SPEAR Physiotherapist Julia Answers Your Questions
In clinic, there are a handful of questions we seem to be asked frequently – with misconceptions and/or misinformation (thanks to Dr. Google!) that potentially come with these. I thought it would be helpful to touch on a couple things we as physiotherapists get frequently asked – with little tips and tricks we find go a long way for our patients!
Hot vs. cold? Which is better? When should I use what?
Using cold or heat can be useful for treatment of muscular or soft tissue injuries. Both work to decrease pain in joints, muscles and soft tissues – having opposite effects on blood flow, tissue metabolism, inflammation and swelling, and tissue flexibility. Hot works well to relax muscle spasm and increase flexibility within stiff joints, while cold works to decrease tissue temperature and thus blood flow to limit tissue damage. Both applications reduce pain – but the question is when to use which application IS STILL DEBATED! Thus, I tend to use PATIENT PREFERENCE over anything else, unless it is an acute injury (within the last 2-3 days), and then ice should be used to limit the amount of swelling and bruising. If using ice, be careful to always put a wet towel between ice and your skin to prevent ice burns. We have seen a number of impressive ice burns and these should be avoided.
Does foam rolling help? How do I best use a spikey ball to optimise recovery after training?
Foam rolling can help to enhance BOTH performance and recovery – despite the lack of robust evidence on the exact mechanisms for which drive these benefits. Again – I tell my patients – if it feels GOOD and helps you – I’m all for it! Foam rolling has been found to reduce muscle stiffness and increase range of motion (in a variety of muscles/joints), particularly when used with dynamic stretching in an active warm up. It can also help reduce delayed onset muscle soreness (oh the dreaded DOMS!), which is why its smart to foam roll AFTER a run or strength-training program within your cool-down. It can help increase blood flow and circulation – which has been found to help with psychological relaxation (again – I’m all for this!!).
As for using the spikey ball – the biggest mistake I find with ALL myofascial release is that patients DO NOT HOLD LONG ENOUGH on the tighter, dull achy spots. Its important to avoid any bony bits – or ‘sharp’ pain when performing. You want to find the good pains. First roll around the tighter area – then once you find a DULL ACHE hold onto this until you feel relief… this takes us to our next question…
How long do I need to hold a stretch?
Just the same as trigger point releasing (relaxing) tight muscles with either foam rolling or the spikey ball, the length we hold a stretch is patient specific. I tend to tell my patients to ‘hold until relief of the stretch’… with the aim of holding anywhere from 30 secs to a couple of minutes. It is unlikely that you will make a significant improvement in muscle length with holding a stretch under 30 seconds (and that is if you are performing it correctly!). Dynamic stretches are different (for warming up)- where as we focus on moving through range within a stretch repeatedly. Static (prolonged holding of stretches) are for COOL DOWN only. The only time static stretching should be done in a warm-up is if you do not have the range of movement for the activity you are warming up for. Ideally this should be worked on outwith the warm-up though so the warm-up can be dynamic.
How much pain is too much? Should I stop (insert activity/sport) if I feel pain?
I’m sure many of us at SPEAR have a common answer to this… if your pain isn’t climbing above a 3-4/10 on the pain scale, it is unlikely that you need to STOP what you are doing. That being said, this rule goes for after activity as well. I tend to say if you wake up in pain less than your ‘baseline’ pain level the day after the activity, you’re likely able to continue! Using the traffic light system (green = 0- 2/10, amber = 2-4/10, and red 4+/10) – we tend to use this as a guide for re-loading (depending on your history and specific injury of course!). It is better to scale back your activity then stop completely!
I hope you’ve found these little tid-bits helpful! For further information or questions about your specific ache or pain, please do make an appointment for an assessment and specific treatment and advice on how to get you back to doing what you love!