Mar 25, 2016Best of Both Worlds
By Timothy Neal
A soccer player sprains their ankle at practice and visits the athletic training room for care the following day. A lacrosse player reports that same day for chronic patellar tendonitis. As the athletic trainer, you must choose which type of therapy to apply. Of the many treatments at your disposal, you elect to address each injury with the tried and true approach of hot and cold therapy.
The lacrosse player will benefit from hot therapy modalities. These are used to increase circulation to the injured area, which provides an environment for the body to repair itself. Typically, hot therapies are applied when the acute inflammatory period following an injury has passed or in treating chronic conditions.
There are many types of modalities available for hot therapy. The method of choosing one depends on the area of injury, tissue depth desired for treatment, and whether active motion is also incorporated. Sample hot therapies include:
- Warm whirlpool: Good for chronic injury care. Can be used with range of motion.
- Warm plunge pool: Good for whole body or large body treatment or to increase circulation prior to exercise. Can be used with range of motion when full weight-bearing is contraindicated.
- Moist heat packs: Good for small, specific body parts, usually the back or upper leg.
- Ultrasound: Good for deeper tissue heating of a specific body area (if used on continuous setting for thermal effect).
- Diathermy: Good for deeper heating of a specific body area.
- Paraffin bath: Good for encasing the hand or foot.
Monitoring the athlete receiving hot therapy to prevent burns is recommended. Refer to manufacturer and educational hot therapy guidelines for acceptable treatment temperatures and time of application.
The soccer player will benefit more from cold therapy modalities. These are used immediately following an injury and during the early acute stages of inflammation. Controlling pain and swelling are the desired goals of utilizing cold therapy, which helps the injured area enter into the repair stage of healing. Cold therapy can also be combined with range of motion exercises or used to affect varying depths of tissue and surface areas. Examples are:
- Ice bags: Good for initial care. Provides a barrier over the skin, especially over superficial nerves.
- Ice massage: Use on wider body area. Can be used with active range of motion.
- Cold whirlpool: Good for larger body parts. Can be used with range of motion.
- Cold packs: Good at treating large surface areas.
- Cold plunge pool: Good for whole body or large body parts. Can be used for range-of-motion exercises when full weight-bearing is contraindicated.
- Cold pneumatic compression devices: Good for upper- or lower-body treatment. Provides compression along with cold therapy.
Care must be taken when applying cold therapy. The potential to freeze a superficial nerve, expose an athlete to frostbite, or cause them to develop cold urticaria should be taken into account.
Cold and hot therapies can be combined during the same treatment session. This is known as “contrast” therapy. The goal is to stimulate circulation and the lymphatic system to reduce swelling. An example of contrasting therapies would be using both a hot and cold whirlpool–alternating between two-and-a-half minutes in the cold tub and thirty seconds in the hot tub.
The athletic trainer has many forms of hot and cold therapies at their disposal to provide care to the athlete. Utilizing and, at times, combining hot and cold therapies is a prudent approach to injury care.
Timothy Neal, MS, ATC, is President of TLN Consulting and an Assistant Professor of Health and Human Performance at Concordia University-Ann Arbor.