HEAT VERSUS COLD

• Acute: If it is an acute injury, there is generally some swelling and pain, both of which are aggravated by an increased flow of blood into the area. Cold (20 minutes every 2 to 3 hours) will decrease the blood flow and as a result the amount of inflammation and discomfort. The mantra is RICE - rest, ice, compression, elevation. Cooling will 1) provide direct pain relief (analgesia), 2) muscle relaxation in ways not clearly understood, and 3) blood vessel constriction (which then slow the onset of tissue swelling and bleeding in the area of injury).

  3 to 5 days after the injury, warmth becomes the approach of choice. An alternative to heat alone is ice for 10 minutes followed by 10 minutes of heat. This maximizes the return of blood flow (to facilitate healing) as vasoconstriction from cold accentuates the rebound vasodilation from the warm packs/heating pad.

  More is not necessarily better when it comes to heat and cold therapy Ice will decrease blood flow to the area, but some blood flow is necessary to assist in healing. Likewise too much heat can in itself cause inflammation and swelling.

  Later in the process, when you are beginning to rehab the injury, you may opt to use heat before the activity to increase circulation and "warm-up" the injured part. After activity you might want to apply an ice pack to prevent any recurrent inflammation re-irritated by the activity itself. Rehabilitation of the area is will gradually restore joint range of motion via stretching and gentle range of motion exercises. Heat therapy facilitates the rehabilitation process as it "relaxes" the collagen tissues within these structures, and thereby aids in the stretching process.

• Chronic: Chronic injuries are most commonly related to either overuse (most common) or biomechanical imbalance. For these heat is the treatment of choice as it will increase blood flow to the injured area as well as help relax the muscles which tend to be tight and occasionally spasm. The only time one would use ice on a chronic injury is after beginning rehab, to treat the mild inflammation that can result from reuse of the injured joint/muscle/ligament.

  An example of a chronic injury is Achilles or Quadriceps tendonitis. The biggestquestion is whether it might be an acute injury of the bursa (the sac around the tendon which provides the "lubrication" for the tendon or of the tendon itself.)An acute inflammation of the bursa (the Achilles rubbing on a new pair of shoes for example, is treated as an acute injury). But this can also be a chronic overuse injury in which case heat and anti inflammatories may be counterproductive. One of my readers sent in this link which might be of interest. Tendinosis.

FIRST AID IDEAS

• Medications. Anti-inflammatory medications can be helpful. Ibuprofen, naproxen and aspirin are all available without a prescription. Acetaminophen (e.g. Tylenol) is NOT an anti-inflammatory. These drugs are most effective if they are taken early since the inflammation cycle is often hard to treat once it has become established.

  One danger of anti-inflammatory mediations is that they are also pain killers. Pain is your body's way of letting you know that you are using an injured area and might be doing damage. If you block the pain signals, you can easily aggravate an injury without knowing it. The pain relief eliminates the ability to follow the mantra "if it hurts when you use it, stop. If not, go ahead."

  Muscle relaxants are sometime prescribed for back problems. These should only be obtained from a physician.

• Ice, Heat, and Massage.
  • Ice can be a great way to reduce pain and inflammation. Ice is particularly good for the first couple of days. Some injuries respond to focal icing -- rubbing ice directly on the exact spot of the pain. Stop when your skin begins to get numb. 20 minutes every 3 hours up to three timesa day should provide plenty of therapy for your ailmentwithout injuring your skin. Remember to protect your skin with barrier cream or baby oil if you are using ice massage directly to the skin.

    A simple way to apply ice is to freeze water in a paper cup. Peel the cup back to expose the ice and then use the cup as a handle while gently rubbing the ice over the effected area. It helps to use a hand towel or paper towel to protect your hand (and skin) when using both the crushed and block ice. Another alternative is crushed ice in a ziplock baggie.

  • Heat, especially moist heat, can be useful. However, it should not be used for the first few days after injuring your back or after aggravating a current injury. Regardless of the timing, if you feel worse during or shortly after heat treatment, stop doing it.

Treatment depends on the type of fracture. With a greenstick orhairline, one can forgo a figure-8 brace as long as the rideris careful not to stress the shoulder. However, any simple or compound fracture needs to be immobilized. Motion in an unset fracture can cause excess calcification with a noticeable bump or an abnormal set angle. These are actually quite common as the brace is uncomfortable and it's even more uncomfortable to sleep on one side only. This can be remedied with a little tape and a couple of thumbtacks. It only takes a couple of nights to get used to it.

Broken collarbones rarely hurt unless reinjured. That's why it'simportant to understand the seriousness of a second trauma. A wide figure eight brace with padded straps 2 to 3 inches wide and tightened firmly will help prevent reinjuries and bad sets. All it takes is a slight turn orreaching for something at the wrong angle.

A word of warning. If the break is not allowed to sufficiently heal the ends of the bone will calcify preventing a strong bond and probable refracture from normal cycling loads. Also, a crash with an inadequately healed collar bone could sever the innominate or common carotid artery.

One can resume training on a turbo trainer after three or four days. This is best carried out with a road bike with dropped handlebars. Turn thebars upside down. Then take another set of road bars and tape them tothe upturned set. This makes a big S giving you a rail to hang onto at aconvenient height. This allows you to resume training on a turbo ina more upright position. If you feel any pain or discomfort stop.

Q. Can I ride with a broken clavicle?

A.It's not that unusual to break a collarbone (or clavicle) in a fall. Although it is uncomfortable, you can still get on the bike and train. You will only be limited only by pain and range of motion of your upper body. You will need to be aware of your body position. Because you'll be putting little or no weight on the broken side, you could experience back pain from constantly leaning to the other side during indoor cycling sessions. Being aware of this and doing your best to balance your position on the trainer will help. Another option would be to add some aerobic alternatives into your training program such as walking on a treadmill at 8-10 degrees of incline. The incline will decrease the pounding (and thus pain in the clavicle) while keeping your quads and heart strong.