The therapy corner
Fire and Ice – revisited and revised
Many years ago, I wrote a
couple of columns on the subject of heat vs. ice, with regard to the treatment
of sprains and strains (http://www.syracusechargers.org/therapy/therapy.html
- #8 and 9). The indications for the use
of each modality in different situations were discussed.
The subject of the most recent column (#86) – delayed
onset muscle soreness, or DOMS – covered the inadvisability of using topical
"heating" creams, but did not get into the question of whether actual
heat or cold treatments could be of benefit.
Coincidentally, just after I wrote and submitted that column, a new
study on this topic appeared in a well-respected rehabilitation journal (Mayer
JM et al, Arch Phys Med Rehabil 2006;87:1310-7). Let's
see what they found.
The conventional wisdom to date has generally
favored the use of cold application to treat any acute muscle pain, regardless
of the mechanism of onset (trauma vs. overuse).
In fact, several years ago some "experts" were advocating the
idea of immersing sore legs in very cold, if not downright icy water for 10-15
minutes immediately following prolonged, strenuous exercise. The thinking was that, since DOMS seemed to
be caused by micro-tearing, bleeding, and inflammation, it made sense to use
the same modality used to treat similar injuries such as acute ligament sprains
or tendon strains. (Now, this seemed
logical to me, so after one particularly hot, hard 20-miler, I lowered myself
into the frigid creek behind my house. I
honestly cannot say whether or not it helped my usual DOMS, but since I quickly
and decisively elected to forego any further experimentation along these lines,
the results of that one-person study were deemed inconclusive.)
The recent study by Mayer's group decided to look at
the other side of the coin. The researchers
asked two questions: (1) could the use of low-level, continuous heat
application prevent the onset of DOMS after experimentally-induced eccentric
exercise of low back muscles, and (2) does the same treatment, applied after
the bout of exercise, have a greater effect than cold packs in reducing the
symptoms and functional limitations of DOMS?
The study designers used a commercially-available, disposable
lightweight heat wrap that is air-activated and produces, after 30 minutes, up
to 8 hours of consistent heat of approximately 104o F. The heat is generated by a wrap's ingredients
(charcoal, iron, table salt, water) once exposed to oxygen. The wearer can move around and perform most
normal daily activities.
The results of the study showed that while there was
some benefit derived from the prophylactic application of the heat wrap
compared to a control group, the more significant difference was seen in the
comparison between post-exercise application of the heat wrap and use of cold
packs. In that group, there was a clear
reduction in the pain and limitations associated with DOMS in those subjects
using the heat wrap.
The authors hypothesize several explanations for the
apparent efficacy of these heat wraps in preventing and treating DOMS. Some of these are what we might expect –
elevating temperature of the muscles improves extensibility and resistance of muscle
tissue to tearing; improved circulation helps remove inflammatory mediators
from muscle tissue; motor function is improved, etc. The authors also note that these heat wraps
allow the subject to move about freely, which is also helpful, compared to the
usual, short-term application of heat in a stationary position.
As in many studies, there are some design
shortcomings that the authors acknowledge, but their tentative conclusions are
certainly thought-provoking and challenging to another one of those traditional
beliefs we have "known" for years.
Age may have something to do with it (retire to
Gabe Yankowitz, PT
Gabe is a physical therapist practicing in Westvale
and LaFayette. He has evaluated and
treated