Cool it down with Ice or turn up the heat?

One of the most common approaches for clinicians and the public alike, to find pain relief for lower back pain, is to apply heat or cold therapeutics. These take the form of heat packs, hot water bottles, wheat bags as well as ice packs, ice gel packs etc. It’s one of those topics that everyone has an opinion on what works for them (and what will work for you).
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But what does the research have to say on this topic?

Unfortunately there is no high quality research on this subject. There is moderate level evidence to support the use of heat packs for short term symptom relief, and only low levels of evidence that shows minimal benefit from cold therapies for the treatment of lower back pain in acute (< 6 weeks ) and sub-acute patients. There appears to be a benefit of adding exercise to this approach which has ever increasing levels of support in the research.
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So what can we take away here?

Both heat and cold therapies are commonly used low risk interventions for lower back pain. Heat has moderate evidence demonstrating some benefit in pain reduction and this enhanced with adding exercises.

French, S. D., et al. (2006). "Superficial heat or cold for low back pain." Cochrane Database of Systematic Reviews(1).

Concussion is a disturbance to normal brain function, rather than a structural injury to the brain. A mild/subtle concussion is when the person is seeing stars and a more obvious one will show function deficits. Biomechanical forces of concussion can be linear or rotational. A concussion can occur due to impact to another player, the playing surface or playing equipment (e.g. ball or goal posts). According to data in the US there is reports of 1.6-3.8 million sports related concussions and unreported rates are 6-10 times more than this figure. Rugby league + union show a prevalence of 3.9 rates per 1,000 player hours (horse racing has the most, between 17-95 rates per 1,000 player hours). NRL in the past 4-5 years in elite competitions reports that between 5-7 concussions will be seen per team per season.
 
Signs and Symptoms that a concussion has occurred
Obvious signs may include:

• Loss of consciousness or non-responsive
• Person is on the ground or slow to return to feet
• Person not bracing for the fall to the ground (this usually means they lost consciousness before fall)
• Loss of balance or unsteady on feet
• Poor co-ordination
• Blank or dazed look
• Obvious trauma to face or head

 
Indications during play:

• Unsure of what occurred (most consistent sign is a few moments after event)
• Disorientation (e.g. not knowing who you’re playing, what venue you’re playing at, time of game, which direction your team is going)
• Forgetting structures and team plays
• Feeling slower (decision making, movements, processing information)

 

 

 
 





Management of acute concussion:

• If in doubt sit them out!! Loss of consciousness and memory loss does not have to occur for the person to be concussed
• Management begins as soon as the person is identified as having a suspected concussion. Remove person from play and/or training and should not return to play on the same day and at least 48 hours after, even if there is no signs or symptoms.
• Players are removed to decrease the risk of further injury, allow for examination of injury and reduce the risk of long-term problems related to concussions and injuries.
• CALL AMBULANCE when red flags signs and symptoms are present:

• Neck pain or tenderness
• Numbness or tingles down upper or lower limbs (possible spinal cord injury)
• Headache becoming worse
• Seizure
• Loss of consciousness
• Persistent confusion
• Worsening of symptoms (this can even be hours after the game)
• Vomiting
• Changes in mood
• Double vision

• Unconscious player means using first aid principles (ABC check airways, breathing and perform CPR if needed). They must be removed from the field with care on a stretcher and immobilise the neck as there may be a neck injury and then wait for ambulance.
• A concussed person must not be left alone for at least the initial 2 hours post injury and not to be sent home by themselves, which means no driving as well. Not to take certain medications including anti-inflammatory or strong pain relief medications as this can mask the symptoms of a concussion. It is not safe to drink alcohol during the initial period post injury. Check breathing during sleep that night and even waking to check for a response.
• Concussions usually are resolved within a two-week period without any issues. A small number of athletes can develop post-concussion syndrome which is a continuation of symptoms greater than 3 months. Recovery time for young athletes is longer than adults.
• Complete rest 24-48 hours post event is recommended

 
Return to play:

• Return to normal daily activities such as school or work and then return to sport. Concussions may have an effect with memory and processing information, this could interfere with the person’s ability to learn.
• A medical practitioner should always be the one deciding the timing of return to school and/or play
• If the athletes are still experiencing symptoms, they should not return to play and usually means they have not fully recovered. If the player returns to play early there is a chance for further concussion, increased risk of other musculoskeletal injury and prolonged recovery.
• Slow progression of involvement back into play is needed to reduce the risk of further complications post 24-48 hours of initial rest period. The 6-stage graduated return to sport (GRTS) is a good guide:
  1. Symptom-limited activity – activities that do not aggravate or worsen symptoms.
  2. Light aerobic exercise – walking or light exercise bike (no resistance/weight training)
  3. Sport specific exercise – drills without contact
  4. Non-contact training – resistance/weight training
  5. Full contact training – after clearance by medical practitioner begin skills and tackling
  6. Return to play

Each stage should be a minimum of 24 hours duration, this means that a period of 7-8 days as minimum time for return to contact sport and this period is twice as long for young athletes (18 years and younger). If there is a return of symptoms at any stage, then the athlete should move back to the stage where they were not experiencing symptoms.

 
http://sma.org.au/resources-advice/concussion/
https://playnrl.com/trainer/concussion/

Josh Hallinan - Chiropractor
Tue & Thur 8am - 6pm