North City Physiotherapy is proud to annouce on Monday 10th July 2017 we will be opening our central Porirua CBD clinic. We will be be able to continue provide top class rehabilitation services in the community we love and have been part of for many years.

Recently I have been asked by several clients “what should I put on my injury, ice or heat? And what are the differences?” As physiotherapists, we see a lot of injuries ranging from new to old. For the most part, people are familiar with the acronym R.I.C.E – rest, ice, compression and elevation. But is this up-to-date practice? Let’s review this topic to try and give a confident, well-informed answer to this common question.

Ice. It is one of the most common treatments used around the world. Ice works by constricting the blood vessels and reducing tissue metabolism. Basically, it slows down any bleeding, swelling and how the tissues work as a whole. There is also evidence that once the skin temperature falls below 15®C then there is an analgesic (or pain relieving) effect. This is because the nerves conduct their messages more slowly at lower temperatures. Research shows that a standard application of ice after a soft tissue injury consists of a crushed ice bag with a towel between the skin and ice to avoid frostbite/ice burn. This should be held over the affected area for 20 minutes and reapplied every two hours for the first six hours. Furthermore, there is evidence that shows a combination of ice and exercise is more effective than exercise alone at healing injuries.

In comparison, heat works by opening up the blood vessels, thereby increasing the blood flow and making the tissues more elastic. Heat can also produce its own pain relieving effect. In the acute stage after an injury (within the first five days), there is evidence to suggest that applying heat can actually make the injury worse due the increased bleeding and swelling. Therefore, the use of heat is more effective on injuries that are more longstanding. For example, heat can decrease joint stiffness and pain in people with osteoarthritis and can be used as a relaxant on sore muscles and trigger points. Interestingly, there are studies that have shown heat therapy provides short-term reductions in pain and disability in people with acute low back pain and provides significantly greater pain relief of Delayed Onset Muscle Soreness (DOMS) than cold therapy.

Overall, after reading the research on this cool topic, the results are inconsistent. For me personally, if a person came to me with an acute rolled ankle, I would recommend that they ice the injury for 20 minutes every three to four hours, for the first week. However, if a person came in with a four month history of neck pain and stiffness, with associated soreness in the surrounding muscles, I would suggest they apply heat for 30 minutes a day over the area. Above all else, I believe in personal preference and past experiences to guide the decision. Others may differ from this but you and your physiotherapist can discuss this further to come up with a tailored plan for your needs.

Our bodies are in a constant battle with gravity to stay upright. Whether you are sprinting towards the try line or simply standing up from a chair, the ability to maintain balance is essential for almost any activity. When an injury does occur, it is very likely that your balance has been affected in some way and it is our job as Physiotherapists to fix this. So, what is going on? How does balance work? And most importantly, how do we improve it?

Your body’s balance is actually reliant upon 3 systems sending your brain information: The visual system, a balance organ located in your ear known as the vestibular system and through information provided by receptors in your joints, the proprioceptive system. Information from all three of these systems is processed in your brain allowing you to maintain an upright, level posture and be aware of where all of your body parts are in relation to each other.

Research has shown that your average person is about 70% reliant on the proprioceptive system, 20% vestibular and 10% vision when standing on a firm flat surface. When an injury occurs such as a sprained ankle or knee injury all the receptors carrying proprioceptive information from that joint are disrupted and your other systems have to compensate as best they can.

There are plenty of ways physio can help retrain the proprioceptive system and help restore you back to full balance potential. Firstly, your current level of balance would be assessed both statically and dynamically (with movement). From there appropriate exercises can be given that challenge the proprioceptive system- practice makes perfect. Here are just some common exercises used to re-train balance used by our physiotherapists:

Practicing maintaining posture on uneven surfaces such as foam or a wobble board
Strengthening exercises for the muscles around the injured joint for increased stability
Perturbation training: Improving reaction times to a quick change in body position
Balance really is a key aspect of rehabilitation; the deficit may not be as blatantly obvious during the initial stages of an injury compared to other symptoms such as pain and weakness. This can cause balance to be an area overlooked and not addressed properly during your rehabilitation. In turn, this can lead to a patient not returning to full pre-injury potential. If you are feeling a bit wobbly on your feet, don’t let gravity win and book into see us today.