Warm it Up!

C ompetitive athletes are realizing the benefits of warm therapy for most of their musculoskeletal and soft tissue injuries. Through a better understanding of these therapeutic modalities, clinicians will better optimize their present treat­ment strategies, which will ultimately enhance the athlete's healing process. Although warm and cold treatment modalities both decrease pain and muscle spasms, they have the opposite effect on tissue metabolism, blood flow, inflam­mation, edema, and connective tissue extensibility. A cool therapy as the choice of modality will decrease these effects while a warm therapy will increase them. There are three general phases of healing for most musculoskeletal and soft tissue injuries, which include the acute inflammatory phase, the regen­eration or repair phase, and the remodeling phase. When used during the appropriate phase of healing, each modality can positively affect the time-period of rehabilitation for the athlete and assist the return to their respective fields of play. Between the three phases of healing, only the initial acute phase indicates use of a cool therapy. A passive cryotherapy modality will assist with the immediate swelling, inflammation, and the accommodating redness from the increased local temperature, which generally lasts up to 72 hours. This initial inflamma­tion period can be prolonged from the overuse of the injured area and from premature application of heat that can exacerbate tissue damage and add to the swelling and pain. The primary goal of rehabilitation during this acute stage of healing is to protect the athlete from further injury and to progress to the regeneration phase as quickly as possible. The body is already attempting to protect the injured area from the immediate inflam­mation and swelling, but often, this stage of healing may require the immobilization of the injured area. The athlete endeavors to get back to competition, but rest is necessary to protect the damaged tissue from additional injury. Therefore, exercise and any added stress involving the injured area is not recommended during this phase of healing. The regeneration phase of healing, also known as the repair phase, generally lasts up to 8 weeks and is characterized by the laying down of new tissue and the formation of scar tissue; the time period is dependent on the individual and the severity of the injury. The athlete can determine if he or she has entered this second phase of healing when the initial swelling of the injury starts to decrease and the pain has subsided. Often, the athlete will want to prematurely get back to training and competition due to a decreased level of pain; however, this may cause a set-back in the rehabilitation process if the injury has not healed completely. It is during this phase of healing that a thermo-therapy can be administered to the injured area to accelerate the healing process. Adding a warm therapy to the injury will increase circulation and cellular metabolism, which will result in the influx of oxygen and nutrients to promote healing of the damaged tissues. Vasodilation and the increased circulation will also facilitate the removal of debris and waste products from the injury site. According to Chrissy Chew, LMT, "Applying heat not only dilates the blood vessels, which gives cells the opportunity to receive nutrients for reconstruction of damaged tissue, but it encour­ages fascia and other connective tissue to move from a gel state to a solid state. In addition to reducing pain and discomfort, this allows me to work deeper into the tissue due to increased pliability and circulation." Restoring flexibility and increasing the range of motion (ROM) is also important during this phase of healing and the addition of a warm therapy will assist with the ROM. Because tissue becomes more extensible after it has been warmed up, range of motion exercises can be performed after heating to improve joint mobility. The primary goal is to gradually increase the range of motion of the joint and restore to pre-injury levels. After the collagen fibers are laid down, the body can begin to remodel and strengthen the new tissue in a more organized structure as the athlete begins to enter the remodeling and final phase of healing. Approximately 6 to 8 weeks post-injury, the colla­gen fibers can now withstand near-normal stress, although final maturation of the injured tendon and ligament tissue may take as long as 6 to 12 months. Remodeling is a motion-dependent phase of heal­ing that governs the quality of healing in the tissues and this is why emphasis on the improvement of the range of motion is so important. Common chiro­practic adjustments move joints through their entire range of motion allowing all of the injured tissues the chance to properly remodel. A warm therapy modality, whether superficial or deep-tissue, will prove beneficial and assist in these adjustments as well as help prevent further injury. According to Jeffrey E. Poplarski, D.C., who is the longtime US OPEN Golf Championship Wellness Chairman, "Sombra warm therapy is an integral part of my chiropractic adjustments, especially in the athletic world I participate in. Love the way the original gel maintains warmth in the muscle with its deep pen­etrating heat and the calming relief the cool therapy provides for inflammation and swelling after an initial injury or proceeding a workout or event." References: -Jeffrey Edward Poplarski, D.C., LLC 217 Merrick Rd. Ste. 204 Amityville, NY 11701 http://www.drjeffpoplarski.com -Chrissy Chew, LMT / The Art of Health, LLC 2055 15th St. N Ste. 201 Arlington, VA 22201 http://artofhealthmassage.com -Anderson, M.K., Hall, S.J., & Martin, M. (2005). Foun­dations of Athletic Training: Prevention, Assessment, and Management. (3rd Ed.). Lippincott Williams and Wilkins: Philadelphia, PA. -Starkey, C. Therapeutic Modalities (3rd ed.). Phila­delphia: F. A. Davis, 2004. Jeff Baskett is the Program Marketing Manager for Sombra Professional Therapy Products and has been in that position for al­most 10years now. He is an avid multi-sport athlete and understands the value oj complementary and alternative medicine for all his therapeutic needs.