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Cindysphinx
01-11-2010, 04:37 AM
I'm still marking time with my bad knee. You know, the knee where they don't know exactly what is wrong. I've been playing doubles, doing clinics and basically hanging on until surgery in May.

I've fallen into a predictable pattern, regardless of whether I do or don't play.

I wake up in the morning with everything feeling wonderful. If I exercise in the morning, I will ice because that seems sensible. Throughout the day, the knee feels increasingly tight and stiff, especially on the lateral side. Advil helps some, but not enough to bother with it so I usually don't. Icing in the afternoon or evening doesn't do much either. I can do stretches and strength exercises, which seem to loosen things up, but it never lasts very long. I go to bed, and then everything feels good again the next morning. Rinse and repeat.

So I am wondering if I should be using heat rather than icing. How do you know whether icing or heat is appropriate?

jrod
01-11-2010, 05:50 AM
Cindy- I assume the injury is old, yet is aggravated repeatedly after exercise. My general rule of thumb is apply ice to reduce any inflammation, usually post-exercise. Prior to exercise (or getting going for us old folks) you can apply heat to get blood flowing in the joint. This is a simple rule of thumb and it may be that your situation requires a different application of ice/heat.

mike53
01-11-2010, 05:53 AM
Good question. At this point you could try either or both and continue with the one that works best for you.

mikeler
01-11-2010, 06:19 AM
Good question. At this point you could try either or both and continue with the one that works best for you.


For my elbow, if I medium to heavy inflammation I use ice. Light inflammation I'll use heat.

SystemicAnomaly
01-11-2010, 11:17 AM
Cindy- I assume the injury is old, yet is aggravated repeatedly after exercise. My general rule of thumb is apply ice to reduce any inflammation, usually post-exercise. Prior to exercise (or getting going for us old folks) you can apply heat to get blood flowing in the joint. This is a simple rule of thumb and it may be that your situation requires a different application of ice/heat.

I'll second this. Before heading out to the courts, I'll often get under a hot shower and perform some static and dynamic knee (and shoulder) exercises. I'll then head over to the gym and spend 15-20 minutes on an exercise bike to get the synovial fluid flowing in may knees. More dynamic stretches at the courts before playing. After tennis, static stretches and then ice.

Topaz
01-11-2010, 01:33 PM
I'll second this. Before heading out to the courts, I'll often get under a hot shower and perform some static and dynamic knee (and shoulder) exercises. I'll then head over to the gym and spend 15-20 minutes on an exercise bike to get the synovial fluid flowing in may knees. More dynamic stretches at the courts before playing. After tennis, static stretches and then ice.

I'm about to 3rd this, but I have one question...

Wouldn't heat bring more blood flow (and more healing white blood cells) to the area? And we want this, right?

So why do so many people do icing? I would understand icing if there is swelling, but if there isn't, wouldn't it be wiser to go for the heating pad instead?

I feel like I should know the answer to this, but I don't! :)

jswinf
01-11-2010, 03:23 PM
Basic idea is ice to constrict blood vessels and slow blood flow, to reduce swelling after injury or prevent swelling that might happen in stressed muscles/joints as result of exercise. Heat to dilate blood vessels and increase blood flow, to carry off debris from previous inflammation to stressed muscles/joints.

Standard practice, then, is ice after exercise, maybe heat several hours later for pain/stiffness. As noted, though, sometimes seems to work better for some people in some situations the other way around. Careful use of ibuprofen should be helpful.

Cindysphinx
01-11-2010, 05:22 PM
How weird.

I actually managed to find the electric heating pad in this debris field I call a home. I used it for 30 minutes. And my knee feels awesome right now.

What do you make of that?

jrod
01-11-2010, 05:28 PM
How weird.

I actually managed to find the electric heating pad in this debris field I call a home. I used it for 30 minutes. And my knee feels awesome right now.

What do you make of that?


Makes good sense to me. Increase blood flow, helps relax the joint, carry off all those toxins collecting in the affected area.

Topaz
01-11-2010, 05:48 PM
How weird.

I actually managed to find the electric heating pad in this debris field I call a home. I used it for 30 minutes. And my knee feels awesome right now.

What do you make of that?

Makes good sense to me. Increase blood flow, helps relax the joint, carry off all those toxins collecting in the affected area.

Exactly!

This is why I don't understand why so many people ice!

Cindysphinx
01-11-2010, 06:35 PM
In all of my PT sessions over all these years, not once has a PT used heat on my knees or suggested that I do it at home when asked.

Well, I'm off to bed. Let's see what happens tomorrow. Every day is an adventure!!

mike53
01-12-2010, 08:00 AM
Exactly!

This is why I don't understand why so many people ice!

Icing reduces secondary tissue injury, among other beneficial effects. Heat reduces general soreness. To obtain the benefits of increased blood flow through the affected area, light exercise is better than heat.

LeeD
01-12-2010, 09:36 AM
Me, 600 mg's of Ibu an hour and a half before starting play.
If I don't, I play like a 60 year old.
If I do, I play like a 60 year old, who doesn't hurt and can move somewhat.

SystemicAnomaly
01-12-2010, 12:49 PM
I'm about to 3rd this, but I have one question...

Wouldn't heat bring more blood flow (and more healing white blood cells) to the area? And we want this, right?

So why do so many people do icing? I would understand icing if there is swelling, but if there isn't, wouldn't it be wiser to go for the heating pad instead? ...

In all of my PT sessions over all these years, not once has a PT used heat on my knees or suggested that I do it at home when asked...

Yup, ice generally is prescribed more than heat for various reasons. Within the 1st 48 hours of an acute injury, ice is used to prevent or minimize swelling/inflammation. Heat should never be used on a new injury. For chronic injuries, ice is still often more beneficial than heat -- whether or not visible signs of inflammation are present. Low-grade inflammation of internal tissue may not display any obvious signs (such as redness or noticeable swelling).

Even where inflammation does not appear to be present at all, ice is still used for pain management for chronic injuries. While initially it would seem that ice reduces blood flow, the body responds, in the long run, with improved circulation according to some sources. The first link below states the following:

"After the first 48 hours when bleeding should have stopped the aim of treatment changes from restricting bleeding and swelling to getting the tissues re-mobilised with exercise and stretching. Ice helps with pain relief and relaxation of muscle tissue."

"Ice often gives better and longer lasting effect on the circulation than heat. The pain killing properties of ice are also deeper and longer lasting than heat."

www.patient.co.uk/health/Ice-and-Heat-Treatment-for-Injuries.htm (http://www.patient.co.uk/health/Ice-and-Heat-Treatment-for-Injuries.htm)

orthopedics.about.com/cs/sportsmedicine/a/ICEorHEAT.htm (http://orthopedics.about.com/cs/sportsmedicine/a/iceorheat.htm)

.

SystemicAnomaly
01-12-2010, 01:13 PM
I'll second this. Before heading out to the courts, I'll often get under a hot shower and perform some static and dynamic knee (and shoulder) exercises. I'll then head over to the gym and spend 15-20 minutes on an exercise bike to get the synovial fluid flowing in may knees. More dynamic stretches at the courts before playing. After tennis, static stretches and then ice.

Conventional wisdom has stated that muscle & joints should not be stretched when cold. However, some current sources indicate that muscles/joints can (and should?) be stretched when cold. I've provided a link or 2 in other threads that mentioned this. I'll look into this further to see if this is becoming generally accepted. If so, I'd be inclined to do my static stretches prior to my hot shower and perform only dynamic stretches while in the shower.

After the hot shower, I'll oten apply heat packs or heat pads to my shoulder (or knees). I also try to make the time to get on an exercise bike (or some other low impact cardio equipment) before heading to the courts.

Tennis_Monk
01-12-2010, 06:47 PM
Here is a something i found useful.

Before a match, ie 30-45 mts earlier, apply ICY-HOT or BENGAE or equivalent ointment on both knees (be generous). I apply a bit on my serving shoulder joint too.

My friends call it Placebo but i find this very helpful.

mikeler
01-13-2010, 05:04 AM
Here is a something i found useful.

Before a match, ie 30-45 mts earlier, apply ICY-HOT or BENGAE or equivalent ointment on both knees (be generous). I apply a bit on my serving shoulder joint too.

My friends call it Placebo but i find this very helpful.


Pay the extra money and find a local chiropractor that sells Biofreeze. It works a little bit better than those other 2 you mentioned.

SystemicAnomaly
01-13-2010, 05:05 AM
Here is a something i found useful.

Before a match, ie 30-45 mts earlier, apply ICY-HOT or BENGAE or equivalent ointment on both knees (be generous). I apply a bit on my serving shoulder joint too.

My friends call it Placebo but i find this very helpful.

These ointments primarily consist of counter-irritants (http://www.encyclopedia.com/doc/1O62-counterirritant.html) that mask or distract you from pain that is deeper in the tissue. These topical ointments do not get much below the upper layers of the skin but can still be very effective in pain management. If you want to drive such an ointment deeper into the tissue, you might try it in concert with DMSO or emu oil.

www.medications.com/news/view/216906 (http://www.medications.com/news/view/216906)

.

SystemicAnomaly
01-13-2010, 05:11 AM
Pay the extra money and find a local chiropractor that sells Biofreeze. It works a little bit better than those other 2 you mentioned.

BioFreeze can also be effective for pain management. You should be able to find it online. I believe that it is also used in hospitals for cryotherapy

http://biofreeze.com/images/products/tn_HiRes16oz_Spray_250dpi_front_outline.jpg (http://biofreeze.com/)

chess9
01-13-2010, 05:14 AM
I'll second this. Before heading out to the courts, I'll often get under a hot shower and perform some static and dynamic knee (and shoulder) exercises. I'll then head over to the gym and spend 15-20 minutes on an exercise bike to get the synovial fluid flowing in may knees. More dynamic stretches at the courts before playing. After tennis, static stretches and then ice.

Ditto. Except I ride my bike to the courts or do a dynamic stretching routine at the wall before hitting some balls gently.

-Robert

larry10s
01-14-2010, 03:54 AM
If so, I'd be inclined to do my static stretches prior to my hot shower .

if i tried that im not sure id touch my patella!!!!! after really getting warm ie running a few miles or playing in 80 degree weather i can still touch my palms to the floor minimal bend in the knee!!!!!

larry10s
01-14-2010, 03:56 AM
to the op you may want to do both ice and heat . ice after you play heat later in the day. with a chronic injury this might be ok . id check with your p.t. first.

SystemicAnomaly
01-14-2010, 06:04 AM
if i tried that im not sure id touch my patella!!!!! after really getting warm ie running a few miles or playing in 80 degree weather i can still touch my palms to the floor minimal bend in the knee!!!!!

"...top soft tissue experts are now recommending that static stretching should be done cold, without warming up. The idea behind this is that when warm, the muscles simply elongate and then return to their normal state, whereas stretching a cold muscle will force it to undergo structural changes and increase in length."

I've seen several recent sources advocating stretching cold. Here is one:

http://www.hotbodytraining.com/the-low-down-on-static-stretching (http://www.hotbodytraining.com/the-low-down-on-static-stretching/)


to the op you may want to do both ice and heat . ice after you play heat later in the day. with a chronic injury this might be ok . id check with your p.t. first.

I'd do the ice periodically throughout the day (shortly after exercise and 2 other times during the day). I tend to only use heat before warmup & exercise. (Take a look again at post #14 for the rationale on this).

charliefedererer
01-14-2010, 10:59 AM
"...top soft tissue experts are now recommending that static stretching should be done cold, without warming up. The idea behind this is that when warm, the muscles simply elongate and then return to their normal state, whereas stretching a cold muscle will force it to undergo structural changes and increase in length."

I've seen several recent sources advocating stretching cold. Here is one:

http://www.hotbodytraining.com/the-low-down-on-static-stretching (http://www.hotbodytraining.com/the-low-down-on-static-stretching/)


That is interesting, and indeed may turn out to be a superior way to increase range of motion.

But would you still not agree that it is probably detrimental to do static stretching right before playing tennis, or other competitive athletic endeavors, because static stretching actually results in a small, but measurable, loss in strength?

SystemicAnomaly
01-14-2010, 11:35 PM
That is interesting, and indeed may turn out to be a superior way to increase range of motion.

But would you still not agree that it is probably detrimental to do static stretching right before playing tennis, or other competitive athletic endeavors, because static stretching actually results in a small, but measurable, loss in strength?

I would agree that performing static stretches 30 minutes prior to competition can result in reduced muscle performance (both speed and strength). It is even possible that the performance degradation can last for 60 minutes (or more) for certain stretches are utilized or if an extended stretching session is performed. This is why I recommend performing static stretches at home before heading over to the courts.