ACTIVE P.T. SOLUTION S ...BECAUSE LIFE SHOULD BE ACTIVE APTS Monthly Office Hours: VOLUME VI, ISSUE III M A R C H 2 0 1 6 Monday - 8:00am - 5:30pm Tuesday - Heat or Ice? 8:00am - 7:00pm Wednesday - When to use heat or ice on an the onset of pain or injury. 8:00am - 5:30pm injury, ache, or pain is a common Living in Central New York, I question in a healthcare office. Thursday - have come to think it is a natural While there are generalities that reaction to prefer heat instead of 8:00am - 5:30pm can be followed, it can also be an ice. In general, heat usually feels Friday - extremely specific self-treatment. nice and comforting; unfortu- It is very difficult to go wrong 8:00am - 4:00pm nately, it is not the right thing to with ice. On the contrary, if you do when it comes to an injury or Location: put heat on an inflamed body painful musculoskeletal condition. part, there is potential to worsen 91 Columbus Street If you do apply heat, it should be the condition. A general rule of moist in nature. A hot shower or Auburn, NY 13021 see a provider. thumb in our office is to ice the hot bath is a good form of home The best form of cold is ice P: (315) 515-3117 painful body part for 15-20 minutes heat application. There are spe- itself. Your relatives may recom- with at least 40-45 minutes off be- cial heating pads available that are mend frozen peas, corn, or other fore the next ice application. A thin made with a moist sponge, or frozen produce. Frozen produce will INSIDE THIS protective layer should be placed there are also several microwav- not supply the same degree of cold ISSUE: between the ice and the skin, such able devices available in your local as ice itself. Counter irritants such as as a paper towel or t-shirt. Always pharmaceutical retailer. You can rubs that produce a cold sensation inspect the skin after the applica- also make your own moist heat Heat or Ice? 1-2 do not reduce swelling or inflamma- tion. It should be pink and cool, pack (see the APTS Recipe Box). tion. They are designed to relieve returning to normal color and tem- One thing that I would absolutely perature before the next ice appli- pain by tricking your brain to focus Exercise of the 2 recommend you not use is a dry cation. on the cooling or heating sensation Month: Pelvic Tilts heating pad. I tell my patients “if produced by the ingredients in the The majority of injuries or muscu- you own a dry heating pad, give it lotion or cream. This is where the loskeletal ailments will respond to to someone you don’t like”. Dry Dr. Buchberger 2 term “counter-irritant” comes from. Speaks on Baseball ice. Unfortunately most patients fail heat applications usually make the Remember the acronym PRICE to ice frequently enough to be ef- problem worse by creating local therapy when applying ice: Protect, fective. For instance, if you have an dehydration, , and inflam- What is the Differ- 3 Rest, Ice, Compression, and Ele- ence Between Chiro ankle sprain, you may need to apply mation. and PT? vation. ice to the ankle 4 to 5 times a day So when is heat the treatment of It is also common for patients to APTS Recipe Box: 3 for 2 or 3 days for the ice to be choice? Moist heat is very helpful bring up the old adage of ice for the Homemade Heat and effective. If any body part swells, when you have a chronic degen- Ice Packs first 24-72 hours and then apply becomes discolored, or causes a erative condition, such as a non- loss of function (in this case, the heat. This is a poor rule to follow Heat vs. Ice Quick 4 inflammatory arthropathy like because it negates the presence of Reference Chart inability to bear weight), you should degenerative joint disease of the pain and loss of function. If the con- see a healthcare provider and have knee or back (i.e. ). Un- an x-ray to rule out a fracture or dition is actively swelling or limiting fortunately these conditions are function (weight bearing, sleeping, additional pathology. Applying ice in usually associated with some level working, etc.), it is appropriate to this case should be for comfort and of pain. In this case using apply ice more than 72 hours after swelling control while arranging to “contrast therapy” may alleviate P A G E 2 Exercise of the Month: Pelvic Tilts

Pelvic tilts are often rec- on the floor. Tilt your then performing 10 repe- ommended for developing pelvis up so that the small titions of pelvic tilts to support for the low back, of your back flattens out prevent the back from abdominals, and sacroiliac to the floor. Hold 2 sec- “stiffening up”. As always, joints. They are great for onds and relax. Perform if your low per- low back problems due to 10-12 repetitions twice a sists, make an appoint- poor posture and muscle day to keep the low back ment for an evaluation atrophy, and they provide stretched and strong. with your doctor and/or a starting point for spinal physical therapist. Pelvic tilt, start posi- For symp- stabilization exercise pro- tion (top), exercise toms, we recommend grams. position (bottom) lying on your stomach Lie on your back with with an ice pack on your your knees bent, feet flat back for 15 minutes, and

Heat or Ice? Con’t

Remember the the stiffness and the pain. pack or heating device ap- more common areas are the Applying moist heat for 15- plied to a body part! There is outside of the knee, inside of acronym PRICE 20 minutes, followed by an a risk of falling asleep with the elbow, the groin, and when applying ice: ice application for 15-20 the ice or heat in place and lower abdomen. If you are minutes, and then gentle this can result in worsening unsure or have a question Protect, Rest, Ice, movement or exercise (such of the condition or causing about applying heat or ice to as walking) is a form of con- further injury or tissue dam- an injured area, call a health- Compression, and trast therapy that works well age. There are areas of the care provider who knows Elevation for patients with arthritis of a body where certain nerves your medical history and non-inflammatory type. are very superficial and at whom you trust. Never go to bed with an ice risk of injury from prolonged Article by Dale Buchberger, ice or heat application. The DC, PT, CSCS

Dale (right & bottom, kneel- Dr. Buchberger Speaks on Baseball ing, 2nd from left) at Salt On January 30, Dr. Buchberger spoke on the pre– and post- Then on February 11, Dr. River Flats was a featured speaker at the game routine: reducing the Buchberger spoke at the Au- 2nd Annual Professional Base- negative effects of throwing. It burn YMCA on injury preven- ball Chiropractic Society meet- was a great opportunity for tion of the shoulder and elbow ing in Scottsdale, AZ. The Dale to meet and exchange in baseball and softball. Do you meeting was held at the joint ideas with chiropractors that know a team that could benefit spring training complex of the work for a variety of Major from a talk on this topic? Let Colorado Rockies and the League Baseball and Minor us know and we’ll be glad to Arizona Diamondbacks at their League Baseball teams the set it up for you! Salt River Flats facility. He country.

APTS MONTHLY VOLUME VI, ISSUE III P A G E 3

What is the Difference Between Chiropractor and Physical Therapist?

It is not uncommon in the course of a day purpose of manipulation is to restore joint While chiropractic clearly has its historic focus on in clinical practice to hear the question, mobility by manually applying a controlled spinal manipulation, the profession has matured and “what is the difference between physical force into joints that have become hypomo- expanded creating high level educational programs therapy and chiropractic?” In large part, bile, or restricted in their movement as a including specialty residencies and fellowships. the difference is three-fold: philosophy of result of a tissue injury. Manipulation, or an Chiropractors practice in hospitals, military institu- practice, work environment, and third adjustment of the affected joint and tissues, tions, universities, professional sports teams, etc. party reimbursement, commonly known as restores mobility, thereby alleviating pain and Chiropractors in the 21st century treat more than health insurance. While the history spawn- muscle tightness, and allowing tissues to heal. the spine to the point that the director of the ing each profession is quite diverse, the sports medicine clinics for the United States Olym- The American Association two professions have been on converging pic Committee is now a chiropractor. (APTA) defines physical therapists as: “health Chiropractors paths ever since their individual genesis. I care professionals who maintain, restore, and Physical therapists, like their chiropractic col- will attempt to bring clarity to the before improve movement, activity, and health ena- leagues, have expanded their education to include have a more stated question and with it there is sure to bling individuals of all ages to have optimal similar educational programs that recently included be controversy from each side. functioning and quality of life, while ensuring the addition of an academic doctoral degree. Physi- expansive The American Chiropractic Association patient safety and applying evidence to provide cal therapists have traditionally worked in hospitals (ACA) defines chiropractic as “a health efficient and effective care. In addition, physical and, by history, the military. Private physical therapy diagnostic care profession that focuses on disorders therapists are involved in promoting health, practice including home physical therapy practice of the musculoskeletal system and the wellness, and fitness through risk factor identi- has expanded greatly in the last 30 years. Physical education while nervous system, and the effects of these fication and the implementation of services to therapists also work in the professional sports and disorders on general health. Chiropractic reduce risk, slow the progression of or pre- university settings. physical care is used most often to treat neuro- vent functional decline and , and So the long and the short of it is that chiropractors musculoskeletal complaints, including but enhance participation in chosen life situations.” therapists have have a more expansive diagnostic education while not limited to back pain, neck pain, pain in The APTA also provides this historical synop- physical therapists have an intervention- or thera- the joints of the arms or legs, and head- an intervention- sis regarding the genesis of physical therapy as peutic-based education. While chiropractors can aches. Doctors of Chiropractic may also a profession. “When the polio epidemic be- provide services such as rehabilitative exercise and be referred to as chiropractors or chiro- or therapeutic- came widespread in the United States in 1916, modality treatments, their main form of treatment practic physicians. They practice a drug- the need for muscle testing and muscle re- remains the manipulation. Physical therapists may free, hands-on approach to health care based education to restore function grew dramati- provide manual therapy techniques to their pa- that includes patient examination, diagno- cally. The United States entered World War I tients, but therapeutic exercise, modalities, and sis and treatment. Chiropractors have education. by declaring war on Germany in 1917, and the activity modification remain the foundation of physi- broad diagnostic skills and are also trained Army recognized the need to rehabilitate cal therapy practice. to recommend therapeutic and rehabilita- soldiers injured in the war. As a result, a tive exercises, as well as to provide nutri- Spinal manipulation aside, the two professions have special unit of the Army Medical Department, tional, dietary and lifestyle counseling.” converged to the point that some prominent indi- the Division of Special Hospitals and Physical viduals in each profession have begun to discuss the In 1895, Daniel David Palmer founded the Reconstruction, developed 15 ‘reconstruction unthinkable: merger. It would not be out of the Chiropractic profession in Davenport, aide’ training programs in 1917 to respond to question to see the first combined chiropractic – Iowa. The most common therapeutic the need for medical workers with expertise physical therapy program within the next 15-20 procedure performed by doctors of chiro- in rehabilitation. The profession of physical years. practic is known as “spinal manipulation,” therapy, as it was later termed, had begun.” also called “chiropractic adjustment.” The Article by Dale Buchberger, DC, PT, CSCS APTS Recipe Box: Homemade Heat and Ice Packs

These are two cost-effective ways to manage your choice. Tie or sew the pouch shut. Gel Ice Pack Microwave pouch for 1-3 minutes to produce Do not use if you have hypersensitivity to your pain at home with heat or ice. What you need: (2) 1-quart or 1-gallon plastic a moist heat. cold, poor circulation, or peripheral vascu- Moist Heat Pack freezer bags, 2 cups water, 1 cup rubbing alco- lar disease. Another option is to take a towel or wash- hol. Moist heat packs are less dehydrating to the cloth and run it under warm water until Other tips: Whether you’re using cold or Instructions: Fill the plastic freezer bag with water skin than dry heat packs (i.e. an electric thoroughly soaked. You may also microwave heat therapy, do not apply for more than and rubbing alcohol. Try to get as much air out heating pad) and they allow heat to absorb for increased warmth. Place inside a bag and 15 minutes at a time. Avoid direct contact of the freezer bag before sealing it shut. Place better into the skin, thus relieving pain faster. wrap the bag inside another dry towel. Never with the skin; always be sure to have a the bag and its contents inside a second freezer layer of toweling or fabric between the What you need: some kind of cloth pouch lie directly on a heat source. bag to contain any leakage. Leave the bag in the cold or heat and your skin. Do not use (sock, fabric), 4-6 cups of filling (uncooked Do not use over areas that are swollen, and freezer overnight. cold or heat therapy over an open wound. rice, flax seed, buckwheat, oatmeal), needle check with a health care professional if you Another option is to freeze water in a paper Never go to bed with cold or heat, which and thread (if needed). have poor circulation or diabetes. cup, peel back the top of the cup, and rub it could cause further tissue damage. Instructions: Fill the pouch with the filling of directly on the affected area. By Tom Zirilli, PT, & Carolyn Collier, PTA At Active Physical Therapy Solutions, we utilize the most cutting edge treatment and management techniques available. Our goal is to deliver the best possible healthcare in Active P.T. Solutions a friendly, caring, and well-organized 91 Columbus Street environment. Our staff is here to Auburn, NY 13021 provide active solutions to achieving Phone: 315-515-3117 Fax: 315-515-3121 your personal goals! E-mail: [email protected] website: www.activeptsolutions.com ...BECAUSE LIFE SHOULD BE Get Well...Get Active...Be Active ACTIVE! Newsletter Edited by Carolyn B. Collier, PTA Heat vs. Ice Quick Reference Chart

Heat Ice

Acute Injury X (Sprains, Strains, Bumps, Bruises) (24-48 hours or until swelling decreases)

Chronic Injury X (tendinosis, osteoarthritis)

Headache X X Tension (muscular) Migraine (vascular)

Gout X

Muscle Spasms X X

Post-exercise X (to decrease pain/inflammation)

In general, use heat to decrease pain, increase blood flow, promote soft tissue healing, and relax tight muscles. Use ice to decrease pain, decrease blood flow, and decrease swelling and inflammation. By Tom Zirilli, PT