Musculoskeletal

Physical Therapy

What's better for treating back pain, heat or ice?

The Truth About Treating Back Pain: Ice and Heat Aren't the Solution

Alright, what's better for treating back pain, heat or ice? So this is a question that comes up a lot of times in physical therapy with any client that I really see. I treat a lot of athletes and a lot of active individuals that will have episodes of low back pain. So low back pain has a prevalence of more than 85% in this country. It's not necessarily a condition of genetics or being sedentary or being really active, neither squatting nor dead lifting really preclude increased back pain. It's just sort of a condition of being human. So at some point, given the human condition, it's likely that you or I or all of us will experience low back pain. So really kind of knowing what to do is going to better help you be able to handle those episodes of low back pain. Neither heat nor ice are really supported in the literature. The old adage is that ice is what you would use for an episode of increased inflammation along with the rest, ice, compress, elevate, rice principle. Whereas heat is oftentimes used for muscles that are in spasm. Neither one of those are really supported. Neither ice packs nor heat packs really, their temperature doesn't go to the level of tissue that's really being implicated if it's muscular or if it's related to some other structure in your back. There's a lot of centimeters of tissue to go through before you get to what is maybe causing your problem. So the surface level that ice packs and heating packs get to, it's not really going to affect that. So the take home message here is that motion is lotion, right? And to try to avoid that fear of motion that you'll get if you're in spasm or if you're having really acute low back pain. So it's kind of working your body, going for a walk, working through exercises that are comfortable to do, and just kind of being sure that you're doing things throughout the day. The best thing you can do is just lay on your bed and not move at all. That's the best thing to do for back pain.

The best way to treat back pain is to move. This is better than using heat or ice, as the temperature of these treatments does not affect the underlying tissue causing the pain. Motion is lotion, so getting up and moving gently is the best thing to do for back pain.

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When it comes to treating back pain, the question of whether heat or ice is better often arises. As a physical therapist, I frequently encounter this question from my clients, especially athletes and active individuals who experience episodes of low back pain.

Low back pain is prevalent in more than 85% of the population, and it can affect anyone regardless of genetics, activity level, or specific exercises like squatting or deadlifting. It's simply a condition that can arise due to being human.

Interestingly, neither heat nor ice is strongly supported by scientific literature for treating back pain. The traditional belief is that ice is used for episodes of increased inflammation, following the RICE principle (rest, ice, compress, elevate). On the other hand, heat is often used for muscle spasms. However, neither method effectively reaches the deep tissues that may be implicated in the pain. The temperature of ice or heat packs doesn't penetrate deeply enough to have a significant impact on the underlying structures causing the problem.

The key takeaway here is that motion is lotion. It's important to avoid the fear of movement that can arise during episodes of acute low back pain or muscle spasms. Engaging in gentle exercises, going for walks, and staying active throughout the day can be beneficial. Simply lying in bed and avoiding all movement is not the best approach for managing back pain.

In summary, while heat and ice may provide temporary relief, the most effective strategy for treating back pain involves staying active and incorporating gentle exercises into your routine.

If someone has lower back pain, how should he be taking care of it?

Key Takeaway: Get moving to alleviate lower back pain!

If someone has lower back pain, how should he, I guess, or they be taken care of it? So I can't remember the exact statistic but I think it's something above 85 to 86 percent of Americans will experience back pain at some point in their lives. So it's not really a matter of if you'll experience back pain but when and it's not so much that you're gonna be doing something that would be expected to lead to back pain as like a deadlift or something like that is just you know I've had people come in for back pain because they bent over and picked up a pen or like a piece of paper. So those are the factors that can kind of go into back pain. The best thing that you can do for it is to get yourself moving again. You want the regular blood flow over those muscles. You want to be working into gentle stretching, gentle strengthening, mobilizing what's sore and to your tolerance. The worst thing you can do is to lay on your back. Bed rest is not proven to be effective at all. Sometimes those passive modalities will help if you're gonna put a heat pack or an ice pack on them to kind of mitigate the the initial pain symptoms that you're getting but ultimately research doesn't support the use of heat or ice in cases of back pain. So if you can go for a walk, get some gentle stretching in and then be sure that you get evaluated by your physical therapist.

85-86% of Americans will experience back pain at some point in their lives. The best way to take care of it is to get moving, do gentle stretching and strengthening exercises, and avoid bed rest. Heat or ice packs may help with initial pain symptoms, but research does not support long-term use. It's best to seek evaluation from a physical therapist.

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If someone is experiencing lower back pain, how should they take care of it? Statistics show that a significant percentage of Americans will experience back pain at some point in their lives. It's not a matter of if, but when. Back pain can occur from simple movements like bending over to pick up a pen or a piece of paper, not just from strenuous activities like deadlifting. The best approach to manage back pain is to keep moving. Regular movement promotes blood flow to the affected muscles. Gentle stretching and strengthening exercises can be beneficial, focusing on mobilizing the sore areas within your comfort level. It's important to note that bed rest is not effective for back pain. While heat or ice packs may temporarily alleviate initial pain symptoms, research does not support their long-term use for back pain. Going for walks and engaging in gentle stretching exercises are recommended. Additionally, it's advisable to seek evaluation from a physical therapist for proper assessment and guidance in managing your specific case of back pain.

How do you prevent knee problems from breaststroke kicks? Some of my swimmers have a “pop” when they finish the kick.

Preventing Knee Problems in Breaststroke: Key Mobilizations

So my experience with my breaststrokers, oftentimes when they get knee pain, it's sort of in this medial part of their knee, just outside the kneecap, kind of on the inside part of their thigh. That's an important part of the knee. You have your adductors, which are your big thigh, like inner thigh muscles that come in there, as well as a sartorius, which comes from your hip and then crosses your knee joint medially. And then your medial hamstrings come in and insert right onto that space. So the question, I guess, is where is the popping coming from, right? So typically it comes from your adductors being really tight, in addition to some limited hip mobility in the actual hip joint itself. And that's oftentimes because swimmers, like runners and cyclists, they have a lot of just sagittal motion in that hip joint, meaning their leg mostly is moving forward and backwards and not so much laterally. Breaststrokers are a little bit different in that they do have that whip kick motion, so they're getting a lot of rotation at that hip. But when most of the practicing that they're doing is with a flutter kick, that hip joint can get tight. So my favorite three hip mobilizations for breaststrokers are these three. So this first one is sitting with your knees bent, keeping your torso up nice and high and your feet about hip width apart. And what you're going to do is just drop your knees to one side and then kind of back to the other and just rotating back and forth while you keep your torso nice and high. And what it does is it kind of facilitates some of that rotation in the hip joint. You can hold it for a breath or so, you just don't want to hang out if there's pain or for any extended amount of time. So this next one works on hip internal rotation. You start on your hands and your knees. You have your knees about hip width apart and then turn your toes out to the side. And you're just going to rock your hips back towards your heels. Take a breath there and shift your weight forward, just kind of in and out that way. And that sort of helps to open up into that hip internal rotation. And then last but not least, you want to work into that external rotation. So you get into a pigeon pose where you have your front leg in front of you this way, stretch the other one straight back, and then just kind of spend some time working it.

Breaststrokers can often experience knee pain in the medial part of their knee just outside the kneecap. This can be due to tight adductors, limited hip mobility, and a lack of lateral motion in the hip joint. To help alleviate this pain, I recommend three different hip mobilizations: 1) Sitting with knees bent and dropping them to one side and then the other; 2) Rocking hips back towards heels while on hands and knees with toes turned out to the side; 3) Doing a pigeon pose and stretching the leg straight back.

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In my experience with breaststrokers, knee pain often occurs in the medial part of the knee, just outside the kneecap and on the inside of the thigh. This area involves important muscles such as the adductors, sartorius, and medial hamstrings. The popping sensation at the end of the kick may be related to tight adductors and limited hip mobility. Swimmers, like runners and cyclists, tend to have predominantly sagittal motion in their hip joint, with less lateral movement. Breaststrokers, however, engage in a whip kick motion that requires more hip rotation. However, if they primarily practice with a flutter kick, their hip joint can become tight.

To address these issues, I recommend three hip mobilization exercises for breaststrokers. The first one involves sitting with knees bent and torso upright. From this position, you can alternate dropping your knees to each side while maintaining a high torso. This exercise helps facilitate rotation in the hip joint.

The second exercise focuses on hip internal rotation. Start on your hands and knees with knees about hip-width apart and toes turned out to the side. Rock your hips back toward your heels while taking a breath, then shift your weight forward in a gentle motion. This movement helps open up hip internal rotation.

Lastly, it's important to work on hip external rotation. Assume a pigeon pose by placing one leg in front of you with the other leg stretched straight back. Spend some time stretching and mobilizing this position.

It's crucial not to force these movements and to avoid any exercises that cause pain. These exercises aim to improve hip mobility for breaststrokers and potentially alleviate knee problems associated with breaststroke kicks.

In what patient populations has blood flow restriction therapy been found beneficial?

Blood Flow Restriction Therapy: Beneficial Across All Patient Populations

In what patient populations has blood flow restriction therapy been found beneficial? I just got back from a con ed course by Owens Recovery Sciences a couple days ago that's about BFR or blood flow restriction therapy and that the take-home message from that, sorry this is Luna she's gonna yell about some stuff here, is that BFR there's really not a population that BFR is not for. The indications are generally if you're having a hard time completing a heavy lift due like with limitations due to pain, post-operative, even wound fracture, all those kinds of things. If you're not able to complete work with one side that you can do with the other side you're feeling limited by that. The application of the tourniquet to occlude a certain percentage of your blood flow in that area has been shown to produce really good results as far as being able to load tissue with lesser load with the tourniquet applied and still achieve gains as far as hypertrophy or muscle growth, strength, oxidative behaviors, all that kind of good stuff that you're looking for with with strengthening. So the take-home message is that lifting heavy is still you know kind of the gold standard but if you're limited in your ability to lift and to achieve that kind of repetition because of some limitation then blood flow restriction therapy might be a good choice for you.

BFR therapy has been found to be beneficial for a wide range of patient populations, including those with pain, post-operative, and fracture limitations. It can help to strengthen tissue with lesser load and produce good results in terms of hypertrophy, strength, and oxidative behaviors.

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Blood flow restriction therapy has been found beneficial in various patient populations. This information is based on a recent con ed course by Owens Recovery Sciences. The key takeaway is that there isn't really a population for which BFR is not suitable. Indications for BFR include difficulty completing heavy lifts due to pain, post-operative conditions, wounds, fractures, and imbalances between one side of the body and the other. By applying a tourniquet to occlude a specific percentage of blood flow in the area, BFR has shown promising results in allowing tissue to be loaded with less weight while still achieving desired outcomes such as hypertrophy, muscle growth, strength gains, and oxidative behaviors associated with strengthening. While lifting heavy weights remains the gold standard, if limitations prevent individuals from achieving that level of repetition and loading, blood flow restriction therapy may be a viable option to consider.

Why do I only experience scapula pain when doing a loping/gallop freestyle?

Discover why scapula pain arises during loping/gallop freestyle

Why do I only experience scapula pain when doing a loping or a gallop freestyle? So a loping or a gallop freestyle is what you'll see in swimmers like Michael Phelps or Katie Ledecky, whereas a more standardized freestyle is much more of a symmetric length of pole and catch and finish past the hips. Katie Ledecky, I believe she's short left long right. It's much more of a shoulder driven freestyle than those that are more symmetric. So the difference I think between you know Katie Ledecky and Michael Phelps and those really super elite swimmers is that they have very strong support systems, right? They have the nutritionist, they have the strength coach, they have the swim coaches, and they're really able to support the demands of a really shoulder driven stroke through all those plannings, whereas a lot of times swimmers that are not at that elite level, if they're at your high school program or USA Club swimming, they don't necessarily have the same resources for strength and conditioning that are available to those more elite athletes. So that loping galloping freestyle is a much heavier and taxing stroke on the shoulders because it is so shoulder driven, so your scapula is having, and those scapular stabilizers are having to work way harder to support that increased demand on the arm that is doing the loping or that short side stroke. So in order to do that you want to be sure that you're maintaining really good scapular strength, being sure that your rotator cuff is really strong, and being sure that you're staying on top of those imbalances that oftentimes show up so that you can support that stroke.

The difference between elite swimmers like Michael Phelps and Katie Ledecky and less experienced swimmers is that the elites have more resources for strength and conditioning. As a result, their loping or galloping freestyle stroke is much heavier and taxing on the shoulders than a more symmetric freestyle stroke. This can cause pain in the scapula, which can be prevented by maintaining good scapular strength and addressing any imbalances.

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The reason you may only experience scapula pain when doing a loping or gallop freestyle is due to the nature of these swimming strokes. Loping or gallop freestyle, as seen in swimmers like Michael Phelps or Katie Ledecky, involves a more asymmetric and shoulder-driven technique compared to a standard freestyle. Elite swimmers like Phelps and Ledecky have robust support systems with nutritionists, strength coaches, and swim coaches to help them handle the demands of this shoulder-driven stroke. However, swimmers at high school or club levels may not have the same resources for strength and conditioning. The loping or gallop freestyle places greater stress on the shoulders, requiring increased engagement from the scapular stabilizers. To mitigate scapula pain, it's crucial to maintain strong scapular strength and a robust rotator cuff. It's also important to address any imbalances that may arise to properly support this stroke technique.

Can you tell me about a patient who has made a significant improvement while under your care?

Incredible Patient Transformation: From Fearful to Olympic Weightlifting

Can you tell me about a patient who has made significant improvement while under your care? These are the kinds of things that we all love to talk about, right? Is to kind of like prop yourself up and give you a pat on the back as it were. So I am fortunate, you know, that I've worked in sports therapy almost all my life. I'm now the owner of a performance-based physical therapy clinic, so I have had the distinct pleasure to work with a lot of athletes who are very good at what they do, as well as, you know, kids who just want to get better at what they do, as well as rehabbing, you know, people that after rotator cuff repair, after labral repair, after ACL reconstruction, impingement, low back pain, all these kinds of things. I think my favorite story right now that's probably the most recent is a gentleman who had a lot of pre-existing conditions and came and found me based on the referral from someone who he'd seen virtually throughout the course of the pandemic and really wanted to get back into Olympic weightlifting and, you know, maybe even some Highland Games type things, but was so afraid to move that he could barely walk. So now we have him deadlifting easily 225 pounds, he's working on his squat, and it's really been fun to see how far he's progressed in a really pretty short amount of time.

A gentleman I worked with had a lot of pre-existing conditions and was afraid to move, but now he is deadlifting easily 225 pounds and working on his squat. It has been amazing to see how far he has come in a short period of time.

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I'd like to share a story about a patient who made significant improvement while under my care. As a sports therapist and owner of a performance-based physical therapy clinic, I've had the privilege of working with various athletes, individuals striving to enhance their skills, and those recovering from injuries such as rotator cuff repair, labral repair, ACL reconstruction, impingement, and low back pain.

One of my favorite recent success stories involves a gentleman with pre-existing conditions. He was referred to me by someone he had been seeing virtually during the pandemic. Despite his desire to return to Olympic weightlifting and potentially participate in Highland Games, he was initially afraid to move and could barely walk.

Over time, we worked together to build his strength and confidence. Now, he can easily deadlift 225 pounds and is making progress with his squat. It has been incredibly rewarding to witness his remarkable improvement in a relatively short period of time.

These are the stories that remind us of the positive impact we can have as healthcare professionals and motivate us to continue helping our patients achieve their goals.

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Dr. Kari was born and raised in Madison and always knew she wanted a career working with and helping people achieve their greatness. She finished her Bachelor's Degree in Kinesiology at the University of Minnesota - Twin Cities and graduated with her DPT from the UW in 2012. She worked in a health system outside town for a while but soon moved her career to private practice in the Madison area. Here, she was able to work more for the patient, rather than be driven by insurance company requirements. She achieved a Specialist Certification in Orthopedics (OCS) in 2018 and has also been a Certified Strength and Conditioning Specialist (CSCS). Her niche is working with athletes of all varieties, though swimming is her passion. Outside of work, Dr. Kari coaches swimming and loves being with her family and friends, traveling, hiking, and baking. She's an avid sports fan and loves dogs of all shapes and sizes.

Neither AnyQuestion nor its Experts provide medical advice, diagnosis or treatment or otherwise provide professional healthcare services.

Dr. Kari Martin, PT, DPT, OCS