Should You Heat or Ice Your Injury?

Use the right strategies to ease your pain

By Cindy Kuzma February 1, 2016 Ice may not always be the answer.

Bottom of FormLike tea or yoga, pain relief comes in more than one temperature. You reach for a bag of frozen peas from the freezer if you twist your ankle. You might even take a clue from your chiropractor and use a heating pad to relax that knot in your right shoulder. But what about when your shins start aching from too many miles cross-training on the pavement, or when you pull a muscle while mountain biking?

No cold pack or heated blanket can repair a sprained ankle or mend a torn tendon, but both warming and chilling a painful area can help minor injuries heal faster and temper pain. “That’s important, because if you feel better, I believe you’re going to heal better,” says Sonu Ahluwalia, M.D., clinical chief of orthopedic surgery at Cedars Sinai Medical Center. In part, the link appears psychological, but the mending comes from physiological factors too: reduce the ache and you may move more, increasing healing blood flow to the area. (Discover how counting out loud can make you feel better, plus 10 More Natural Cures For Pain.)

So when should you reach for peas versus the heating pad? Follow our guide below to choose the right degree of relief.

When To Chill Out

Ice quickly constricts the blood vessels in your skin and underlying tissues, decreasing blood flow, says Jessica Hettler, PT, a physical therapist at Hospital for Special Surgery in New York City. All the chemical reactions in the area slow to a crawl, including those that contribute to swelling and inflammation.

To use cold therapy safely, apply a gel pack, bag of crushed ice, or even frozen vegetables for 15 to 20 minutes every hour or two, all day if possible. (Hettler recommends toting a gel pack to work.) Place a moist towel or dishcloth in between the ice and your skin to prevent frostbite. And if you go the veggie route, mark the bag so no one cooks it later—thawing and re-freezing can spoil the food.

Use ice:

• Within the first 24 to 48 hours after an injury. Whether you sprained an ankle or pulled a muscle, you’ll reap the most reward from ice’s inflammation-fighting properties at this stage, Dr. Ahluwalia says. “Allowing inflammation to run rampant can lead to increased pain, increased swelling, and the loss of strength and mobility,” Hettler says.
• Immediately after a tough workout. If you think you overdid it, icing now can prevent soreness later by slowing the immediate inflammatory response, Hettler says.
• On injuries that feel warm when you touch them. This is a sign of active infection or inflammation; heat could worsen your condition at this stage.
• While pregnant, especially near your abdominal area. Hot packs in this spot could increase your core temperature and harm your baby. In extreme cases, a high core temperature could even contribute to birth defects—so check with your doctor if you have questions

When To Heat Things Up

Heat operates in the opposite way, opening up blood vessels and increasing blood flow, delivering nutrients that allow cramping muscles to relax. Hot packs also fight pain by altering the messages your sensory nerves send back to your brain, Hettler says.

You can use a moist heat pack warmed in water, electric heating blanket, or a popcorn-type pack that goes in the microwave. Place a towel or cloth over your skin first to avoid burning. Leave it on no more than 20 minutes, and let your skin cool completely before reapplying. And never go to sleep with a heating pad (or ice pack, for that matter), Hettler warns.  

Use heat:

• A day or two after a tough workout. In this case, skip the heating pad and create warmth from within through gentle movement—say, a few minutes of walking or easy cycling. “A hot pack is not going to get down to the big meaty layer of muscle that needs it,” Hettler says.
• For chronic soreness, such as low back pain. Warm showers or baths can prove especially helpful by releasing the tension from continually contracted muscles, Dr. Ahluwalia notes.
• On an injury after the first few days. At this point, inflammation has decreased and increasing blood flow can provide healing nutrients. There’s no set time that you have to switch, Hettler says—if ice still provides relief, stick with it, but if its effectiveness fades, then heat could help

This article originally appeared on Prevention.com

5 Life-Saving Signs of Heart Trouble Every Cyclist Should Know

Riding a bike is indisputably good for your heart, but it doesn’t make you immune to heart disease. Here’s what one heart surgeon who rides wants everyone to know.

By selene yeager February 1, 2016

Listening to your body isn't just about avoiding injury—it's also about recognizing it. Photograph by Philip Choi/Flickr

In some ways, we health and fitness reporters are a bit to blame for misconceptions about our favorite topics. We get so excited about all the health benefits of cycling, and all the ways riding a bike strengthens and protects your heart and prolongs your life, that it’s easy to think riding makes you immune to heart problems. That assumption can lead you to brush off some serious symptoms.

“You see it all the time: Men in their 40s and 50s who are healthy and recreationally active, like cyclists and triathletes, make the assumption that because they’re active, heart disease won’t happen to them. That’s not necessarily true,” says Larry Creswell, MD, a triathlon enthusiast, heart surgeon, and author of the Athlete’s Heart Blog. Creswell admits to having had similar thoughts when he took up endurance sports. “I was really surprised when I started swimming and running and cycling in my 40s how many of the folks I trained with either had a heart problem or knew someone with one—pretty much everyone! Exercise helps strengthen your heart and is good for cardiovascular health. That is a certainty. But there’s obviously no guarantee that everyone who exercises will be forever immune to heart disease."

The good news is that because you are physically active and in tune with your body, you’re likely to see the signs before they become serious. You just need to recognize and heed them. We tapped Creswell to share five key symptoms that your heart could be in trouble—signs many riders (especially men) ignore.

Chest pain or tightness: Seems like a no-brainer, right? “I can’t tell you how many guys who have had a heart attack or other cardiac event say that they had some chest pain and/or tightness and ignored it or figured it was something else,” says Creswell. “That is the one thing that always surprises me.” To be fair, Creswell concedes that everyone feels pain differently and if you’ve never felt chest pain and you’re a healthy cyclist, it’s easy to think it must be something else like acid reflux or a pulled muscle. “The defining characteristic is that it is brought on by exercise and it subsides when you rest,” he says. “It is generally very reproducible in character." If you feel intensely during exercise and it subsides when you're at rest, get to the doctor ASAP.

Abnormal heartbeats: Heart palpitations are another symptom that you should never ignore. “Pay attention anytime you have the sensation of having an abnormal heartbeat,” says Creswell. It could be pounding in your chest or a light, fast fluttering. If something doesn’t feel right, that’s a sign that it isn’t. “This is where your heart rate monitor can really help,” he says. “If your heart is suddenly zooming along at 210 beats per minute for no good reason, that’s a sign to get checked out. Same thing goes if you’re at home going through your data file and you see episodes where your heart rate is pushing 200 or so when you felt like you were going along at 125.”

Mysterious shortness of breath. If you’re a cyclist—no matter what your level—you know what your breathing pattern is like when you’re riding. When it doesn't feel normal for the exertion level you're at, particularly if you’re cruising along fairly easily and suddenly working to catch your breath, something is wrong. This is another easy one to blow off as something else, says Creswell, and indeed it might be. “You could be fatigued or coming down with a cold or virus. But it’s a warning sign and if it’s unexplained, you need to get it checked out,” he says.

Unexplained fatigue. This one generally shows up off the bike. You’re just run down and hunting for a quiet place to nap for no good reason. “It also can show up as a performance decrement that is unexplained,” says Creswell. “If for no good reason, you’re tired on the bike and not progressing or you’re even regressing, it’s a warning sign.” 

Nearly blacking out. This is a big red warning flag. If you are nearly blacking out—or worse, actually blacking out—while you’re exerting yourself, it’s really dangerous for a few reasons. One, you could crash. Two, you could suddenly die from a serious underlying heart problem. Get it checked pronto.

Women take note, your heart problems may not present so obviously, particularly in the chest pain department. “Chest pain presents differently in women. It may be less severe or be more difficult to pinpoint where the pain is coming from,” says Creswell. “The other symptoms I mentioned should still demand your attention, especially since you may not have the same early warning in the form of chest pain.”

One last crucial heart care tip: Get a regular check-up from a primary care doctor. “This is where women are often at an advantage. They tend to go to an OB/GYN regularly, so they get their blood pressure checked; they get some blood work done," says Creswell. But guys? "There are men who are healthy and in their 40s, maybe even their 50s and they don’t have a primary care doctor. They’ve never had their blood work done, and can’t remember last time they had their blood pressure checked. If you’re going to spend all that money on a nice bike and bike computer and maybe even a power meter and a coach, get yourself a doctor, too! It’ll cost a fraction of all that and take less than an hour out of your year!” 

Advice For Aging Athletes

Build your core and leg muscles to stay strong and steady over time.

By William O. Roberts, MD Tuesday, January 5, 2016, 12:34 pm

Zandra asks: I am 81 and still love to run. I like to do half-marathons. But I am feeling increasingly ill at ease on the trail because I am getting slower and slower. It often feels that the trail is no place for old ladies. What do you think? 

Good for you to still love running at age 81. I hope to be like you. If "ill at ease" means you are worried about how you look because you are slower, I would say push on and have fun. But if you are uncomfortable with your strength and balance, we are talking about a different issue.

Physical activity is a use-it-or-lose-it proposition, especially in your ninth decade. A fall and fracture of the hip does not bode well for people over 65, especially women. You can improve your balance by working on your core and leg strength. There may be classes at your local fitness center or YMCA that help you with this. You may or may not be the oldest participant, but you will be an inspiration to the younger crowd.

I am also not sure what you mean by “on the trail.” Literally speaking, that would refer to trail running, which is a challenge at any age due to the inconsistencies in the surface. Exposed rocks and roots and loose debris can upset your balance and bring you to the ground. But "on the trail” can mean heading out on the roads or running path to put in some miles. At 81, I would usually recommend staying on relatively smooth surfaces with good traction.

Almost everyone gets slower with age. That is not a bad thing, just the way it is. People also tend to get weaker with age, and that is a bad thing. You will need to work on your strength to keep your balance even if you choose not to run. If you enjoy running, even though it is at a slower pace, keep it up. It is good for your heart, good for your body, and good for your soul.

Should Your Muscles Be Sore After Every Workout?

• By Tony Gentilcore

We've all been there.

The day after a brutal squat session or copious amounts of dumbbell flies and bicep curls, you're finding yourself cringing as you walk down a flight of stairs or reach up to grab your toothbrush.

You're sore and maybe cursing that last set of deadlifts from last night.

DOMS

The soreness you feel can be attributed to delayed onset muscle soreness (or DOMS as it's more affectionately referred to), and it's a phenomenon that's been well researched over the years. The feeling often manifests within six to eight hours post-exercise and peaks up to 48 hours afterward.

Some people seek out DOMS no matter what. They gauge the effectiveness of their training sessions on how much of it they can elicit, thinking the more sore they are, the more progress they've made.

Others avoid DOMS like a bad movie. For the non-masochistic, being sore isn't pleasurable. These people often find themselves wondering why they never make any progress.

So, which vantage point is correct?

Both.

What Causes DOMS?

First and foremost, it's important to understand what doesn't cause DOMS: lactic acid.

Everyone from our middle school gym teacher to our mailman used to attribute soreness with a build-up of lactic acid in the muscle. This myth was debunked decades ago.

Ironically, despite all the research, there's no clear-cut winner as to the exact mechanism. Our best guess, according to a 2013 study by Bret Contreras and Dr. Brad Schoenfeld, is that soreness comes from inflammation.

"DOMS appears to be a product of inflammation caused by microscopic tears in the connective tissue elements that sensitize nociceptors and thereby heighten the sensations of pain," the study states.

People Are Different

When it comes to soreness and whether or not it's mandatory to make progress in the gym, the answer is a loaded one.

In order to progress—whether your goal is to add muscle mass or lose fat—it's crucial to consistently challenge the body to adapt. This is done by making your muscles work—pushing things, pulling things, carrying things and doing anything else to add variety to your workout regimen.

When you try a new workout or unfamiliar exercises, your body is going to respond with some feedback on subsequent days. The common response? Muscle soreness.

Should Your Muscles Be Sore After Every Workout?

• By Tony Gentilcore

We've all been there.

The day after a brutal squat session or copious amounts of dumbbell flies and bicep curls, you're finding yourself cringing as you walk down a flight of stairs or reach up to grab your toothbrush.

You're sore and maybe cursing that last set of deadlifts from last night.

DOMS

The soreness you feel can be attributed to delayed onset muscle soreness (or DOMS as it's more affectionately referred to), and it's a phenomenon that's been well researched over the years. The feeling often manifests within six to eight hours post-exercise and peaks up to 48 hours afterward.

Some people seek out DOMS no matter what. They gauge the effectiveness of their training sessions on how much of it they can elicit, thinking the more sore they are, the more progress they've made.

Others avoid DOMS like a bad movie. For the non-masochistic, being sore isn't pleasurable. These people often find themselves wondering why they never make any progress.

So, which vantage point is correct?

Both.

What Causes DOMS?

First and foremost, it's important to understand what doesn't cause DOMS: lactic acid.

Everyone from our middle school gym teacher to our mailman used to attribute soreness with a build-up of lactic acid in the muscle. This myth was debunked decades ago.

Ironically, despite all the research, there's no clear-cut winner as to the exact mechanism. Our best guess, according to a 2013 study by Bret Contreras and Dr. Brad Schoenfeld, is that soreness comes from inflammation.

"DOMS appears to be a product of inflammation caused by microscopic tears in the connective tissue elements that sensitize nociceptors and thereby heighten the sensations of pain," the study states.

People Are Different

When it comes to soreness and whether or not it's mandatory to make progress in the gym, the answer is a loaded one.

In order to progress—whether your goal is to add muscle mass or lose fat—it's crucial to consistently challenge the body to adapt. This is done by making your muscles work—pushing things, pulling things, carrying things and doing anything else to add variety to your workout regimen.

When you try a new workout or unfamiliar exercises, your body is going to respond with some feedback on subsequent days. The common response? Muscle soreness.