NorthShore University Health System Primary Care Sports Medicine, University of Chicago, Pritzker School of Medicine; ATC National Athletic Trainers’ Association cjaworski@northshore.org
The authors reported no potential conflict of interest relevant to this article.
This pictorial review can help you advise patients on how to reduce pain and increase ROM, strength, and balance following acute injury or in chronic impairment.
❯Have patients apply ice to an acute injury for 15 to 20 minutes at a time to help control inflammation, and prescribe an anti-inflammatory medication, if indicated. A
❯Reserve heat application for use following the acute phase of injury to decrease stiffness. A
❯Instruct patients who have an acute lateral ankle sprain to begin “ankle ABCs” and other range-of-motion exercises once acute pain subsides. C
❯Consider recommending an eccentric heel stretch to help alleviate plantar fasciitis symptoms. C
Strength of recommendation (SOR)
A Good-quality patient-oriented evidence
B Inconsistent or limited-quality patient-oriented evidence
C Consensus, usual practice, opinion, disease-oriented evidence, case series
References
The mainstay of treatment for many musculoskeletal (MSK) complaints is physical or occupational therapy. But often an individual’s underlying biomechanical issue is one that can be easily addressed with a home exercise plan, and, in light of the COVID-19 pandemic, patients may wish to avoid in-person physical therapy. This article describes the rationale for, and methods of providing, home exercises for several MSK conditions commonly seen in the primary care setting.
General rehabilitation principles: First things first
With basic MSK complaints, focus on controlling pain and swelling before undertaking restoration of function. Tailor pharmacologic and nonpharmacologic options to the patient’s needs, using first-line modalities such as ice and compression to reduce inflammation, and prescribing scheduled doses of an anti-inflammatory medication to help with both pain and inflammation.
Once pain is sufficiently controlled, have patients begin basic rehabilitation with simple range-of-motion exercisesthat move the injured region through normal patterns, as tolerated. Later, the patient can progress through more specific exercises to return the injured region to full functional capacity.
Explain to patients that it takes about 7 to 10 days of consistent care to decrease inflammation, but that they should begin prescribed exercises once they are able to tolerate them. Plan a follow-up visit in 2 to 3 weeks to check on the patient’s response to prescribed care.
Which is better, ice or heat?
Ice and heat are both commonly used to treat MSK injuries and pain, although scrutiny of the use of either intervention has increased. Despite the widespread use of these modalities, there is little evidence to support their effect on patient outcomes. The historical consensus has been that ice decreases pain, inflammation, and edema,while heat can facilitate movement in rehabilitation by improving blood flow and decreasing stiffness.1-3In our practice, we encourage use of both topical modalities as a way to start exercise therapy when pain from the acute injury limits participation.Patients often ask which modality they should use. Ice is generally applied in the acute injury phase (48-72 hours after injury), while heat has been thought to be more beneficial in the chronic stages.
