Should you use an ice pack or a hot wheat bag for your back pain?

By Adrian Davies

16/12/2024

Back pain is a common musculoskeletal issue in Australia, with around 15% of Australians experiencing it at any given time. When faced with pain, many people instinctively turn to medications as the first line of treatment. However, as a physiotherapist, I believe that heat and cold therapy are often underutilized alternatives. These methods are effective, safe, and come with minimal side effects, making them an easily accessible option for pain management. Research, including studies published by Cochrane, supports their benefits, and the Royal Australian College of General Practitioners also recommends them too.

Should you reach for a cold pack or a hot wheat bag?

Your body may have already given you some clues about which treatment you prefer. For example, you may feel relief after a hot shower. If you’re unsure, I recommend trying both heat and cold to see which one offers the most comfort and pain relief. You should be able to determine which works best for you fairly quickly.

Key Tips before for using heat or cold therapy:

• Always place the heat or cold pack over a towel or a t-shirt to avoid direct contact with the skin and prevent burns

• Check the sensation of your skin before applying a pack. If you have reduced sensation, speak to your therapist as you will need to be extra cautious to avoid burns

• Aim for 20-minute sessions, 3-4 times a day.

Heat Therapy Options:

• Hot water bottles

• Wheat bags (soft packs filled with grain)

• Hot towels

• Hot baths

• Saunas

• Heat wraps

Cold Therapy Options:

• Ice packs

• Cold towels

• Cold gel packs

eferences:

https://www.cochrane.org/CD004750/BACK_superficial-heat-or-cold-for-low-back-pain

https://www1.racgp.org.au/ajgp/2024/september/best-practice-care-for-acute-low-back-pain

BONE STRESS INJURIES AND THE EFFECTS ON BONE MINERAL DENSITY

By Kristin Haigh

25/06/2024

Bone Stress Injuries (BSIs) are injuries that occur when bones are subjected to repetitive stress or overuse, leading to small cracks or fractures. These injuries typically result from activities that involve repeated impact, such as running or jumping. Examples of these injuries are Shin Splints (Tibial bone stress or Medial Tibial Stress Syndrome) and metatarsal (foot bones) stress fractures.

People with BSIs generally have pain that develops gradually and worsens with weight-bearing activities, and sometimes have swelling and tenderness at the injury site.

BSIs in runners commonly are in the tibia. These injuries often require a prolonged recovery period, and there is a high rate of reinjury. Popp et al. (2021) investigated the effects of a tibial BSI on the Bone Mineral Density (BMD) of female athletes. They evaluated 30 female athletes aged 18-35 years, all diagnosed with a tibial BSI. The athletes all underwent an initial period of reduced weightbearing, such as walking with crutches or a pneumatic walking boot.

From time of BSI diagnosis to 12-weeks post diagnosis, all measures of BMD declined by between 60%-95% in both the injured and uninjured legs, indicating that reduced weightbearing associated with the initial management of a BSI affects the BMD in all weightbearing bones. Weightbearing physical activity was at its lowest during the first 8 weeks of the study then steadily increased, while BMD continued to decrease until 12 weeks before beginning to increase again. This finding indicates that reintroducing higher level weightbearing and impact loading of bones takes some time to begin to produce noticeable changes in BMD. Therefore, the critical time to ensure safe and cautious progression of weightbearing is at least the first month, as re-loading in this period involves increasing the impact load on bones that may be briefly continuing to decline in BMD.

By 24 weeks, bone measurements returned to near-baseline values, and had surpassed baseline values by 1 year post-injury. 10 of the 30 participants (1/3) experienced a subsequent BSI during the re-loading period of the study. Participants of a younger age, who’d had a later age of menarche, and who’d had previous BSIs were more likely to sustain a second BSI.

To summarise, bone density declines in both legs post-BSI and does not return to baseline for 3-6 months. It’s vital to cautiously re-load impact and weightbearing to avoid overloading bones that may continue to have reduced BMD for 4 weeks. Please see your physiotherapist if you have any running-related pain or injuries.

ROTATOR CUFF TEARS AND TENDINOPATHY

By Ali McGill

29/02/2024

Managing the painful shoulder

The shoulder joint (also known as the glenohumeral joint or GHJ) is surrounded and supported by a powerful band of muscle tendons called the rotator cuff. The rotator cuff muscles of the shoulder work as a dynamic structure to centralise the head of the humerus (upper arm bone) in the socket (made by the shoulder blade or scapula) and aid movement, acting to keep the GHJ functioning and stable.

Structural changes in muscle tendons:

• Type 1 collagen is the most abundant connective tissue in tendons, but these can degenerate over time, in response to injury or due to metabolic conditions (such as diabetes). This phenomenon is termed “tendinopathy, and this process can affect a tendon’s:

• tensile strength ie. the ability to transmit force from muscle to joint

• shock absorption

• innervation and blood supply, leading to a potential increase in sensitivity and increased risk of tears

MRI and ultrasound are the preferred imaging modalities for imaging and evaluating tendon tears. Important to note however, is that tendon abnormality seen on imaging does not always diagnose the cause of your pain, as many people with asymptomatic pain-free shoulders demonstrate rotator cuff tears or tendon abnormality on imaging. In adults over the age of 60, 66% of rotator cuff tears found on imaging are asymptomatic. The use of routine scanning for cuff tears therefore remains debated in terms of efficiency. Your physiotherapist can refer you for necessary imaging as they see fit to assist in the diagnosis and management plan for your painful shoulder condition.

Management of rotator cuff tendinopathy

The two treatment pathways for rotator cuff tendinopathy are; Non operative management such as lifestyle changes, physiotherapy and injections or shockwave therapy; and operative management, which consists of a subacromial decompression surgery to increase the available anatomical space for the tendons to pass through.

Management of rotator cuff tears

In the case of an acute rotator cuff tear, urgent referral to a specialist surgeon is advised to discuss the potential for surgical management and repair. Indications that support surgical tendon repair are:

• High energy traumatic injuries

• People in high performing roles that require shoulder use for their sport or hobby

• People under 50

• In the case of non-traumatic tears: where non-operative management including physiotherapy for >3 months has failed and patient has persistent pain and dysfunction