Sports
Medicine Report: Some like it Hot!
By
Gerald W. Bell; EdD, PT, ATC/L
Heat has been used as an athletic treatment
for the relief of pain for generations. The primary concern
with the application of heat (hot water bottles, immersion,
heating pads) early in the injury cycle is that cells have
increased permeability secondary to the trauma and any application
of heat will cause increased weeping of cell fluid, thus increasing
swelling and edema. Therefore, any heat application early
(within 24-72 hours following trauma) is contraindicated.
A comparison of heat and cold application gives an indication
of what is occurring.
Heat
Analgesia-relaxes muscle spasm
Vasodilatation-increases blood supply to increase nutrition
for healing, as well as carries off waste products of metabolites
and edema fluid, but has a limited penetration of 1/16"
to 1/8".
After Application-10-15 minutes, spasm returns with voluntary
movement.
Cold
Anesthesia-relaxes muscle spasm and reduces pain
Vasoconstriction-decreases blood flow and metabolism, thus
creating a need for nutrients, but also decreases waste
products (Lactic acid) and allows additional time for healing
with deep penetration.
After Application-30 minutes to 1 hour, patient experiences
a reflex vasodilatation or return to previous blood flow
that carries off edema and maintains a relaxed muscle.
Heat does have a place in treatment of athletic injuries,
but cold assists the healing process initially following
trauma (1-10 days). Examples of moist heat applications
are a warm shower, towels soaked in warm water, a hydrocollator
and whirlpool. Examples of dry heat applications are infrared
and heating pads. I would recommend the massage effects
of a whirlpool or a warm shower for 20 minutes daily before
dry heat applications, as they tend to reduce blood flow
to the surface of the skin, thus increasing capillary congestion.
Any heat application should not be longer than 20-30 minutes
and should be applied in an elevated position to stimulate
venous return for that body segment.
In summary, heat is important in the treatment of athletic
injuries to increase motion following immobilization and
surgery where swelling is a concern. Application can be
done by whirlpool, hydrocollator and a warm shower. However,
cold applications will provide pain reduction and can be
used as an adjunctive therapy following reconditioning/rehabilitation
of the injured body segment. These techniques should be
reviewed to prevent undue harm to the athlete, thus prolonging
the recovery process.
References
Baker & Bell (1991). The effect of therapeutic modalities
on blood flow in the human calf. Journal of Orthopedic Sports
Physical Therapy, 13(1), 23-27.
Bell in Prentice: Ed: Therapeutic modalities in sports medicine,
Mosby, 1990, Pgs 79-119.
Bell in Prentice: Ed: Rehabilitation techniques in sports
medicine, Mosby, 1990, Pgs 1-23.
