Time for injured athletes to give sauna the cold shoulder with ice therapy

OK, YOU’VE just finished a tough workout or a punishing five-a-side game. Next stop: the sauna, to help relax those muscles, prevent stiffness and repair any minor injuries. But hold your horses.

What if you're going about this all the wrong way? What if, like Jonny Wilkinson, Jonah Lomu and Paula Radcliffe, you should be dunking your weary limbs into an ice bath instead? It’s probably not the most inviting prospect, but perhaps it should be cold, rather than heat, you use to help your body recover.

If you’ve ever had a sports injury, you’re not alone. In a UK study of 2,000 people, carried out by One Poll for the people who make Deep Heat and Deep Freeze, 76.7 per cent said they had suffered in some way or another. The most commonly affected parts of the body were knees (19.7 per cent), ankles (19.1 per cent), legs (17.8 per cent) and shoulders (13.2 per cent), while the sports concerned ranged from running (21.1 per cent) and five-a-side football (16.1 per cent), to gym workouts (15.7 per cent) and cycling (10.8 per cent).

Worse, as far as the national economy is concerned, the report claims sports-related injuries are a common cause of days off work, with 37 per cent of people saying that they had taken time off, ranging from a day to as much as a year or more. How they treated their injuries is not documented. Indeed, many of us don’t really know when to apply heat and when to use cold.

Thermotherapy works in two ways: by increasing blood flow and therefore transporting proteins, oxygen and other nutrients to the affected area. It also helps dilute the pain signals being sent to the muscle or joint. Cold analgesia relieves pain in the same way as heat, by sending a signal to the brain which completes with those “Ouch, that hurts” messages. But, unlike heat, it causes the blood vessels to constrict, restricting blood flow.

“Despite the pending obesity epidemic, there remains a significant percentage of the population who take part in sport and physical activity,” says Dr John MacLean, physiotherapist and chief executive of the National Stadium Sports Medicine Centre at Hampden. “But the one guarantee from exercise is the potential for injury.”

He says most of those injuries are relatively minor, and the majority of us don’t bother seeking medical treatment, choosing instead to treat ourselves. But some of us could be applying a hot water bottle to an injured area when, really, it should be a bag of frozen peas.

“The application of cold is best in the acute stage – ideally as soon as possible after the trauma,” he says. That’s why any decent physio worth his smelling salts always has ice packs, cold patches and freeze gels in their kit bag – so they can treat the injury on the side of the pitch or track or bus on the way home.

“Cold application results in vasoconstriction (narrowing) of blood vessels entering the injured area, minimising bleeding and swelling and tissue damage. It also limits the local release of inflammatory mediators, which are an integral part of the response to injury.”

So if you have a sprain, strain, or an injury where there is bleeding, bruising or inflammation, reach for the ice pack as a part of the PRICE regime, recognised by amateur and professional sports people all over the world: Protection, Rest, Ice, Compression and Elevation. “It is generally agreed that the use of cold therapy in the first 48 hours will limit the tissue damage and allow faster rehabilitation,” says MacLean.

The use of thermotherapy – in the form, say, of a hot water bottle, Deep Heat or hot bath – should come two or three days afterwards, when the injury has started to heal. “In contrast to cold, the application of heat will increase blood flow to the injured part and increase the removal of damaged tissue,” says MacLean. “It also has a local relaxant effect which is particularly beneficial where muscle spasm is prominent. Like cold, heat-sensitive sensory nerve endings are stimulated, further reducing the sensation of pain.”

For muscles that are simply sore, where there is no inflammation or swelling, heat therapy is also ideal. Not as you might expect, after exercise, but before, to warm muscles, tendons and ligaments, allowing them to move more easily and helping prevent injury in the first place. It also relieves nagging muscle pain from previous workouts.

Immediately after that tough cycle or weights session, again, it is cold therapy rather than heat that has been proven to help prevent the stiffness, otherwise known as delayed onset muscle soreness (DOMS), that rears its ugly head a day or two later. All of which means, sadly, that the toasty post-gym sauna might not be such a hot idea after all.