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Ice vs. Heat Therapy

October 27, 2015 by Maggie Bauman, DPT

I often get questioned by my patients about whether to ice or heat to help manage their symptoms. Here are some quick answers to these common questions:

Should I use ice or heat on my injury?

It depends on the type of injury and how long it has been present. For more chronic conditions or even just minor irritations, you can use either. Both ice and heat will help with managing your pain, so it may just be up to your preference. Typically what I tell my patients, go off of how it feels. If it feels “irritated”, “inflamed”, or “painful”, for example, then ice would probably be most beneficial. Think of ice as Nature’s Anti-Inflammatory. But if it feels more “tight”, “stiff”, or “achy”, heat might be better since it helps to bring blood flow and to relax the muscles.

But in a more acute situation, such as a sprained ankle, do not use heat (or soak in a hot tub for instance) for at least the first 72 hours due to the inflammatory response that takes place. Heat can cause more blood flow and exacerbate the swelling. In this situation, stick to the RICE principle: Rest, Ice, Compression, Elevation. This is also true for muscle strains, such as a pulled hamstring.

How long should i use ice or heat at a time?

For optimal therapeutic benefits, just 10-20 minutes is recommended. Be careful not to do any prolonged ice or heat as this can actually cause a burn on the skin (yes, even Ice can cause a burn!). It is not recommended to fall asleep with either modality in contact with your skin.

Should i use it before or after exercising?

The most effective results would be to heat before, to help increase blood flow and improve flexibility, and to ice after, to help with muscle recovery and minimize inflammation. There are some exceptions, such as if you have a lot of stiffness (e.g. with moderate to severe arthritis), and feel loose and more mobile after heat and stretching, you may want to wait until later in the day to ice to help maintain that mobility throughout the day.

Here at Physical Therapy Spine and Sports Medicine, we use large gel packs for ice that are moldable and conform easily to the contours of your body, as well as being very durable and staying cold for a long time. (These are available for purchase, no appointment necessary!) We also utilize Moist Heat therapy, with clay packs that sit in a vat of very hot water (160 degrees!), which allows the heat to penetrate deeper into the tissue and thus produce more effective healing. Feel free to call or stop by to learn more about ice and heat therapy!

Tags: Ice; Heat; Injury;

Osteoarthritis and Physical Therapy

September 28, 2015 by Brett Stuppy, SPT Maryville University

Osteoarthritis, also known as OA or degenerative joint disease, is the most common type of joint disease that affects millions of people worldwide. In fact, the Center for Disease Control (CDC) estimates 20 million individuals in the U.S. alone lives with some form of OA in their joints and is the leading cause of chronic disability in those 65 years and older.

What is Osteoarthritis?Osteoarthritis is caused by the breakdown of cartilage, which is found in joints of the body and acts as a cushion. Common symptoms of OA include deep, achy pain especially after prolonged use of the joint, decreased motion of the joint, clicking or popping of the joint and stiffness of the joint. Stiffness continues to decline with time as the individual avoids certain motions that cause pain. This can lead to overuse of surrounding joints and can lead to a spiraling decline of activity and quality of life.

So how can physical therapy help with osteoarthritis?Many times when someone is referred to a physical therapist with a diagnosis of OA, the patient wonders how physical therapy will change the structures of the joint including the space between bones. Although physical therapy can’t alter the integrity of the shape of bones, there are numerous ways an individual with OA can benefit from therapy. As discussed earlier, a primary goal of therapy will be to restore motion in the joint that has been reduced as a result of stiffness and pain. Physical therapists are trained in proper mechanics of the joint and can assist with techniques to facilitate proper movement and can educate patients on self- mobilization techniques to help ease pain and gain motion in the joint. Another goal will be to increase strength of muscles that surround the joint to alleviate pressure and work on the joint itself. In addition to strength, the muscles around the joint provide stability, which allows the bones to move and glide properly avoiding bone on bone contact. Finally, physical therapists can analyze body movement to correct impairments or recommend products for proper body mechanics.

The ultimate goal for physical therapy for an individual with osteoarthritis will be for the patient to return to activities in a pain-free manner so the patient can increase their quality of life. If you suspect you may have OA or have been diagnosed with OA, talk to your doctor about seeking a physical therapist so we can assist you back to activities you are longing to return to.

Tags: osteoarthritis; OA; joint;

Iliotibial Band Syndrome & Physical Therapy

September 27, 2015 by Ryan Knuckles, DPT

As we continue to be spoiled with beautiful weather leading into fall, parks and streets will be filled with bikers, runners and walkers out in full force among St. Louis County. A common injury among this population is Iliotibial Band Syndrome, abbreviated ITBS.

The ITB is a thick band of web-like connective tissue that lines the outside of the thigh. It attaches to the pelvis, connects to muscles on the lateral thigh (including the gluteus maximus and tensor fascia latae) and continues downward and attaches to the lateral knee. Therefore, the ITB crosses both the hip and knee joints and cause pain at one or both of the joints.

The ITB provides lateral support to the hip and knee during movements. Runners and cyclists commonly experience tightness in their ITB because of the tension placed on this tissue during activity. Hip pain occurs when the ITB snaps or rolls over the hip, causing an inflammation within the body. Knee pain can be cause by a similar rubbing of the connective tissue across the knee joint. Knee pain can also result when the ITB pulls the kneecap to the outside of the joint, causing it to be improperly positioned relative to the other structures in the knee. This can cause pain to either the inside or outside of the kneecap. Whether ITB syndrome causes symptoms at the hip and/or knee depends on a person’s particular anatomy and mechanics with dynamic activities.

How Can PT Help?The good news about ITB syndrome is that this condition can typically be treated conservatively with proper stretching and strengthening through physical therapy. However, patience is required with this diagnosis as it can take weeks to months for full relief of symptoms with activity. There are also some simple changes an individual can make to prevent ITB symptoms. For runners, it is recommended to frequently change directions with prolonged running. Therefore, runners should try to run on different sides of the street as safety allows with running towards traffic. For indoor runners, one should try switching directions on the track to alleviate tilts of the pelvis and overuse stress on the lower extremity. Bicyclists should be aware of their pedaling, avoiding turning the foot inward. Finally, it is important to frequently stretch the muscles that attach and surround the ITB including the hamstring, gluteus maximus and tensor fascia latae to maintain the integrity and flexibility of the ITB.


Tags: Iliotibial; ITBS; Band; Knee;


September 2, 2015 by Rachel Kinser

What is an orthotic? An orthotic is a supportive device which is placed inside footwear to change the mechanical function of the foot and alignment throughout the lower extremity. It works dynamically during weight-bearing activities like walking, running and standing. Orthotics provide custom and corrected arch support so that the foot and lower extremity work in a biomechanically correct way. They can be made in a variety of styles to accommodate your lifestyle.

What are problems that can benefit from orthotics? Orthotics can help a variety of lower extremity ailments and malalignments. The majority of the population over-pronate, or have flat feet. This can cause problems to develop as the foot is the initial contact point during gait. If the foot is not contacting with the ground in a proper pattern, the muscles throughout the foot and lower extremity have to work harder to propel the body forward. In the opposite case, if the foot has a rigid, high arch the body cannot absorb the shock during weight-bearing activates and increased pressure is created throughout the joints. Deformities of the foot like bunions or hammer toes can also be helped with the use of orthotics. Plantar fasciitis is a common diagnosis that can be alleviated with orthotics. By putting the foot in the proper anatomical alignment, the stresses placed on the tissues and joints are decreased, therefore decreasing pain. Along with many common foot and ankle disorders, orthotics can help alleviate knee, hip, and back pain. As the foot is the first part of the kinetic chain, having it in the proper alignment for weight bearing activities will give you the best possible chance to decrease disorder and deformity.

How do we create our custom orthotics here at Physical Therapy Spine and Sports Medicine? Here at PTSSM we use Xtremity One software. The system incorporates imaging software to create a 3D scanned image of your foot along with computer technology that allows our therapists to select the appropriate specifications to create the best orthotic for you. We offer orthotics in a variety of styles and sizes.

Does insurance cover orthotics? Several insurance companies have coverage for orthotics. If you do not have insurance benefits to cover orthotics, the out of pocket cost that we quote is less than you would pay at a podiatrist or other foot/ankle specialist. Call our friendly front desk staff to find out more information today about you coverage.

Tags: Orthotics; Plantar Fasciitis; Foot;

Plantar Fasciitis

July 20, 2015 by Ashley McFadden

Have you ever experienced a pain in your heel that is worst in the morning and with weight bearing activities? It is often described by patients as a sharp, stabbing pain. If you have experienced these symptoms before, it could be plantar fasciitis. Plantar fasciitis involves pain and inflammation of a thick band of tissue called the plantar fascia that runs across the bottom of your foot and connects your heel bone to your toes.

Plantar Fasciitis

Some factors that contribute to plantar fasciitis include:

  • decreased calf flexibility
  • increased body weight (body mass index of greater than 30)
  • poor foot support (pronated foot)
  • improper footwear
  • age (greater than 40 years old)

This can develop in athletes who run long distances or even non-athletes whose job requires them to be on their feet for prolonged periods. The good news is that this diagnosis can be treated by a Physical Therapist specialized in foot and ankle rehabilitation!

After a thorough evaluation, Physical Therapy will consist of, but not limited to the following:

  • stretching
  • soft tissue massage
  • foot ankle strengthening
  • fitting for orthotics and/or proper footwear
  • modalities such as ice and ultrasound

Research is showing that conservative treatments, such as Physical Therapy are extremely beneficial and surgery is rarely required. If you think you may be experiencing these symptoms, and would like a screening by a Physical Therapist, stop on in or call the clinic with additional questions.

Tags: Plantar Fasciitis;

Properly Treating a Frozen Shoulder with Physical Therapy

April 7, 2015 by Matt Helfrich

Welcome to our very first Physical Therapy Spine and Sports Medicine blog post!

As physical therapists, we invest in our expertise within the industry by continuing our education with conferences, home study, and courses. We understand the importance of advancing our clinical knowledge and skill set, and we take this very seriously since it not only keeps us current within our profession, but it also helps improve our patients’ outcomes.

Dealing with a Frozen Shoulder

In my nine years of studying and practicing physical therapy, one of my favorite topics of education has always been the shoulder.

I find the shoulder interesting because of just how much motion and the amount of muscles, tendons, and ligaments that are responsible for a motion that we often take for granted. That is, until we have a problem.

Probably one of the most ambiguous problems for the shoulder is a FROZEN SHOULDER. Everyone has heard this term but let’s dive a bit deeper into exactly what it is and how we treat it with physical therapy. Most patients want to know how it starts, and especially, why me?!

The unfortunate part of having a Frozen Shoulder is that it typically happens without an injury. What we’ve found is that there are certain types of people (usually females aged 40-65) that get a frozen shoulder more than others.

10-20% of the time, patients suffering from frozen shoulders are diagnosed with diabetes mellitus as well. All patients that develop a frozen shoulder have some type of inflammation in the shoulder either from pre-existing scarring, tendonitis, tendon tearing, or a trauma like a fall or a car accident.

These patients will all go through four stages of the freezing process including the thawing stage, but, in my experience, the faster a patient can start therapy the faster they can regain functional motion. A patient from my clinic recently confirmed this on her second to last day of the rehab process when she said, “The worst part is the middle of therapy because it’s frustrating how long it takes, but I really have come a long way after I turned the corner.” This was the same patient who had earlier been very vocal about wishing she had started therapy sooner than she did.

The First Step is Identifying the Problem

If you think you may have shoulder pain or stiffness in your shoulder it will ALWAYS be a good idea to get it checked out by a physician or with a quick screen by your therapist to determine the proper course of action.

If you’re in need of a screen for pain in a joint, give us a call today and we’ll work around your schedule - no script or insurance card needed.

Tags: Frozen; Shoulder;


This blog will serve as a direct channel to our physical therapists who are here to help assist our current and future patients with educational content that spans everything from what we do in therapy to the current concepts that may concern you or a family member in the future.