The use of Ice baths and are they worth it……?

A view from Professional football

 

There has been plenty of topical discussion about Cryotherapy within the media and medical discussion boards recently. I would love to tell you that this is a fairly new argument but I would be wrong in saying that as this debate has been going on for decades. Having worked in professional sport for over 5 years it is arguably one of the most heated debates between staff members from Physio’s to sport scientists and coaches on a near daily basis, particularly in the pre-season. The majority of “old school” coaching staff still religiously believe that players and sportsman should take a cold ice bath after every training session. Now let me assure you, cryotherapy for the majority is never nice and from experience all I ever received was abuse from football players when informing them they have to spend time in freezing cold water for minutes on end! Overseeing players standing or sitting in ice baths, often gives time for player reflection and in that moment one of two questions nearly every player asks is if it will freeze their manhood and more importantly what do ice baths actually do?

 

Therefore, in this blog I will go over what the recent evidence proposes happens during the time you are freezing cold standing in artic cold water or a futuristic ice chamber and is it actually worth your time, or would you be better leaving out the cold treatment altogether.

 

Traditionally, ice baths/cryotherapy were and are seen as a way to reduce swelling/ DOMs/ inflammation after a hard training session. The word tradition is key in the previous sentence as the majority of cryotherapy treatment is done because of the argument “we have always done it so it must work”. Fortunately in my time within elite sport, tradition was never the main reason for the use of anything in relation to player welfare. We always clinically discussed the best option for best practice. During the off season (June), the medico-sport science team rationalised the use of ice baths particularly during the upcoming pre-season (July/August) period and discussed the disadvantages and advantages of using ice baths as a recovery method for football players. The advantages and disadvantages were:

 

Advantages:

 

  • Positive psychological response following ice bath use.
  • Build team morale. (This sounds odd, as above I have stated that the players used to complain about going in ice baths however, once we convinced the players to go in, they used to joke and make fun of the staff and players.

 

Disadvantages:

 

  • Typically players didn’t like being told what to do.
  • Filling up the ice baths was a lengthy process and very time consuming.
  • Contrasting literature around ice baths and their positive influence on recovery
  • The supportive evidence suggesting ice baths are a good recovery tool, have also stated that they potentially inhibit muscle adaptation (which during the pre-season is what we were after).

 

As it is a blog, I will give my opinion on whether ice baths work. I do believe they have a place within professional sport/training, and professional sport/training only. You may be asking why I have this viewpoint? My rationale for this stance is that an ice baths’ aim is to enhance recovery and inhibit muscle damage therefore giving professional sports people the ability to train/play harder, faster and longer the next day/day after that. A great example of this is seen when a football team plays a match on a Saturday and then again on a Tuesday. Now if your not a professional sports person and you don’t train every day for 48 weeks of the year you may need to ask yourself if an ice bath is what your after. Several articles have reported that ice baths as a recovery tool actually have detrimental effects on training (1)

 

I will use myself as an example. On a good week, I try and get myself to the gym or partake in physical activity 5 times a week. My goals are unfortunately to look great in the mirror and on holiday and obtain some level of fitness so I can run for 3 to 5 miles twice a week. Getting big muscles and looking “shredded” is referred to as muscle adaptation in the professional world, if I want to look “hench or ripped” I don’t want to be submerging myself in sub 15 degree temperatures every week. The latest literature states that we want the inflammatory response within our muscles for them to grow and adapt and therefore I will be preventing the good work I am achieving in the gym completing weight after weight session (2,3).

 

 

 

 

 

  • Higgins, T R, Heazlewood, I T, Climstein, M. (2011) A Random Control Trial of Contrast Baths and Ice Baths for Recovery during Competition in U/20 Rugby Union. Journal of Strength & Conditioning Research, 25, 4: 1046-1051.
  • Giraldo E, Garcia JJ, Hinchado MD, Ortega E (2009) Exercise intensity-dependent changes in the inflammatory response in sedentary women: role of neuroendocrine parameters in the neutrophil phagocytic process and the pro-/anti-inflammatory cytokine balance. NeuroImmunoModulation 16(4):237–244
  • Lateef, F. (2010) Post exercise ice water immersion: Is it a form of active recovery? J Emerg Trauma Shock. 3 (3): 302.

The new Flex Building

Hi All!!!!

We are so excited for you to see the final pictures of our new physiotherapy practice located within the grounds of the University! We are official partners with the University  and are located at the following address:

4B Newland Science Park

Inglemire Lane

HU6 7TQ

Reception

Walk way

Treatment room 1

Treatment room 2

Treatment room 3

The Gym!!

The Studio!!

This will be used for yoga/pilates based work.

And last but not least, our favourite bit of equipment………. the anti gravity treadmill!

Why Flex……. ? and who are we?

So by now you may have seen numerous video posts and social media content about how we differ from other Physiotherapy clinics in the area. The reason for this is our passion for exercise based rehabilitation which comes from many years of experience in elite sport. Having a total of 20 years experience in elite sport and healthcare we have refined our processes to ensure that whoever the patient, we treat them like a professional athlete! Now this doesn’t mean that we expect  you to be super fit, run long distances or to be able to train like a professional athlete. We are talking about our (Flex Health’s) processes and using exercise as a fundamental tool to improve your pain and symptoms. We aim to treat every single patients as a professional athlete, as professional athletes are used to receiving the highest possible care and attention frequently.

Take low back pain (LBP) for example, we offer soft tissue management as a treatment method for improving symptoms inline with NICE guidelines however, our main process is to “consider exercise programmes (biomechanical, aerobic) with low back pain with or without sciatica” (NICE, 2016). Therefore we use clinical research and our elite experience in sport to demonstrate that exercise rehabilitation successfully works. For an acute LBP case, as per professional sport we recommended that frequency of treatment is key. Within professional sport athletes are treated daily, as a result of this the players rehabilitation times are generally quicker than the general public. We implement the same strategies seen in professional sport to the general public, and aim to review patients twice weekly if possible to ensure better carry over of treatment and quicker progression of rehabilitation. Ultimately this process returns the patient back to work/exercise more quickly as we know this rehabilitation method is proven!

Our exercise processes are taken very slowly and we do not push the patient quicker than pain, weakness or discomfort allows. We listen to all our patient’s individual needs and understand what their goals and expectations are.

We feel that frequency of treatment is also important. Having worked with and currently working with professional athletes we see that frequency of treatment is key to returning to work, sport or daily actives more quickly. At Hull City football and every other football club in the country, players are seen 5 times a week/daily and work through a number of different processes during a typical rehab period. The rehab process will include passive treatment, strength based exercises, balance based exercises and range movement based exercises. We follow this exact process and have seen excellent results with all our patients. The reason we believe in this process  is because you have a better carry over of symptom relief and pain reduction from the last Physiotherapy session and we can monitor your symptoms more easily and progress you more quickly through the rehab stages. For example, an ACL rehabilitation process needs a lot of external feedback from a therapist to correct movement patterns and ensure that exercises are performed correctly, this is done much more easily with a therapist present compared to doing it alone (Bucksworth et al., 2007).

We also take this exact approach for the neurological conditions that we see. We are a unique facility that not only caters for musculoskeletal conditions but neurological conditions also. We have specialist rehabilitation equipment only seen in few clinics in Yorkshire please see the link http://www.cyclonemobility.com/f.e.s . Our neurological team assess and treat patients with conditions such as Parkinson’s, Multiple Sclerosis, Stroke and traumatic brain injuries to name just a few. Our processes and technology help patient’s with increasing their strength, improving fitness, improving the ease of carrying out daily activities and ultimately gain a level of independence.

So who are we and what do we know? 

Alex Chester: Has spent 7 years working for Hull City FC with both the first team and academy, as a key member of the rehabilitation team overseeing the soft tissue needs of all players and leading the rehabilitation processes for a multitude of different and complex injuries. Has a specific passion for gym and outdoor based rehabilitation and is extremely creative when it comes to performing functional rehabilitation drills. Using unique techniques and patient led targets to design and implement drills to ensure patient’s recover better and stronger.

Matthew Booth- Is currently working for Hull City FC and spent the last 5 years working at the club. Involved with the medical needs for the first team and being in charge of all the medical needs of the entire academy in the role of “Head academy Physiotherapist”. This role involves ensuring that the player’s welfare is maintained from initial injury to return to sport. Being directly involved in every players rehabilitation process has given him a wide knowledge of a vast array of different injuries. He has a MSc in sport and exercise medicine and uses the knowledge learnt from this when assessing and treating all patients.

Imogen Fryer- Imogen is our lead neuro-rehabilitator and has extensive experience treating a range of disabilities and injuries. She has worked with neurological patients for over 5 years and has vast experience in assessing and treating a different array of injuries and disabilities. We have leading equipment at Flex Health that is only seen in few clinics in Yorkshire, Imogen is extremely experienced on these machines and has helped numerous patients to achieve their rehabilitation goals. Focusing on providing exercise rehabilitation to maximise independence and mobility, Imogen is able to help patients improve their health, well being and quality of life.

Steve Watson- Steve has three years experience working within academy football at Hull City FC. He has seen different injuries from a number of age groups and has an excellent understanding of how to rehabilitate adult and juvenile conditions. He is currently completing his Phd at Hull University and will be conducting his studies out of our new premises within Hull University.

Alex Hastie- Alex has also had 3 previous years of working within a professional football academy setting. He has worked at Hull city FC and has also treated and rehabilitated a number of different conditions. Alex helps Imogen with our neurological patients and aids in delivering rehabilitation plans for these patients.

Reference List:

Bucksworth, J., Lee, R. E., Regan, G., Schneider, L. K., DiClemente, C. C. (2007) Decomposing intrinsic and extrinsic motivation for exercise: Application to stages of motivational readiness. Psychology of Sport and Exercise, 8 4: 441-461.

Cyclone Mobility- http://www.cyclonemobility.com/f.e.s/benefits

Gardner, A., Buchanan, K. (2015) Neuromuscular Strengthening Exercises following ACL and Meniscal Repair in a 15 Year Old Female Athlete with Generalized Knee Laxity: A Case Report. Accessed from: http://dune.une.edu/cgi/viewcontent.cgi?article=1043&context=pt_studcrposter

Nice Guidelines (2016) Low back pain and sciatica in over 16s: assessment and management. Accessed online: https://www.nice.org.uk/guidance/NG59/chapter/Recommendations#assessment-of-low-back-pain-and-sciatica

 

 

 

Flex FES

A condition known as ‘Drop foot’ is a common side effect from those suffering the aftermath of a stroke. For the patient, it means there is a problem in lifting the foot and toes properly which can affect walking and may lead to trips and falls.

The reason that this condition occurs, is because the muscles are no longer strong enough to lift the foot and toes or there may be spasm in the calf muscles. In some cases, Drop foot can cause the patient to hit the ground on the outside of their foot resulting in ankle injuries.

At Flex, we use physiotherapy treatments to help those suffering with post-stroke and other neurotherapy symptoms alongside a treatment called Functional Electrical Stimulation (FES). FES works by sending small electrical impulses to stimulate the muscles and nerves, helping muscles to contract and assist with achieving movements.

In situations of Drop foot, FES has been found to be very effective in that he peroneal nerve which sits just under the skin in the lower leg, is easy to stimulate

How does it work?

While there are other ways to receive FES treatment including surgery and mobile battery operated devices, the most common method of applying FES treatment is to apply electrodes to the skin over the nerves. It is important that electrodes are professionally applied to ensure the correct movement is produced for the patient. For the patients who undergo FES treatment for drop foot experienced the following (according to 11 independent studies):

  • Improvements in walking speed and distance
  • A more natural walking pater
  • Improved confidence and independence
  • Reduced falls
  • Reduced muscle spasm
  • Increased energy in walking levels.

Don’t just take our word for it, Pete Stephenson is a Flex Health spinal injury patient with limited movement from the neck down who underwent FES treatment to stimulate his muscles and movement. Pete said;

“ I feel more ‘connected’ with my walking and the circulation in my lower limbs has felt the best it has in years. There has been gradual improvement over the weeks in terms of the distance covered and the speed at which I can now go and I’m at the point now where it has become a good cardio work out too and I have noticed some muscle definition and tone improvements also”.

For Pete, and patients with many Neurotherapy needs, FES has changed their lives. Along with being clinically proven, it is recognised by many leading bodies as effective treatment including the National Institute for Clinical Excellence (NICE) and the Royal College of Physicians.

If you know someone we can help, contact the team today.