Heat or Ice? What’s Best for Your Injury?


One of the most commonly asked physical therapy questions is, “should I use heat or ice on my injury?” or “I didn’t know which one to use, what is the difference?”


Heat increases blood flow to the applied area and can help to relax and loosen tissues. Heat is often used with areas that have been bothersome for some time or before participating in activities. Ice causes the opposite effect; it decreases blood flow and is often used to minimize swelling, inflammation and irritation to an area.  Ice tends to be used on new injuries and areas of swelling. Both heat and ice can have pain-relieving effects if used appropriately and sometimes it may be appropriate to use both. For instance, some individuals might heat up a chronic painful area before activity and ice it down after to decrease soreness.


Here are some common examples and suggestions as to what is best for certain types of injuries. A newly sprained ankle should be iced to decrease the swelling and inflammation. Ice is also commonly used after surgeries to minimize inflammation and can be used indefinitely for pain and inflammation. It is often recommended to ice injured areas for ten minutes twice a day. On the other hand, a tight back or stiff leg would most likely respond favorably to heat before physical activity. Heat will help to increase blood flow and loosen the muscles whereas, back pain, that is caused by nerve irritation or inflammation, would probably respond better to ice as ice will minimize swelling and inflammation.


Heat and ice should never be applied directly to the skin and should not be left on longer than 15-20 minutes at a time. Both can be applied throughout the day, but you should allow 45 – 60 minutes between applications. The skin should be monitored for excessive redness and pain, which could be signs of a burn or frost- bite.


Hopefully this information has helped so that next time you have an injury you know exactly how to assist in treating it. Do you have any specific examples that you would like guidance on?


Annual Watchfire Honors our Armed Forces and our Flag

Mike Greenlar / The Post Standard

Russell Oakes remembers playing little league baseball as a kid and the friendships he formed at a young age. He graduated from Albany High School in 1965 and when he got word that a few of his little league friends had been killed in Vietnam, he decided to join the Marine Corps. Russell pulled four tours of duty in Vietnam from 1966-1968 and was honorably discharged in 1969. In 2001, he retired from the Department of Defense where he spent more than 15 years as a plan engineer. Russell has nothing but praise and admiration for the men and women who serve our country today.


This past weekend, his time was spent setting up for the Annual WATCHFIRE ceremony at the New York State Fairgrounds in Geddes. This event commences every year at sundown on the Sunday before Memorial Day to pay tribute to U.S. soldiers and veterans. A bonfire was lit at Veteran’s Watchfire Park to properly dispose of thousands of retired and tattered US flags. Over 20,000 people were expected to attend this year’s event.


The watchfire holds an important place in military history. It is said that following a battle or long march, a large fire was started so those missing or lost could locate and rejoin their comrades.1 Today, the Watchfire also provides the community an opportunity to properly retire unserviceable American flags.


If you have a flag no longer suitable for flying, there are several organizations that will retire your flag in a proper and respectful ceremony including the VFW, American Legion, Boy Scouts of America, Girl Scouts of America and the Marine Corps League.


In honor of National Military Appreciation Month and Memorial Day, we send a heartfelt THANK YOU to Mr. Oaks and to all our U.S. servicemen, servicewomen and their families, for your valiant service and sacrifice.


Patient Walks Daughter Down the Aisle Despite Setbacks


When physical therapist Meredith McHale introduced herself to her new patient James, neither one could have ever imagined the clinical roller coaster ride they would soon be taking.


James came to physical therapy (PT) like so many others, with severe pain in his back. After a thorough evaluation, Meredith created a specific treatment plan for him, and with his positive attitude, he was looking forward to getting started. When James returned for treatment 2 days later, Meredith realized that he had lost movement in his leg and immediately referred him to a spine specialist. James was rushed into emergency surgery on Easter Sunday to undergo a laminectomy, a procedure in which a portion of the patient’s vertebrae is removed to relieve pressure on the nerve.


Unfortunately, James’ emergencies did not end there. One week after surgery he suffered a pulmonary embolism, a blood clot in his leg that had traveled to his lung.  He was transferred back to the hospital for surgery to receive a femoral stent. Post surgery James went back to the in-patient rehab facility only to find out an infection had developed at his incision site. Most of us would have found it difficult to bounce back from just one of these setbacks, but James is a survivor.


After endless nights in the hospital, James was finally able to come home. He began in-home PT as well as wound care, three times a week.  Meredith was kept informed of the traumatic journey her friend James had been on.


Eventually, James became strong enough to start outpatient physical therapy and he returned to Meredith for treatment. He was unable to lift his left foot but he set an important goal for himself – James’ daughter was getting married and he wanted to walk her down the aisle. Meredith was by his side every step of the way to help him achieve that goal.


James began his sessions in a back brace, using a cane, and unable to drive himself to therapy. Through months of hard work, a positive attitude and lots of good old fashioned laughter, James was able to trade the brace and cane for his daughter’s arm on their special day. Meredith credits James’ determination and incredible outlook for achieving his goal, and all the while motivating every other patient in our office to do the same. Congratulations James, you did it!!


Treating Vertigo and Balance Disorders


Dizziness is a very common symptom that people may have at some point in their lives. From 2001 through 2004, 35.4% of US adults aged 40 years and older (69 million Americans) had experienced vestibular, or inner ear, dysfunction leading to dizziness.1


Some common causes of dizziness are vertigo, stroke, medication side effects, and sinus congestion, to name a few. Vertigo is caused by crystals in the inner ear getting lodged in the wrong place. Sometimes this can happen from a head injury or force to the head, but most of the time it happens for no reason at all. People who suffer from vertigo will complain of severe room-spinning dizziness, which may make them nauseous or even vomit. Many people describe vertigo as feeling like they had way too much to drink and then lay down. Vertigo can also impact balance and cause falls.


If you experience a sudden onset of dizziness, the best advice is to go to the emergency room or call your physician. It is important to rule out any significant causes, such as a stroke or cardiac event. If it is ruled to be vertigo, the physician may prescribe anti-dizziness medication and refer to a physical therapist (PT) who specializes in “vestibular therapy.” This specialized PT may be able to get rid of the vertigo in one visit.


The treatment for vertigo is usually very easy for the patient to tolerate. The patient will be given a thorough exam, and will then be led through what is called the Epley Maneuver. The Epley maneuver basically repositions the crystals back into a place in the inner ear where they won’t cause dizziness or loss of balance. The physical therapist will have the patient quickly lie down on their back with their head facing the symptomatic side, then turn the head slowly around about 270 degrees to the floor. The patient will then be instructed to sit up.


Most people report immediate relief, but some may take a few visits before they feel completely better.  The sooner they seek treatment the better to prevent any falls.


At Sports PT, we have three physical therapists that specialize in Vestibular Therapy. Becky Korosi and myself offer treatment in Tonawanda and Susan Kim at our York Avenue facility in Manhattan also offers this treatment. If you are suffering from vestibular dysfunction and have questions or are seeking treatment, please contact us directly.


Can Physical Therapy Help to Alleviate Low Back Pain During Pregnancy?

Are you pregnant and suffering from low back pain? Well you are not alone; over 50% of pregnant women experience low back pain during their pregnancy.1 This pain can be debilitating, preventing you from working, taking care of your home and taking care of your other children. Pregnancy-related lower back pain can be due to postural changes, ligament laxity due to the release of the hormone relaxin, and weight gain, resulting in decreased stability of the back and hips.1, 2


The good news is that you don’t need to suffer with pain during pregnancy. It has been shown that physical therapy can help to decrease or even eliminate pregnancy-related low back pain and improve your function through manual therapy, spinal stabilization exercises, and education on sitting, standing, lifting, use of support pillows, and turning in bed.1, 2, 3 Exercises will emphasize the abdominals (stomach), pelvic floor (muscles you use to stop urination), and gluteal/hip (buttock) muscles to help stabilize the pelvis. For example, some exercises your physical therapist might show you include: lying on your back with a wedge doing a bridge, getting on your hands and knees lifting opposite arm and leg, side-lying lifting your leg, and sitting on a physioball marching and standing doing small range squats.1, 2


As mentioned above, the hormone relaxin is increased during pregnancy to ten times the normal levels.3 The purpose of relaxin is to help the pelvis adapt and prepare for childbirth by softening connective tissues and ligaments around the pelvis, pubic symphysis, and sacrum. These changes will allow the baby to pass through the birth canal.3 Unfortunately, due to the increased release of relaxin, your sacroiliac joint and lumbar joints can become unstable and move out of alignment contributing to your pain. Research has shown that it is safe and effective for your physical therapist to perform gentle muscle energy techniques (manual therapy) to correct the alignment and allow you to train your muscles in proper position.3


Bottom line, you are not alone and you do not need to suffer with low back pain during pregnancy. It has been shown that exercise, education, and manual therapy during pregnancy is a safe and effective way to treat low back pain, reduce sick leave from work, reduce need for bed rest, and prepare you for labor. 1, 2, 3



3.  The Effects of Manual Physical Therapy and Therapeutic Exercise on Peripartum Posterior Pelvic Pain: Two Case Reports. The Journal of Manual & Manipulative Therapy. 2005; (2): 94-102.


What Lies Ahead for Yankee Pitcher Mariano Rivera After ACL Injury

(AP Photo / YES Network)


The words “ACL tear” resound with many sports enthusiasts who know that this is usually a season-ending injury for an athlete. Yankees fans were devastated to hear that superstar closing pitcher Mariano Rivera suffered an ACL tear during batting practice last week. ACL is short for anterior cruciate ligament, a major stabilizer of the knee when cutting, running, and even going up and down stairs. An ACL tear can happen at any age and from many different causes, including sports, falls, and work injuries.


When an ACL tears, some people hear and feel a pop in the knee. They can also have swelling, pain, and a feeling of their knee giving out. Clinical testing of the knee and an MRI would confirm the diagnosis. Some people can rehabilitate their knee after a tear without surgery, especially if they do not need to perform high-level leg activities like running and sports. Other people may opt to have ACL reconstructive surgery instead.


ACL surgery involves taking a tendon from another part of the leg and connecting it in place of the torn ligament or using a graft from a cadaver. The incisions are typically very small and barely noticeable once healed. After surgery, the knee will be put into an immobilizer (knee brace) to keep it straight and stable. Crutches are used to move around, although most people can start to put some weight on the leg almost immediately.


The rehab for ACL reconstruction typically starts in the first 2 weeks after surgery. It is lengthy but very important to restore knee function and a return to prior activities. A typical person, athlete or not, can expect to be in rehab for at least 3 months. The first phase of rehab focuses on regaining full knee range of motion and return to normal walking. The second phase focuses on strengthening and the third on return to sports or work-specific activities. Most surgeons will clear someone for running around 4 months after surgery if they have adequate strength, which is why a ball player is usually out for the season. Time will tell if Rivera is able to pitch at all this year.


What do you think this does for the Yankees chances this year?


From ACL Reconstruction to Physical Therapist


Today we travel to Syracuse, NY to visit with Heather Kidder, PT, DPT. Heather is a graduate of Daemen College in Buffalo, NY, where she earned both her Bachelor’s of Science in Natural Science and her Doctorate in Physical Therapy. Heather joined Sports PT in 2010 and is currently treating patients at our Sports PT Camillus location.


Kelly: Why did you choose to become a Physical Therapist?

Heather: While playing competitive sports in high school, I tore my ACL. I underwent ACL reconstruction and took part in physical therapy. I enjoyed the rehabilitation process and the therapist I worked with, leading me to my career decision.


Kelly: This is your first job out of school. Were you familiar with Sports PT before coming on board?  

Heather: Kind of. My professor at Daemen highly recommended Sports PT, and I drove by the Tonawanda clinic every day during school!


Kelly: Any suggestions or advice you’d share with those currently in PT school?

Heather: Listen to your patient. Think about the patient as a whole versus only focusing on where they’re experiencing pain.


Kelly: What does a young therapist like yourself enjoy doing outside of work?   

Heather: A little bit of everything really! Reading, playing soccer, cooking, being with my family, horseback riding.


Kelly: Horseback riding…I tried that once, it didn’t go so well for me!

Heather: My dad has a horse farm in Copenhagen, NY and I’ve been riding since I was 9 years old. It’s the best time away from the world, no TV, no cell phone…a great stress reliever.


Kelly: Besides being a great rider, you’re also a fantastic therapist Heather. We get the best feedback from our patients after they’ve worked with you. I have a stack of patient satisfaction surveys here to prove it.

Heather: We have a great “team feeling” and supportive environment here in Camillus, and great patients. I love working here!


You can visit our website to learn more about Heather.


Baltimore Raven Terrell Suggs Ruptures Achilles Tendon

Rob Carr / Getty Images

Bad news for football fans today: top defensive linebacker Terrell Suggs of the Baltimore Ravens will likely be out for the 2012 season because of a ruptured Achilles tendon. This injury is particularly devastating to an athlete because of the prolonged recovery time, which usually means the player is out for a year.


The Achilles tendon is the biggest and strongest tendon in our body, connecting the two powerful calf muscles, the gastrocnemius and soleus muscles, to the heel bone. Its duty is to handle the force of the calf muscle’s powerful contraction with pushing off to run, jump, and even walk. It is usually torn when someone jumps or makes a forceful push-off movement. Less often, it can be torn by something hitting the tendon. The athlete will commonly say they felt like someone kicked them in the back of the leg when the tendon tears.


Achilles tears are very easy to diagnose. A clinical diagnosis can often be made by feeling the back of the leg and squeezing the calf. This is known as the Thompson test. The clinician is looking for the foot to move when the calf is squeezed. If no movement is detected, an Achilles tear is to blame. The diagnosis can also be confirmed with a MRI or ultrasound.


The management of a tear can be conservative or surgical. Conservative treatment involves casting and extensive rehab, and is usually more favorable for non-athletes. Athletes like Suggs will typically have an Achilles repair surgery because of the demands on their body with athletics. A surgeon will open the back of the leg and suture the torn ends of the tendon back together. The patient is then usually immobilized in a cast or boot and not allowed to bear weight for the first 4 weeks or so (protocols vary). The patient will then begin a rehab program aimed at gradually beginning weight bearing and gentle stretching exercises. Strengthening typically begins around 6 weeks post-op, with gradual increase in resistance. The athlete is usually not allowed to run until 6 months after surgery, and full jumping and sport-specific drills sometimes even longer than that. The reason the recovery is so long is due to tissue healing times and the risk of re-rupture, which would be devastating to an athlete. One study found that the re-rupture rate is about 4.5 %, which is consistent with most literature and happens more often in people less than 30 years of age.1


Fans will have to wait to see the outcome of Suggs’ injury and recovery until next season.


One Leg Longer than the Other?

Have you noticed that your pants always fit a little weird or that you are always leaning to one leg when standing for awhile? If so, one of your legs may be longer than the other. This is known as a leg length discrepancy.


There are two main reasons for a leg length discrepancy. One reason is that one of your leg bones (tibia or femur) is longer on one side. This is referred to as a true leg length discrepancy because the actual length of your bones is different. A second reason is that your pelvic bone may be rotated on one side making it appear that one leg is longer than the other. This is referred to as an apparent leg length discrepancy because the actual length of your leg bones is not different. In order to figure out if you have a true or apparent leg length discrepancy, your doctor may take an x-ray to measure the length of your leg bones or a simple measurement from your belly button to your ankle can help determine the reason.


Over time, the leg length difference can cause stress on your low back, hips and knees, which may cause pain or discomfort.


How to fix the issue:

You may be prescribed a heel lift, which will equal out your leg length and decrease stress on your low back and legs. If it’s your pelvis causing the leg length discrepancy, then your physical therapist could use your muscles to realign your pelvis and then strengthen your core/abdominal region to minimize the risk of such malalignment happening again.


If you think that one leg may be longer than the other and it is causing you to have pain or you are just curious, then call your local Sports PT facility and make an appointment with a physical therapist.