It is about that time again when everyone here in the northeast has to start clearing their lawns of fallen leaves.  Although the changing color of the leaves is very beautiful, the cleanup can be overwhelming.  Due to our busy schedules, most of us have one or two days to get the entire lawn cleared of the leaves.  
      With that in mind we decide to go out and rake the entire lawn in one day.  This can cause significant pain and discomfort in the shoulder region.  The residual discomfort may be normal muscle soreness but if it persists for 3-4 days after, there may be something else going on.  During the fall season, we here at Manchester Sports Medicine, begin to see an increase in shoulder injuries that are a direct result of the above scenario.
      Usually the primary cause of the pain is muscle soreness that will resolve in 2-3 days after stopping the activity, but there are instances where some inflammation will not go away and continued shoulder pain persists.  In these instances, physical therapy can be beneficial in controlling the inflammation, decreasing the pain and restoring the shoulder back to its pre injury condition.
       Physical therapy will utilize various modalities, manual interventions, exercises and education to allow you to speed your recovery.  Jason and I have over 18 years of experience in treating shoulder problems which will allow us to determine the origin of your pain and what the best course of treatment would be for you.
       If you or a family member begin to experience shoulder pain or any other orthopedic complaint, please feel free to contact us via phone or email.  Also look for next quarters newsletter which will focus on shoveling and lower back pain.

 

Dear Dan:
    My 11 year old son is the pitcher for his little league team and he has recently started to complain of elbow pain after pitching. There is no swelling and the pain goes away in a day or two. We have heard conflicting advice on the use of heat or ice to treat this? Should we use heat, ice, or some sort of sports rub? Some doctors say to use heat, some say to use ice. Please Help.           Confused Mom

 

Dear Mrs. Confused:
    This is a very common question, one often pondered during my pitching days at East Little League!  Many healthcare professionals have conflicting advice on the use of heat or ice for the treatment of acute injuries.
    The best way to answer this question is to explain how the application ice and heat affect the body differently. Heat increases blood flow to the area that it is applied to. The theory is that the increase in blood flow will aid in the healing process by increasing the amount of healing growth factors in that area. Heat also has a feel good component to it, lets face it people like warmth! The downside of heat application is that the increase in blood flow also causes an increase in inflammatory response an actually increase swelling. Ice on the other hand works a bit differently.
    Ice actually causes vasoconstriction, or tightening of the blood vessels, therefore it decreases the blood flow and slows down the inflammatory response. Ice does not actually get rid of swelling, but it helps to prevent it! Compression, elevation, massage, and some medications are the best ways to remove swelling. Ice also has a nice feature in that it actually slows down the speed of the nerve signals from the injured area to the brain. The nerves that tell your brain there is pain are actually slowed by the application of ice helping to decrease the pain you feel. 
    Sports rubs, or creams, work differently than both heat and ice in that they don't really affect blood flow. These distinct smelling creams often comically referred to as "middle aged cologne",  "gym deodorant", or "weekend warrior battle paint"  actually trick the nerves signaling the brain. These topical creams usually contain some sort of irritant that overloads the brain with stimulation from a given area of the body. The brain has a hard time processing all the incoming stimulation from distinct area of the body so it tends to pick the one that gets there the fastest and that's usually the nerves that carry pleasurable sensation! That's the same reason you rub your elbow after whacking your "funny bone"!  So the cream does nothing to aid in the healing of an injury and it truly does mask the pain.
    Ice is usually your best bet for injuries. Ice slows down the inflammation process and  helps to control pain with minimal side effects. Ice application usually follows the CABN response, that's the Cold, Ache, Burn, Numb sensations that follow ice application. The CABN response to ice application is normal, but ice should be removed if the area becomes more painful or if the area becomes numb. The skin will often be pink and cold for some time after the application of cold therapy. Keep in mind that one application of ice for 15 min every hour is fairly safe. Both heat and ice can injure the skin if left on too long and careful inspection of the skin before and after ice application is necessary to determine a safe treatment.
    If your son continues to experience elbow pain before, during, or after throwing he should be evaluated by a therapist or doctor to determine the best course of treatment. Careful consideration should be made on his pitching mechanics and pitching intensity. We work with a wider variety of great local medical professionals and would be happy to give you the names of professionals that could help you. Thank you for your question.
 
Dan Fleury is a physical therapist at Manchester Sports Medicine located at 50 Bridge St, Manchester NH 03101, and Elite Sports Therapy located at 345 Cilley Rd, Manchester NH 03103. Louis Zollo PT is also a physical therapist at Manchester Sports Medicine and is contributing to the content in this column. Dan can be reached for questions regarding the column or for the submission of questions via email Dan@pinncalerehab.net
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The information contained in this advice column is in no way intended to treat, cure, or prevent any disease. This column is in no way and should not be considered as an alternative to medical care. The advice in this column is for educational purposes only and one should always seek the advice of their medical professional if their condition fails to improve or becomes worse.