Ice/E-stim/Ultrasound: Age old therapies that may not be so therapeutic

By: Chris Ecklund, MA, CSCS
For: SB Independent

For years we’ve heard it from the medical community—
    Roll an ankle?  Ice it.
    Pull a muscle? Ice it.
    Jam a finger?  Ice it.
Those who have been involved in athletics or fitness are all too familiar with this advice.  Adhering to it may be another issue altogether, but suffice it to say we have been instructed to do it.  The question is…should we?

Research over the past couple decades has brought the therapeutic effects of R.I.C.E (rest, ice, compress, elevate) for soft tissue injury into question.  Does it actually help?  Is it worth the time and discomfort?  Are there other therapies (i.e. e-stim or ultrasound) that are more appropriate or better yet, more efficacious in bringing about the tissue healing process for acute soft tissue trauma?  Some studies have even gone so far as to say that cryotherapy has a negative impact on tissue healing and can actually slow or negate some of the body’s natural healing processes for recovery.

The truth, not surprisingly, lies somewhere in the middle. 

Local Physical Therapist, Tom Walters, DPT, CSCS notes that “for acute musculoskeletal trauma (due to surgery or injury), the practice of R.I.C.E. still holds value. Numerous studies are available that show the positive effects of RICE, particularly with regard to ice and compression during the inflammatory phase of healing (first 24-72 hours after injury).”  Further, he describes that the exact application technique, total icing/compression time and number of applications per day does vary depending on the size and severity of the aforementioned injury.  As a rule, however, 15-20 minutes of application (particularly that of crushed ice) several times daily with at least an hour between applications are still sound advice.

Where does the confusion lie, then?  Why are some arguing against it?  Primarily in the research evaluating cryotherapy effects past the inflammatory phase.  Here the information is equivocal at best.  Certainly there are enough studies to suggest (and most likely add credibility) to the theory that icing beyond this initial phase of 24-72 hours may actually limit the body’s natural healing response.  However, Walters points out “one must remember that if [he/she does] not rest the injured area, the inflammatory process may be lengthened beyond 72 hours.”  In this situation, further icing therapy may be warranted. 

Okay then, what about E-stim (electrical stimulation) and Ultrasound? Interestingly, while both of these practices have been fairly common practices in therapy regimens in various clinics (physical therapy, chiropractics, athletic training, etc.), the research appears equivocal at this point.  Walters suggests that while there is a need for more research, currently uses are primarily for pain relief (both) and increasing muscle strength (E-stim) but have limited support for tissue healing and repair. 

In short, E-stim and Ultrasound appear to offer very little, if any, additional benefit to tissue repair and the healing process.

Where does that leave us?  R.I.C.E.  Still good advice according to the literature…at least for the first 72 hours.

One stone remains unturned, however: how long is it going to take the tissue to heal beyond the 72 hours and what should we do until then? 

We find many of the clients in our performance center struggle to simply allow tissue repair to take place and often reengage in activities beyond tissue capacity far too soon thinking, “it doesn’t hurt anymore so it must be healed.”  Understanding that injuries are unique and blanket statements can’t be made about healing processes, I asked Walters to offer a general time line and plan of action for a typical ankle sprain based on the latest research.  Here’s what he suggests:

Phase 1: Inflammatory Phase (24-72 hours)1.  If unable to bear weight or have point tenderness along the malleoli (ankle bones), see physician to rule out fracture.
2.  Begin RICE ASAP (assuming no fracture) and continue for 24-72 hours (depending on severity).
3.  Keep ankle as inactive as possible to avoid re-injury.

Phase 2:  Fibroblastic Healing Phase (approximately 4 weeks)4.  Increase Range of Motion, Strength and Proprioception (balance and neuromuscular control) using pain as guide (if pushed into pain, the tissue will regress into the Inflammatory Phase again).
Grade I sprains (least severe) may be healed and allow regular sports participation between 2 weeks – 2 months.
Grade II usually require between 3-6 months to be pain-free with all activities.
Grade III sprains (most severe) may require >6 months to heal and may ultimately require surgery if instability remains.

Walter’s Works Cited:
1. Does Cryotherapy Improve Outcomes With Soft Tissue Injury? Hubbaard TJ, Denegar CR. J Athl Train. 2004 Sep; 39 (3):278-279

2. Cooling Efficiency of 4 Common Cryotherapeutic Agents. Kennet, Jane; Hardaker, Natalie; Hobbs, Sarah; Selfe, James. J Athl Train. 2007 Jul; 42 (3):343
3. The role of physical agents in modulating pain. Fedorczyk J. J Hand Ther 10: 110-121, 1997.
4. Effectiveness of Interferential Current Therapy in the Management of Musculoskeletal Pain: A Systematic Review and Meta-Analysis. Fuentes J, Olivo S, Magee D and Gross D. Physical Therapy. 2010 Sept; 90; 1219-1238.
5. Thermal Agents in Rehabilitation, 2nd ed. Michlovitz SL. Philadelphia. 1990. FA Davis.
6. The effect of cryotherapy on intraarticular temperature and postoperative care after anterior cruciate ligament reconstruction. Okoshi Y. Am J Sports Med 27:357-362, 1999.

Spring Back Into Fitness

By: Kim Clark, NSCA-CPT

In this four part series we will explore the foundations of program design (periodization), giving you some needed tools to apply the progressive resistance model, and finally providing you with an excellent plan to get back in shape through the Spring into the Summer. Are you ready to work hard so you can be ready for Summer?

Periodization is a tool that is very helpful in achieving your fitness goals.  Its 3 primary functions are to avoid chronic overuse injuries, plateaus and exercise cessation that comes from boredom/monotony.  Whether you want to lose body fat or gain lean muscle mass, periodization has consistently been shown in research to be a superior model of progression.  With the use of periodization, any population (from major athletes to stay at home moms) can realize constant benefits.

Periodization primarily offers its users improvement by progressively overloading the body and gradually increasing stress on the muscle to produce adaptations and decrease the risk for injury.  The model presented here for fitness cycles through three different phases.  Each phase will generally last 4-8 weeks depending on the current level of fitness. Phase one focuses on stabilization endurance training and doing low-intensity high-repetition strength training programs. This phase is very important as it strengthens your joints and core musculature while giving you the opportunity to do strength moves with correct form using lighter loads. Phase two focuses on strength endurance promoting increased stabilization endurance, hypertrophy (think definition and increasing lean tissue mass), and strength. This objective is to increase stabilization while increasing prime mover strength. This is accomplished by performing compound sets in your workout. A compound set is a set of two exercises that are performed back-to-back without rest. An example would be a bench press then a push-up. Phase three is strength and power driven. Using increased loads and fewer repetitions will increase intensity and volume. 

Periodization can also be used for your energy system development (ESD).  ESD is a term that is being utilized more frequently in the field to describe what was formerly known as Cardiovascular  or Aerobic Exercise.  There are three important energy systems that you need to know about. The first is Anaerobic/Glycolitic  System: this is what allows your body to push hard for up to three minutes (utilizing Carbohydrates as the primary fuel source). Next we have Phosphagen System and this allows your body to work at high intensity levels for up to 12 seconds (utilizing ATP as the primary fuel source). Lastly is your Aerobic System, which allows to body to work beyond three minutes so it can recover from intense energy bursts (utilizing Fat as the primary fuel source).  The phases or levels for ESD are as follows:
Level one is the aerobic phase- aerobic means your body will be using oxygen so you’ll be at a low steady state of cardio, you should be able to carry on a conversation when you’re at this level. 
Level two you start mixing in moderate interval training with the level one aerobic phase. You should find it difficult to carry on a conversation at this level.

Level three is basically just increasing the intensity of your intervals so your body will be ready for level four.

Level four is the most intense of the intervals where you push as hard as you can for 10-30 seconds. You will initially spend more time at levels one and two and work your way up to the more intense levels, which will improve your overall endurance, strength and power.

Here’s a program that you can do 2-3 times a week.  Do this program for a month and next month I will have the next progression of this workout. Make sure you do a full-body dynamic warm-up before starting the workout. Do each move for the designated amount of reps and go thru each section 2-3 times.

1a. Ab Roller        8-10reps   
  b. Side Bridge    Hold 15-30 secs
  c. Hanging Ab    8-10reps
  d. Quadruped     3x5secs each

2a. Goblet foot Elevated Split Squat   10-15reps
  b.Jungle Gym Rotational Row          10reps each side
  c.Self-Myofascial Release                30 secs

3a. Contra lateral RDL                        10-15reps each leg
  b.Anti Rotation KFT Push-Pull        10-15reps each side
  c.Active Isolated Stretch                   3 times for 5 secs each side

4a. TRX Single Leg Squat-Row 10-12reps each side
  b. TRX Bicep Curls                  10-15reps
  c. TRX Skull Crushers             10-15reps

Energy System Development:
Burpee   5-10 reps
Recover to a HR of 130-140rpm, and then repeat 5 times.
If you can only do 5 burpees the first time through,  each time you do this workout, add one more burpee so by the end of the month you’ll be doing 12 burpees!!
Remember to consult your physician prior to beginning any exercise regimen.  If you experience any dizziness or pain you may need to regress the exercise.

Questions?  Shoot me an email and I’d be happy to offer assistance.  Enjoy!

1.  Clark MA. NASM Essentials of Personal Fitness Training. Chapter 13. Philadelphia, PA: Lippincott Williams & Wilkins, 2008.

Originally from Lompoc, CA, Kim moved to Santa Barbara in 2007.  After a lifelong involvement in sports and exercise Kim decided to pursue a career in fitness.  Upon graduating from the Personal Training Program as SBBC, Kim earned her Personal Training Certificate and became a Certified Personal Trainer through the National Strength and Conditioning Association. Kim joined the PCPC team upon completing the Prevail Conditioning Internship Program.  She enjoys working with clients to help them achieve their general fitness goals and has future ambitions to work with athletes of all ages as well as coaching soccer. You can reach her here:

Another good read

Take a moment to read this article.  I think Martin Rooney puts out some solid material and enjoyed what he had to say about some recent “popular” literature.  For those that have been keeping up on some of the current trends in strength and conditioning, “talent” and “work ethic” are some oft hit topics.  One that is in the not so distant past that reminded me very much of what Rooney covered here is “deceleration training.”  Something that was extremely popular last year (2009) and was a huge topic of seminars, workshops and articles all over the U.S.  My contention was similar to what Rooney concluded in his article here: “this shouldn’t be a brand new training concept.  It should have been something we’ve been implementing all along.”
Hope you enjoy:

The Talent Revelation
by Martin Rooney

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Advocare Teams up with WPS!

AdvoCare is proud to be a Founding Partner for Women’s Professional Soccer (WPS),

as well as providing Rehydrate as the official isotonic beverage.

WPS is the highest ranked women’s professional soccer league in North America. Formed in September 2007 thanks to the efforts of the Women’s Soccer Initiative, Inc., WPS, consists of seven teams across the country.

The markets for the 2009 season are Bay Area, Boston, Chicago, Los Angeles, New Jersey/New York, St. Louis and Washington, D.C.

The inaugural season kicked off March 29, 2009.

Click here to learn more about the WPS

Fox Soccer Channel will broadcast a game each week with the “WPS Sundays on FSC” airing every Sunday April through August with the WPS Playoffs on Fox Sports Net.

Check out the games to see endorser Carli Lloyd and the AdvoCare name on stadium boards, towels, water bottles and more!

“My favorite AdvoCare product is Rehydrate. After a hard workout, Rehydrate really helps recover the water loss and gets me back to feeling like I did before my workout. I also take AdvoCare Spark® or AdvoCare Slam® before games to get an extra energy boost, and drink the Meal Replacement Shakes after my games to help replenish my muscles with extra carbs and protein.”

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Olympic Lifts, Plyos, and the Jane Fonda Outer Thigh Exercise

I don’t care what the exercise is, everyone has an opinion about how do it correctly.

In some recent conversations I’ve had with some colleagues regarding Olympic Lifts, the concept has come up quite a bit. I also noticed an observation of the issue from Robert Dos Remedios (a strength coach that I respect a great deal) last month on his blog (read article here). Lastly, I’ve had countless conversations with students in my NSCA Prep course over the past couple years that have struggled with the same issue. Point?…exercise technique/performance is a common question and a common area of confusion. Quite frankly, I feel like I learn more and more each day about how to “do an exercise right.”

I will say this, though, as with most issues in exercise this is one of the areas where I have to begin my answer with the ever-hated, “It depends…”.

All quality exercise performance starts with some fundamentals, of course. I actually refer back to an old NASM (National Academy of Sports Medicine) biomechanics perspective that was developed by Tom Purvis (if I’m not mistaken). Smart guy. It essentially deals with 6 fundamental rules of lifting illustrated by the following acronym:
G – Goal
R – direction of Resistance
A – Alignment
S – Stabilize
P – Path of Motion
R – Range of Motion

Without getting into all of these areas, let me simply focus on the “Goal” component, as the way I determine the technical components of movement and exercise weighs heavily on this concept.

Case in point:
I will teach a male competitive Olympic Lifter how to do an Olympic Lift very differently than I will teach a female high school Volleyball player how to do an Olympic Lift.

Different people. Different goals and desired outcomes. Different body limitations and structures. Different ability levels.

If these things are true…shouldn’t it determine how we instruct people to move…to lift…to train? And, if it’s true in this situation, doesn’t it make sense that we’re going to have to modify or make appropriate exercises based on the INDIVIDUAL (if we do the lift at all)?

By the way, I have a woman who is 50+ years of age training in a group training class I offer that does Olympic Lifting Variations. Before she came to me she had hardly done any consistent free weight exercise in her life. And, oh yeah, she got out of physical therapy for her shoulder right before she came to me. Results? In the last year she lost weight, had less shoulder pain than she’s had in years. It’s been a process. It’s been progressive. It’s been modified.

P.S. I do that Jane Fonda outer thigh exercise with my clients. It’s a great activation exercise if you use it right.

Therapeutic Massage at Home

Here is something you may be interested in…

A colleague of mine, Kathy Gruver, MS, LMT, RM, has recently come out with an instructional DVD for at home massage. For those of you looking to learn some practical techniques you can use on your own, this might be a good option for you.

I am always looking for ways of doing self myofascial release, foam rolling, etc. for my clients pre-, during and post-exercise to improve neuromuscular communication and recovery. But in the end, they are all “the poor-man’s massage” techniques. This is an opportunity to learn some more practical/scientifically-based techniques you can use at home and still save some bucks in our wonderful economy. I have had the opportunity to meet with and discuss some of these issues over the last couple years with Kathy and have found her to be a great resource of information.

Here’s the link to Kathy’s site: Therapeutic Massage at Home DVD

Advocare links arms with Informed Choice

Advocare has recently announced a partnership with Informed Choice to certify several AdvoCare products as banned-substance free. Eventually, Advocare will have 20 products registered into the program.

It will be the largest and most comprehensive testing program for any company in the world.

The following products are currently registered:
(Click here to view any of these products)
Arginine Extreme
AdvoCare Muscle Fuel
Muscle Gain (both flavors in cans and pouches)
V16 Energy DrinkAdvoCare Spark (All flavors in cans and pouches)
Rehydrate (All flavors in cans and pouches)
AdvoCare Slam (both flavors)

Products that are in the pipeline to receive registration soon are:
(Click here to view any of these products)
Post-Workout Recovery (both flavors in cans and pouches)
Nighttime Recovery
Muscle Strength
CorePlex with Iron
CorePlex Chewable
Calcium Plus
Amplify AT
O2 Gold
Joint ProMotion
Excel Gel

Yet another reason Advocare is the only company I recommend to my friends, family and clients. They go the extra mile to ensure safety and efficacy that other companies simply do not.

A Better Food Guide Pyramid

I just received a link to an alternative Food Guide Pyramid from a colleague of mine (Glenn Town, Ph.D./Kinesiology Dept. Chair/Westmont College). One of the often cited concerns of using the traditional pyramids is how political and economically motivated they are. Glenn cited this one as being one he really likes as it seems to be free from a lot of these issues and simply gives better nutritional guidance. It is from the Harvard School of Public Health (
By the way, I have had the opportunity to have a few discussion at length regarding nutrition and I have really respected what Glenn has to say in this arena.

Click here to visit the site or on the picture to the right.

Hope this is helpful for you.

Prevail Conditioning