the opposite side causing an excessive rubbing against the sides of the trochlear groove.

If the Vastus Lateralis muscle fatigues faster, then the patella tracks against the medial condyle, and the condition is called Patello-Femoral Arthralgia (PFA). Typically, walking UP stairs hurts.

If the Vastus Medialis muscle fatigues faster than Lateralis, then the patella tracks against the lateral condyle, and the condition is called Excessive Lateral Pressure Syndrome (ELPS). Typically, walking DOWN stairs hurts. The foot should be checked too, because ELPS is associated with foot pronation.

(PS. Forget the terms)

Either way, a roughening of the hyaline artilage begins, resulting in a degenerative joint surface. Arthr-algia = Joint-pain. Pain on walking, of course. That's where COLD HOT THERAPY comes in useful.

Sometimes, the calcium starts being deposited in the joint causing "chondro-calcinosis". Can you spot the calcium crystals being laid down in the joint in this next graphic? COLD HOT THERAPY is perfect for pain control.

• More about PATELLO FEMORAL PAIN SYNDROME ...
  
  
• CLARKES TEST is the definitive test for PFPS.
  
  

Ice cold therapy: how good is the evidence?

Chiropractor Dr Mac Auley DC did a literature search (see: Int J Sports Med. 2001 Jul;22(5):379-84.)

A researcher at the Institute of Postgraduate Medicine and Health Science University of Ulster, Dr Mac Auley reported:

Ice, compression and elevation are the basic principles of acute soft tissue injury. Few clinicians, however, can give specific evidence based guidance on the appropriate duration of each individual treatment session, the frequency of application, or the length of the treatment program.

A systematic literature search was performed using the key words ice, injury, sport and exercise.

Temperature change within the muscle depends on the method of application, duration of application, initial temperature, and depth of subcutaneous fat. The evidence from this systematic review suggests that

Using repeated, rather than continuous, ice applications helps sustain reduced muscle temperature without compromising the skin and allows the superficial skin temperature to return to normal while deeper muscle temperature remains low.

Reflex activity and motor function are impaired following ice cold therapy so patients may be more susceptible to injury for up to 30 minutes following treatment.

It is concluded that ice is effective for acute conditions, but should be applied in repeated application of 10 minutes to be most effective, avoid side effects, and prevent possible further injury.

My comment: In this abstract concerning cold hot therapy for muscle injuries no mention is made of the difference in applying ice for joint injuries such as a Patello Femoral Pain syndrome (where the tissue is non-muscular and only a few mm below the skin) and a lower back disc injury where the joints involved are are a good 20-30mm deep.

So it would seem that your ice cold therapy should be applied more frequently for muscle injuries, but for a shorter time. For joint conditions? If the ice is applied directly to the skin as in an ice massage, compared to over a thin cloth, then certainly for a shorter time.

ICE COLD THERAPY

Such an application is messy on the back, perhaps an icepack in a teatowel for twenty minutes might be a good compromise when applying your cold hot therapy.

COLD AND HEAT THERAPY

Take for example this unedited letter I recently received (in the horrible English of some Americans, alas):

I have bulding discs from c2 to c7 and Tietze syndrome,my pain meds help my back ,but do not touch my rib cage,i have beeen disabled for 7 yrs

the pain doctor keeps giving me anti inflamatory drugs and oxcdone/325 that helps my back,no one knows how to treat this syndrome,

when it first occacured the dotors thought I was crazy,the hospitals too,

I got labled as a drug seeker,and know one knows how to treat it,nothing helps either,I was on antiscokics ,seizie meds,got injections nothing works,unless I am on strong pain meds ,and nobdy wants to give them to me,

I do not know what to do ,it is depressing and not even my family understand it. Please help.

COLD HOT THERAPY

Heat therapy over tight muscles and joints BEFORE exercise is advisable making the tissues more supple and elastic. A hot shower, or a hotwater bottle over a moist cloth for ten to fifteen minutes would be fine, depending on the depth of the tissue.

I'm quite strict about lower back exercises before getting out of bed, especially for chronic conditions. The tissues are already warm from a night in bed, curled up under the eiderdown, "onder de veren" as they say in Holland because, once up and about, my lower back exercises usually don't get done. But after your shower or bath they might be even better... if you're disciplined enough to return to your bed for a minute and a half. Lower back exercises ...

USEFUL LINKS @ COLD HOT THERAPY

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