By Shireesh Bhalerao
Photo by Steve Line/Squashpics.com
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| | Shireesh Bhalerao is a licensed chiropractor practicing in Portland, Oregon. He is the tournament director of the Portland City Squash Open, hosted by the Lloyd Athletic Club, and is always looking for advice about his game. |
When you are at the club, just sit back and you will see the gamut. Among the many good things you will observe (like players hydrating and stretching), it is unfortunately likely that you will see players wincing or limping and most likely soon thereafter, icing or heating the injury that caused the pain. But when, and how, should the person ice versus heat the injury? These are important questions that can be difficult to answer. The following tips should help you to make educated choices on proper treatment so that you can get back on the court as quickly and safely as possible.
Pay Mind to P.R.I.C.E.
To correctly treat a recent injury, you should remember the word "PRICE" as a guide for treatment: 'p' represents protect, 'r' represents rest, 'i' represents icing, 'c' represents compression, and 'e' represents elevation. Here we will focus on icing. (Protection, resting, compressing, and elevating are each in their own subjects too vast to discuss in this article but are nonetheless important.)
Cryotherapy
Once cold therapy, or cryotherapy, is initiated several things occur in the damaged tissues. Blood vessels in the target area constrict almost immediately, causing a decrease in the blood flow to the area and helping to prevent further swelling from occurring. Other tissue responses to cryotherapy that occur are a reduction in both metabolic rate and nerve conduction, both of which help prevent subsequent tissue damage and reduce pain, respectively. When applying ice, the typical progression of symptoms is coldness, burning, aching and finally numbness.
There are several different ways to administer cryotherapy, the most common being crushed ice or gel packs. Crushed ice should be applied directly to the skin within minutes after injury for about 10-20 minutes and not any longer once the area goes numb (typically no longer than 30 minutes). If using a frozen gel pack, follow the same parameters but do not place the pack directly on the skin as these packs can maintain temperatures significantly lower than crushed ice and cause frostbite (Place at least one layer of toweling between the gel pack and your skin). You can repeat this process once the skin of the target area has returned to the same temperature as the other side of your body (about 60 minutes).
Please note that some people are allergic to ice and experience an exaggerated response to the cryotherapy in a much shorter timeframe. If this is the case, other alternatives for acute injury treatment should be found by speaking with an experienced healthcare practitioner.
Thermotherapy
After all of this mind-numbing talk, another question still remains: when is it appropriate to switch to heating an injured area? It is generally accepted that the use of heat, or thermotherapy, is beneficial 2-3 days after an initial injury and not any earlier. By increasing blood flow and metabolic demands of the target tissue, heat serves to relieve sore muscles and improve the flexibility of the injured tissues, leading to increased range of motion. You should not use heat over cuts, burns, infections, recent surgeries or areas where you cannot sense heat.
There are several methods of heat application ranging from microwavable beanbags to electric blankets, but regardless of the heat source the following general guidelines should be observed:
1. To avoid burning the skin you should apply a barrier of 4-6 layers of toweling between the skin and the heat source, while avoiding lying directly on the heat source.
2. Treatment time should be 15-30 minutes; check the area after 5 minutes, and the skin should be pink and without any blistering or spotting.
3. The heat should feel pleasantly warm, not hot enough to burn.
4. As with the cold, allow about 1 hour between applications.
Contrast Therapy
Another option during the injury rehabilitation phase is a contrast bath, or applying heat and cold in succession. Using this method, heat is used to warm up the tissues, providing the flexibility to perform the assigned rehab exercises (on-court drills, for example); ice is applied afterward to ward off any resulting inflammation.
Depending on the severity and progression of the initial injury, this may be helpful. As a precaution, you should always seek the advice of an appropriate healthcare practitioner before beginning any unattended therapies.
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