Sore Muscles...Maybe You Need an Ice Bath?

The Effectiveness of Icing  By Sharlene Caldwell

There seems to be a lot of discussion surrounding the practice of icing after exercise these days.   The procedure of icing after workouts has been around for decades, but we are now starting to read statements suggesting it may be the end of the ice age. It seems like some of the very same people who advocated icing for years are now shunning it. “Stop icing” is the battle cry of some popular bloggers.

Why? What has changed in the human body that now makes icing bad? Or what have we learned recently that should cause us to change our mind? In an effort to seek unbiased answers to these questions, we turned to the scientific community.

We used as sources for our information peer reviewed journals that rely on experimental data and scientific methods to draw conclusions, as opposed to articles that merely advocate somebody’s logic or opinion. These are scholarly articles whose authors either performed original testing as part of their research or they reviewed existing studies to ascertain the overall effectiveness of cryotherapy.   A link to the bibliography of references is included at the end of this article. You can find these and other articles online by using an appropriate search site such as PubMed.

The use of ice on traumatic injuries is still in practice at every medical center in the world. The effectiveness of ice on these types of injuries is not questioned and not the topic of concern here. It is the use of ice after workouts to aid in recovery that is being questioned. Accordingly, we limited our research to the use of ice as an aid in recovery after exercise induced muscle damage.

“The effects of multiple daily applications of ice to the hamstrings on biochemical measures, signs, and symptoms associated with exercise-induced muscle damage.”   This is the title of one such article we found, published in the Journal of Strength and Conditioning Research. In it, the authors, a team out of Andrews University, measured the effects of ice on exercise recovery – very appropriate.   They used an icing protocol common to athletes and took data for 72 hours following the workout. Their results? “The cryotherapy group had significantly less pain compared with the control at 48 hours.”

Here’s another article we read. “Stretching versus transitory icing: which is the more effective treatment for attenuating muscle fatigue after repeated manual labor?” This study was published in the European Journal of Applied Physiology by a team in Japan.   In it, they compared stretching to icing on the recovery time of athletes subjected to intense exercise induced muscle damage. By measuring the electrical activity of the muscles along with muscle oxygen levels during the recovery phase, they were able to see the impact of these procedures on muscles. Their results supported the use of ice. “Icing may more effectively induce recovery and thus may be a better choice between the two treatment techniques.”

The Journal of Athletic Training published this study:” Does Cryotherapy Improve Outcomes With Soft Tissue Injury?” This is actually a study of many studies on cryotherapy. The authors, from Pennsylvania State University, created search criteria to locate studies that met their needs. A total of 55 articles were reviewed. While they spent a good deal of effort evaluating the testing procedures themselves, their final conclusion was “Based on the available evidence, cryotherapy seems to be effective in decreasing pain.”

There are many other articles we could refer to ad-nauseam but you would stop reading. If you are interested, our advice is to do your own search. Go to PubMed and search on terms like “ice therapy” and “cryotherapy” with respect to exercise and recovery.   You will be overwhelmed by the amount of research done.

We found that for the span of several decades, all around the globe, teams of doctors, scientists and others have studied the effects of icing on recovery with every tool available. Indeed, the quantity of data that exist on icing is quite formidable. For anyone to state that there is no conclusive evidence regarding icing is tantamount to burying one’s head in the sand.

While exercise programs may come and go, the human body remains the same. The way it works today is the same as it has for a long, long time.

Should you keep taking NSAIDs for pain?

New warnings suggest that even people without heart problems may be at risk for heart attack and stroke with NSAID use.

It seems easy enough to swallow a couple of non-steroidal anti-inflammatory drugs (NSAIDs) for a headache or a sore back. But in July 2015, the FDA announced it would strengthen an existing label warning that NSAIDs increase the chance of a heart attack or stroke.

  “There are some risks,” says Dr. Daniel Solomon, a Harvard Medical School professor who specializes in rheumatology. “But it’s important to put those risks in perspective.” The cardiovascular risk is greater with higher doses and longer use, and in people who already have heart disease or risk factors for heart disease.

Heart and stroke concerns

You can buy NSAIDs such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naproxen) over the counter; stronger doses require a doctor’s prescription. They work by blocking enzymes that produce pain and swelling. The risks of NSAIDs are not very high, but they are real. Regular, long-term use of NSAIDs has been linked to ulcers, stomach bleeding, liver damage, high blood pressure, and increased risk of heart attacks or heart failure.

  The new FDA warnings point out that

► the risk of heart attack or stroke can occur even with short-term use, goes up within the first weeks of use, and may increase over time

► NSAIDs can increase the risk of heart attack or stroke even if you don’t have heart disease or risk factors for heart disease, although the risk becomes greater if you do.

► despite previous studies suggesting that naproxen (Aleve, Naproxen) may be safer than other NSAIDs, there’s not enough new evidence to support that.

What you should do

Stay away from NSAIDs if you have heart disease. Otherwise, talk to your doctor about the risks and benefits of NSAID use. “The new FDA warnings are prudent but not based on new information,” says Dr. Solomon. “NSAID use can be extremely helpful for a variety of pain syndromes. Use the lowest dosage possible for the shortest period necessary. If pain relief is not adequate with over-the-counter preparations, I recommend speaking with a health care professional about other possibilities, either other medications or other dosages.”

  You may also want to consider switching to acetaminophen, a potent painkiller with heart risks. Keep the dosage below 4,000 milligrams per day. If you consume more than three alcoholic drinks every day while taking acetaminophen, you will risk damaging your liver.

  The vast majority of people taking NSAIDs will not have heart problems or any other problems. However, we now recognize that there is some heart risk from these medicines.

Harvard Health Letter

Three steps to build a better back

Strengthening, stretching, and improving posture will go a long way toward reducing back pain that comes with age.

Back pain is one of the top complaints of people around the world, with eight out of 10 people experiencing it at some point in their lives. “Most people tolerate it and work around it. But in older age it’s more challenging to live with back pain, because you have a stiffer back that’s more arthritic,” says Dr. Kevin McGuire, chief of orthopedic spine surgery at Harvard-affiliated Beth Israel Deaconess Hospital.

The aging back

Your spine is made up of many bones (vertebrae), each separated by little cushions (discs) of cartilage. As e get older, the discs tend to wear out, a condition called osteoarthritis “Over time, the discs deflate. The spine gets a little shorter. As you lose disc height, your spine gets stiffer, and you tend to get a bent-forward posture,” says Dr. McGuire.

  In older people who have the bone-thinning disease osteoporosis, the spine is also at risk for tiny fractures. These osteoporotic compressions fractures are common and can also cause people to end up being more bent forward.

  “Whatever the cause, unbalanced posture hurts. The back and muscles are strained by the poor posture. It’s like asking you to walk around with bent legs all day,” says Dr. McGuire.

Reducing pain

The aches and pains of an aging back can often be alleviated with the following steps.

Strengthen your muscles. The muscles that support the back hold us upright and relieve pressure on the spine as we go about our activities. The stronger your muscles, the more they will reduce pressure, and the less pain you’ll feel. Exercises need to target the muscles of your abdomen, shoulders, and legs. You can do that by working with a physical therapist to develop a specific exercise regimen, which may be as simple as regular walks. “Global fitness, such as going for a brisk walk, addresses all of these muscle groups, and that helps our back the most,” says Dr. McGuire. He says doing a modified version of yoga or Pilates, with your doctor’s okay, is also effective.

Stretch your muscles. It’s not enough to strengthen the muscles that support the back. You must also stretch the muscles to keep them flexible, which helps prevent them from becoming injured and provides you with a good range of motion. “If you can’t cross your legs because your hips are tight, you’ll have to bend at the spine and that puts pressure on your back,” says Dr. McGuire. 

  He recommends stretching the hamstrings and quadriceps in the thigh, the gastrocnemius muscle in the calf, the abductor and gluteus muscles in your hips and buttocks, and even the rotator cuff muscles in the shoulders. “Do arm circles, and stretch your arms across your chest. Roll your shoulders back and imagine you’re standing an inch taller. These will help take pressure off your back.”

Improve your posture. Strengthening and stretching your muscles will help you stand up straighter, which will put less stress on your back. But you may need to work on your posture. “Correct posture is when your head is aligned with your hips, and your hips are aligned with your feet,” says Dr. McGuire. “There’s no leaning involved.” He suggests checking your posture in a mirror, considering both a front and side view. Exercises that work the upper extremities help improve neck and upper back posture. Core muscle and leg exercises boost your lower back posture.

Harvard Health Letter

Shoulder Injury Rehab

 This lasat season it seemed shoulder injuries were way too common. Not sure why, maybe because so many pro riders don't wear shoulder pads. If you have hurt your shoulder here is an exercise you can do to build strength.

Building Knee Strength Helps Prevent Injury

Not only does building knee strength help prevent injury, but it can also help your performance. Joel Harper, author of MIND YOUR BODY: 4 Weeks to a Leaner, Healthier Life, is a supporter of knee exercises, especially those performed with knees floating in the air to work them from every angle.

"If you feel any tightness or discomfort in your knees, it most likely comes from muscle imbalance," Harper says. "Make sure you get rid of the tension by stretching and massaging before putting stress on your knees."

Harper has developed a knee exercise routine to strengthen the joints in a safe way. To get the best results, aim to perform each movement at a high intensity for two minutes.

1. Knee Bounces

Purpose: Strengthens your knees with an emphasis on the quads.

Get Ready: Begin on all fours with your hands under your shoulders and knees under your hips. 

Go: With soft elbows, lift your knees one inch off the ground and bounce your knees one inch, up and down, for one minute in the air. Then, sway your knees from side to side, one inch, for one minute. To make this move more challenging, hop your feet up and off the mat one inch each time your knees come up.

2. Shin Bend

Purpose: Stretches your ankles, feet, shins and quads.

Get Ready: Sit on your heels with your knees together and the top of your feet on the floor. Bring your thumbs—pointed toward each other—to your arches for balance.

Go: Pull in your stomach, hunch your shoulders forward, and gently lift your knees off the ground so you're balancing on the tops of your feet. Hold for ten seconds and slowly come down. Place your knees six inches apart and repeat for 10 seconds.

Next, bring your knees back together with your toes apart, and lift them for 10 seconds. Repeat the stretch position that felt the tightest. Only do this stretch if it feels comfortable on your knees.

With time and practice, you'll become more open, and you may not feel this stretch at all. If you feel it, that's your cue to do it each time you finish running.

3. Ankle Sways

Purpose: Strengthens and tones every angle of the front of the thighs and lower abs.

Get Ready: Stand with feet together. Place your left hand on your stomach and your right hand on your lower back. Balancing on your left leg, lift your right knee up as high as you can, aiming to ultimately get your right knee in line with your hips.

Go: While balancing and keeping your right knee stationary, sway your ankle from left to right as far as you can in each direction 25 times. Repeat on the opposite side.

Perform a total of two sets. To increase the intensity, on the second set, perform 50 on each side.

4. Hammock

Purpose: Stretches the hips to open them up and reduce tension on your knees.

Get Ready: Sit on the floor with your knees bent and your feet flat on the mat two feet away from your tailbone. Rest your hands behind you with your palms down and fingertips pointing to the back of the room. Place the heels of your hands about a foot back from your butt.

Go: Keeping the soles of your feet flat on the mat, cross your right leg over your left, resting your right ankle just above your left knee. Sit up straight and focus on pressing your lower back toward your right calf.

If you want to go deeper, press your right knee away from your torso. Hold for 15 seconds and switch sides. Repeat two times on each side.

Keep your arms slightly bent throughout the stretch. If one of your hips is tighter than the other, come back and do the tighter side again. Over time, both sides should be balanced.