Bringing you answers to questions that have been submitted to our inbox, as well as other interesting Physical Therapy or Healthcare Trivia.
1) What is the Most Effective Way to Ice, and for how long?
Almost every person has hear of the acronym “PRICE” for initial treatment of an acute injury.
P – Protect
R – Rest
I – Ice
C – Compress
E – Elevate
The question becomes how to ice and for how long. Common methods of icing include using a bag of peas, ice packs, ice bags, cold wraps or even ice baths. In my practice, the most effective method for self home icing is the ice massage. This involves freezing water in a dixie cup or Styrofoam cup, pealing the top to expose the ice, and then rubbing the ice directly on the affected area for 3-5 min. In today’s fast pace world, convenience is king, and 3-5 minutes of ice massaging is more effective than 20-30 min with an ice pack. It is much more realistic for patients to find 3 times per day where they can spare 3-5 min. vs finding 3 separate 20-30 minute blocks of time for icing. Recent literature also reports that the strategy of icing for 10-20 min, allowing the skin to warm up for thirty minutes and then icing for another 10-20 min seems to improve healing rates and decrease impact of swelling. In the case of an ice massage we would be talking about 3 minutes on, 30 min off, and then 3 min on again. In the near future I will be writing a blog with Dr. David Holmes, about a new product that I think has the ability to dethrone the ice massage as king of icing strategies ( www.drcoolrecovery.com ) due to its ability to provide compression at the same time with a price tag of less than 40 dollars. Regardless of the method of icing utilized, when its numb … you are done!
2) My daughter is a volleyball player with on and off shoulder pain during her competitive seasons. I fear that she does not warm up properly. Is there a good warm up that you recommend that she could incorporate?
Volleyball players like all overhead athletes (swimmers, baseball/softball, basketball, and Field athletes) all perform highly repetitive overhead movements that make them susceptible for rotator cuff irritation or pathology. I highly recommend dynamic, calisthenic, and isometric movements. One of the greatest authorities on shoulder movement prep is Tom House, long time USC pitching coach, throwing guru, and founder of the National Pitching Association. Here is an easy general sequence that I recommend for most overhead athletes.
3) I have really flat feet, do I need orthotics?
This is a great question, and one I answer frequently in clinic. Sadly, and erroneously, the terms flat feet and over pronation are often used interchangeably. The fact of the matter is that not all people who have flat feet over pronate. We do not need to fear pronation … Too many people think that pronation is a bad thing and leads to the formation of bunions and plantar fasciitis, but in fact it is an important and essential function that allows the foot to absorb and disperse the impact forces of the heel hitting the ground. Too much pronation can be a risk factor for increased incidence of Plantar Fasciitis, Achilles Tendinosis, etc., but I can’t stress enough the fact that not all flat feet require extra support. The decision to use orthotics should be based on biomechanical analysis by a foot specialist, it is too expensive of a leap of faith.
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