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Hot vs Cold

Picked up an injury? Tell us about it and we’ll tell you how best to treat it.

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Where have you injured yourself?

What type of injury have you sustained?

As soon as you can, after picking up an injury, whether sport-related or not, you should adopt the P.O.L.I.C.E. method:

Be sure to apply cold treatment to your head for at least the first 24 hours.

You can also attempt 3 sets of 5 reps for the below exercise:

CxTx junction self mobilisation in standing

  1. Stand up straight and place your hands over the tops of your shoulders, close to your neck.
  2. Your fingers should angle in towards your spine.
  3. Pull forwards equally with both hands, and simultaneously retract your head, making a double chin.
  4. As you relax your head a little, ease off with your hands.
  5. Oscillate this movement rhythmically.

Cold treatment is required for the first 24 hours, but don’t rest too much; you want to continue with gentle movements to help prevent additional stiffness, moving to isometric strengthening (contracting the muscles) after 72 hours.

The below workouts are in time order:

Shoulder circles

1 Set / 15 Reps

  1. Roll your shoulders in a circle, pulling them forwards, up, back and down.
  2. Imagine you are moving them around a clock face.

Cervical self-mobilisation with pillowcase

2 Sets / 8 Reps / 5s hold

  1. Sit up straight.
  2. Roll a pillowcase or towel along its long edge into a sausage shape.
  3. Place the pillowcase over your shoulders across the back of your neck.
  4. Cross the ends of the pillowcase over and hold one in each hand.
  5. Place one hand on your chest bone and bring the other up to your eye level with the pillowcase resting on your cheek
  6. Apply a forward and upward tension to the pillowcase.
  7. Turn your head away from your upper hand and then use the pillowcase to assist your head further round.
  8. Hold and repeat.

Small movements, where possible, are encouraged as soon as you have any kind of injury, including to the neck. After 72 hours you can then consider slowly adding weights.

Shoulder circles

3 Sets / 5 Reps

  1. Roll your shoulders in a circle, pulling them forwards, up, back and down.
  2. Imagine you are moving them around a clock face.

Be sure to apply cold treatment to your shoulders for at least the first 24 hours, making time for isometric movements (contracting the muscles).

After 72 hours you can then look to add a range of movements to increase mobility, using either cold or hot treatments.

The below workouts are in time order:

Isometric shoulder external rotation

3 Sets / 8 Reps / 5s hold

  1. Sit or stand up straight next to a wall.
  2. Keep your affected arm by your side and bend your elbow to 90 degrees.
  3. Place the back of your wrist against the wall.
  4. Without moving your body, press your wrist into the wall as if turning your forearm outwards.
  5. Hold this position and then relax.

Shoulder external rotation lying on side with weight

3 Sets / 10 Reps / 1kg weight

  1. Lie on your good side with a weight in your affected hand.
  2. Keep the upper arm resting on your side and bend the elbow to a right angle.
  3. Keeping the upper arm in contact with the body, rotate your forearm upwards.
  4. Make sure you do not roll back with your body.
  5. Control the movement back to the start position, and repeat.
  6. Ensure your keep your shoulder blades back and down throughout.
Start light and build up, working from 1kg to 4kg.

For the first 24 hours you don’t want to apply anything other than cold therapy, moving as able – just shoulder blade squeezes.

After 72 hours you can look to use either hot or cold treatments and incorporate a range of movements.

The below workouts are in time order:

Scapular retraction

4 Sets / 8 Reps / 5s hold

  1. Start in a seated position and place your hands on your hips.
  2. Let your shoulders fall forward by rounding the upper back, then squeeze your shoulder blades together, drawing them back and down as your elbows come out and back.
  3. Keep your shoulders pressed down and away from the ears at all times.

Shoulder flexion stretch, hands up the wall

1 Set / 10 Reps / 5s hold

  1. Stand up straight facing a wall.
  2. Slide your hands up the wall as far as you can.
  3. Ensure you do not hunch your shoulders.
  4. Lean into the wall to increase the stretch.

With a muscle pull, you want to maintain a gentle range of movements while applying cold therapy.

By the time you’ve had the injury for 72 hours you can switch between cold and hot treatment, while focusing on strengthening exercises and utilising resistance bands.

The below workouts are in time order:

Shoulder flexion stretch, hands up the wall

1 Set / 10 Reps / 5s hold

  1. Stand up straight facing a wall.
  2. Slide your hands up the wall as far as you can.
  3. Ensure you do not hunch your shoulders.
  4. Lean into the wall to increase the stretch.

Press up while kneeling

2 Sets / 10 Reps

  1. Start on your hands and knees and walk your hands forwards until you have a straight line from your shoulders to your knees.
  2. Keeping yours body straight, slowly bend your elbows, bringing your chest towards the floor, then push back up to the start position.

Apply plenty of cold therapy for the first 24 hours, reducing movements to simple squeeze and relax movements.

You should switch to hot treatment exclusively by 72 hours and utilise bands into exercises.

The below workouts are in time order:

Prone scapula retraction with UL "Y" in ER

2 Sets / 8 Reps / 3s hold

  1. Lie on your front with your forehead rested on a small towel.
  2. Keeping them straight, move your arms out to your sides and up a little so that they point diagonally up and away from you.
  3. Rotate your forearms out so that your palms face forwards.
  4. Keeping your chest and head in contact with the floor throughout, squeeze your shoulder blades together, and then lift your arms off the floor.
  5. Keeping your chest and head in contact with the floor throughout, squeeze your shoulder blades together, and then lift your arms off the floor.
  6. Relax and repeat.

Shoulder circles

1 Set / 15 Reps

  1. Roll your shoulders in a circle, pulling them forwards, up, back and down.
  2. Imagine you are moving them around a clock face.

Cold treatment to the injured muscle area and gentle movements are advised within the first 24 hours.

After 72 hours you can look to do gentle strengthening exercises, switching over to hot treatments.

The below workouts are in time order:

Supine knee hugs

2 Sets / 6 Reps / 10s hold

  1. Lie on your back.
  2. Draw one foot up and then the other.
  3. Rotate your forearms out so that your palms face forwards.
  4. Bring one knee in towards your chest and then the other, using your hands for assistance to curl yourself in to a ball.

Prone truck extension on forearms

3 Sets / 8 Reps / 5s hold

  1. Lie on your stomach with your forearms under your shoulders
  2. Push your chest up with your forearms, extending in the lower back
  3. Keep your hips pressed in to the floor and your legs straight.

It’s important to maintain gentle movements within the first 24 hours, treating the injury with cold treatment.

After 72 hours you can alternate between cold and hot treatments and should increase your movements to strengthening and motion exercises.

The below workouts are in time order:

Prone press up extension

3 Sets / 10 Reps

  1. Start face down on a mat.
  2. Bend the elbows and bring your hands under your shoulders.
  3. Push your upper body up into an extended position.
  4. Keep your hips and thighs on the floor at all times.
  5. Squeeze the buttock muscles throughout the duration of this exercise.
  6. Hold this position.

Bird dog

1 Set / 10 Reps

  1. Start on your hands and knees, with your hands under your shoulders, and knees under your hips.
  2. Extend the opposite leg and the opposite arm simultaneously, making sure your maintain good control in your torso
  3. Do not allow your body or hips to rotate.
  4. Repeat on the other side.

Unlike a lot of injuries, you only need to use cold therapy for the first 24 hours of experiencing wrist pain.

It’s also important that you keep up a range of movements to prevent stiffness.

AAROM wrist pronation/supination

3 Sets / 5 Reps

  1. Sit upright with a table in front of you.
  2. Place your weaker arm onto the table with your elbow bent.
  3. Using your stronger arm to help complete the movements turn your wrist over so your palm faces up.
  4. Then turn it back over to place your palm on the table.
  5. Aim to keep your elbow, shoulder and body still during the exercise.

Unlike a lot of injuries, you only need to use cold therapy for the first 24 hours of experiencing tendon pain in the wrist.

It’s also important that you keep up a range of isometric exercises, contracting the muscles.

Eccentric wrist extension with weight

3 Sets / 8 Reps / 1kg weight

  1. Start in a seated position with your forearm resting on a table and holding a weight in your hand with your palm facing downwards.
  2. Using the other hand, lift your wrist up, keeping your forearm in contact with the table.
  3. Remove your other hand and then slowly lower your raised hand back down without support.
  4. Relax and repeat.

Be sure to reduce your mobility to basic movements when experiencing outside hip pain.

Cold therapy should be enough to ease the pain for the first 24 hours, but continue to use as you see fit.

Abduction of the hip

3 Sets / 8 Reps

  1. Stand in front of a chair and hold on firmly.
  2. Raise one leg to the side and then return back to the starting position.
  3. Complete one set, then repeat with your other leg.

Gentle, isometric movements contracting the muscles are important when suffering with a groin pull injury.

Cold treatment can assist with this; just be careful where you’re applying products.

Isometric hip adduction in crook

3 Sets / 8 Reps / 10s hold

  1. Lie on your back with your legs bent and feet flat on the floor.
  2. Ensure your knees and feet are hips width apart.
  3. Place a small ball or a rolled towel between your knees.
  4. Tighten your abdominal muscles and pelvic floor, then squeeze your knees together into the ball or towel.
  5. Hold this position.
  6. Relax, and then repeat.

Be sure to continue on with a range of movement-based exercises after feeling anterior knee pain.

To help you move through the pain, be sure to apply cold treatments to the affected area.

The below workouts are in time order:

Single leg knee bend

3 Sets / 8 Reps

  1. Stand on your affected leg close to a sturdy object.
  2. Do not rest your elevated leg on your stance leg.
  3. Try to do this exercise without holding on.
  4. Slowly bend your affected knee, making sure your knee travels directly forwards over your toes.
  5. Control the movement as you straighten your knee, and stand up straight again.
Keep your knee in line with your foot and your back straight.

Squat with resisted ER

2 Sets / 15 Reps

  1. Stand with your legs shoulder width apart and a resistance band tied just above your knees.
  2. Ensure there is some tension in the band.
  3. Drop down into a squat position, pushing your hips back and dropping your chest forwards, whilst resisting the pull of the band by pressing your knees outwards over your toes.
  4. Control the movement back to the start position, and repeat.

Tendon pain can be incredibly uncomfortable, so be sure to get some cold therapy on it right away.

In terms of exercise, start out small with isometric exercise whereby you contract the muscles, before building up to strengthening exercises after 72 hours.

The below workouts are in time order:

Resisted hip abduction standing

3 Sets / 15 Reps

  1. Place a band around your ankles and hold on to a supporting surface.
  2. Keeping your body straight and hips level, lift your symptomatic leg directly out to the side, pulling against the tension in the band.
  3. Control the movement as you lower the leg back down to the start position, and repeat.
Make sure your body does not lean at all when you do this.

Bridging with resisted hip abduction

2 Sets / 10 Reps / 5s hold

  1. Tie a resistance band around both thighs, just above your knees.
  2. Ensure there is some tension in the band.
  3. Lie on your back with your knees bent and legs hips width apart.
  4. There should be tension in the band.
  5. Raise your hips up into a bridge, keeping the knees hips width apart
  6. Control the movement back down to the start position, maintaining constant tension on the band.

Cold treatment is crucial here to helping reduce and control the pain associated with swelling in the knee.

You should be making sure to self-massage all areas of your knee including the knee pad.

Self massage to posterior knee

1 Set / 1 Rep / 10s duration

  1. Sit up straight with your affected leg bent and the foot flat.
  2. Take some cream on your fingers tips and thumbs and rub it gently into the back of your knee.
  3. After a couple of minutes when the tissues are warmed, work your fingers into the tissues at the back of your knee, including your upper calf and lower thigh.
  4. If this becomes easier, straighten your knee and pull your foot up towards you to work these muscles more deeply.

Stick with cold therapy for the first 24 hours, minimum.

You can choose to add heat therapy after 72 hours or continue with cold treatment.

It’s important to have a range of movement, holding off on strengthening until after 72 hours.

The below workouts are in time order:

AROM ankle dorsiflexion

3 Sets / 5 Reps

  1. Start in a seated position with your legs out straight.
  2. Pull your toes up towards your head, keeping the leg straight.
  3. The knee stays flat on the table as your move the foot up and down.

Resisted ankle inversion

3 Sets / 10 Reps

  1. Place a band around the end of each foot.
  2. Cross the affected leg over the other leg, then pull against the resistance of the band to turn the foot away.
  3. The unaffected foot acts as a stabilizer and allows you to create more tension in the band.
  4. Return to the starting position.

Small isometric movements (contracting the muscles, not lengthening them) are all you should be doing when suffering with acute tendon pain in the ankle.

Be sure to compliment this with cold therapy on the area that is suffering.

Eccentric bilateral heel raise

1 Set / 1 Rep / 1s hold

  1. Step up on to a step with a supportive surface such as a wall in front of you.
  2. Walk your feet backwards so that your heels rest over the edge of the step.
  3. Your weight should be in the balls of your feet.
  4. Rise up onto your toes.
  5. Bend your knees and control the movement as you slowly lower your heels back over the edge of the step.
  6. Repeat this movement using as much support as you need, to rise up onto your toes.

Arthritic pain is sadly something that someone living with arthritis is likely to deal with on a regular basis.

Cold therapy products can assist with the day-to-day pain, but you should also be sure to do some simple exercises.

Gastroc heel raises on floor

1 Set / 10 Reps

  1. Stand with both legs straight and at hip-width apart.
  2. Rise up onto your toes, keeping your legs straight, and control the movement back down to the start position.

Disclaimer: The team at Biofreeze UK and all physios who offered advice for the tool aren’t doctors and if the sufferer considers the pain to be severe, or the pain does not subside, they should seek medical attention.

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