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Hot/Cold
 Whenever I get injured during activities, I’m confused whether to use heat or ice and for how long? Please help. Debbie, Wall Township
The rule is when an injury first occurs you should use ice for the first 24-48 hours and then switch to heat. I prefer to tell my patients to use only ice because most of them remain active. The purpose of icing is to decrease blood flow to the area and prevent swelling. Heat on the other hand increases blood flow and is usually used on chronic problems. If you are active your injury stays in the acute phase. I have found that if heat is used incorrectly it can be detrimental to recovery. Recommendation: ice an injured part twenty minutes at a time no longer no less, allow at least ten minutes between icing. If swelling persists contact your doctor.
Shin Splints
Every time I start playing basketball, I have pain in the front of both shins.
What can I do for this and how can I prevent it? Mary Claire, Spring Lake
This condition is known as “shin splints”, a “wastebasket” term comprising many different problems involving the lower leg. The connective tissue found between the tibia and fibula is often stressed because of overuse. Generally pain is localized to the medial midtibial border and is tender to the touch, especially after activity. Treatment involves modifying your workout, and sometimes using heel lifts, or arch supports. Strengthening of the toe flexors is very important because these muscles aid in supporting the arch. Also strengthening the ankle concentrating on the anterior muscles and the gastroc-soleus complex. Icing before and after activity for twenty (20) minutes is a must. If you are doing all of this and pain and tenderness persist, you need to consult your physician. An x-ray should be done to rule out a stress fracture. This is usually done approximately 14-21 days after the onset of symptoms. This is when bone healing begins. If bone healing is noticeable on x-ray, then a stress fractured has occurred and rest is imperative.
Ankle
 While playing basketball, I always turn my ankle. Why does this happen, what can I do to prevent it? Nick, Pt. Pleasant
The ankle joint is a hinged joint and is structurally strong because of the bones and ligaments. The ligaments medially are stronger than the ones laterally. By far, the weakest of the ankle is it’s muscular arrangement since the long muscles tendons that cross on all sides. The vast majority of ankle sprains are the inversion (turning the heel in) inversion type resulting in stretching and tearing of the lateral ligaments (outside). Ligaments do not have an elastic component, so once stretched they remain stretched. The ankle can no longer rely on the ligament to prevent rolling of the ankle; therefore that is why it happens over and over. There are different grades of ankle sprains. Point tenderness and swelling are visible. The treatment consists of ice and rest and after pain swelling has subsided strengthening of the muscles to help pull up the slack of the stretched ligaments. The stronger the muscles are on the outside of the ankle the less probability of inverting your ankle.
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