We frequently get questions from readers who have read one of our particularly enduring and popular articles — about alternating ice and heat for faster recovery after a workout, and we are happy to offer some thoughts on how it works and how it can be applied.
If you’ve read the article on alternating ice and heat, you probably know that we suggest it as a recovery tip for our marathon runners in training as well as our elite athletes. The modality has been used in treating acute injuries for the lower extremities for years, but we also think that alternating ice and heat following a long run or a rigorous workout is just as helpful.
We see this done through contrast baths, which are great for opening up the vasculature (vasodilation) with heat and closing the vasculature (vasoconstriction) with the application of ice. But for those who are not inclined to take a full plunge, simply applying alternating hot and cold packs can be sufficiently effective as long as we always start and end with ice.
Recently, however, a reader asked whether the alternating ice and heat therapy could be helpful for costochondritis, which presents as chest wall pain and is caused by acute and usually temporary inflammation of the Costal cartilage, which connects each rib to the sternum at the costosternal joint.
Treatment of costochondritis has, for years, been a mystery for most doctors. The explanation for this comes from a misunderstanding of the very small, individual rib joints, and where they attach to the spine.
Think of the rib as a semi-circle, originating at the spine and then coming around the front of the body to attach at the sternum. When you inhale and exhale, the ribs are required to flex and extend with breathing. Commonly, the ribs can “get stuck,” or become hypomobile at the attachment with the spine (less frequently, they can also get stuck as they meet the sternum in the front).
When the rib joint losses motion, a friction is created between the hypomobile rib and the normally moving ribs directly above and below. This friction leads to the irritation between the ribs, commonly known as costochondritis.
Costochonditis will be a frustrating and difficult injury to address UNTIL you mobilize the rib joint, restoring normal motion of all the ribs. This has to be the first step in resolving the injury, because the lack of rib movement is the irritating factor.
Once you achieve better rib movement, you have to treat the scar tissue and soft tissue irritation between the ribs. Active Release and Graston techniques are highly effective at treating the small, painful scar tissue that has formed between the ribs.
At this point, ice and contrast icing are helpful, but I would recommend applying cross friction ice massage to the irritated area rather than the contrast bath referenced in the article on alternating ice and heat. The coldness of the ice will help to further reduce irritation and the cross friction of the ice will help to break down the scar.
So how does cross friction ice massage work?
Very simply. Place a small Dixie cup filled with water in the freezer. Once it freezes, peel away a small part of the cup and use the exposed ice to “cross friction” the irritated area between the ribs. Do this for 5-7 minutes.
If you want to incorporate a contrast effect, use a hot cloth on the same area for 5 minutes, and then repeat with a second and even a third session of cross friction ice massage at smaller intervals.
I hope this has been helpful, and of course, we welcome anyone with this condition or other joint inflammations to come to an appointment in our office so we can work on relieving the cause of the problem and not just alleviating the symptoms.