Ice and Heat for Musculoskeletal Injury Recovery

When should I use heat or ice for an injury?

Navigating at-home care for musculoskeletal injuries can be tricky, deciding when and when not to apply heat or ice can have a big impact – especially during the initial phase of an injury. R.I.C.E and H.A.R.M are useful acronyms for aiding the initial care of musculoskeletal injuries, but how do they work?

The principles of R.I.C.E and H.A.R.M can be applied for 3 days after the onset of an injury. During this period it is important to follow R.I.C.E – this stands for rest, ice, compression and elevation. 

After applying R.I.C.E it is important to do no H.A.R.M – this stands for heat, alcohol, re-injury and massage. These are all things to typically avoid after a musculoskeletal injury.


R.I.C.E Principles:


The first component of RICE is rest. It’s essential to allow the injured area to heal by avoiding activities that may exacerbate the injury. Rest does not mean complete immobilisation; it simply involves minimising movement and avoiding activities that strain the injured area.


Ice therapy is a fundamental element in managing acute injuries. Applying ice helps reduce swelling and numbs the affected area, providing pain relief. The cold constricts blood vessels, limiting the amount of fluid that can accumulate around the injury site. Ice packs or cold compresses should be applied for about 15-20 minutes every 2-3 hours during the initial 72 hours after injury.


Compression helps control swelling by applying pressure to the injured area. Compression bandages or wraps are commonly used for this purpose. It’s crucial not to wrap the area too tightly, as this may impede blood circulation.


Elevating the injured limb or area helps reduce swelling by allowing fluids to drain away from the injury site. Ideally, the injured area should be elevated above the level of the heart when possible.


H.A.R.M Principles:


Heat therapy is beneficial for chronic injuries or injuries that have moved past the initial acute phase. Applying heat increases blood flow, which in the acute phase can lead to more swelling. Heat should be avoided in the first 72 hours after an injury.


Alcohol, specifically excessive consumption, can impair the body’s natural healing process and should be avoided during the recovery period. Alcohol acts as a vasodilator, this means it will contribute to swelling especially during the acute phase. Alcohol can also interfere with medication, increase the risk of bleeding, and hinder the body’s ability to repair damaged tissues.


Avoiding re-injury is crucial for a successful recovery. Gradual reintroduction of activity should be guided by a healthcare professional. Rushing back into activities without proper healing increases the risk of exacerbating the injury.


Massage can be beneficial in the later stages of recovery. Similarly to heat, one of the main benefits of massage is increasing blood flow to the targeted area. In the initial phase however this can lead to further swelling and should be avoided, unless carried out by a healthcare professional.

Is heat always a bad thing?

Not always! Having explored the H.A.R.M principles, it’s essential to highlight the role of heat in the later stages of musculoskeletal injury recovery.

The first three days (or 72 hours) is known as the acute phase of an injury, after this period swelling should have peaked. As the acute phase subsides, heat becomes a valuable asset in promoting healing. Heat applications, such as heat packs or hot showers promote blood flow, which aids in delivering nutrient rich blood and oxygen to the injured area.



Navigating the Holidays: Unwrapping the Risks of the festive season

As the festive season descends upon the sun-kissed shores of Australia, it’s time to revel in the warmth of summer and the joy of Christmas. However, amidst the celebrations, it’s crucial to prioritise self-care and ensure a holiday season that is both enjoyable and injury-free. In this blog post, we’ll explore some tips for taking care of yourself and your loved ones during the holiday season.

The Annual Family “Friendly” Competition:
From cricket games in the backyard to hiking trails, the family “friendly” activities that bring everyone together. However, we forget that playing cricket once a year doesn’t mean that we are physically prepared for the fast balls and tackles from our younger, stronger, fitter relatives. It is essential to take certain precautions to ensure that these activities remain safe and injury-free.
Tip: Know your limits, you are not Usain Bolt. Wear appropriate footwear (and padding if you need). Be aware of your surroundings and maybe let the kids take the win.

Tangled Tinsel Tumble:
Whether hosting gatherings or decorating your home, being mindful of potential hazards is crucial. Older members of the family aren’t used to lifting their feet over your rug nor is our dog used to accidentally running into the 6 foot tree in the corner of the living room that wasn’t there before. No one wants their home to be a jenga tower of falling family members during the holiday season. The only reward is new injuries and bruises.
Tip: Secure loose rugs, ensure walkways are well-lit, and be cautious when using ladders or standing on elevated surfaces for decorations. Keep decorations and cords out of high-traffic areas to prevent tripping.

Festive Fatigue
While the holidays can be a time of joy, they can also bring about stress and anxiety. When you are in charge of the pavlova, picking up mum from the nursing home, setting the table all whilst needing to be in two places at once, it is hard not to be put together. Balancing social commitments, family expectations, and personal well-being is key to a healthy and happy festive season.
Tip: Prioritise self-care activities such as mindfulness, meditation, or a leisurely walk to manage stress and maintain mental well-being. Set boundaries to protect your mental health. Take time out for yourself, do not cancel your pilates session or your osteopathy appointment, your body will thank you later.

Don’t Forget Old Mate H20!
The summer heat can be relentless, and dehydration is a common concern during the festive holidays (especially when the egg nog is the go to). Whether you’re enjoying a beach day, a barbecue, or a festive gathering, it’s essential to stay hydrated to prevent fatigue and heat-related issues.
Tip: Carry a reusable (or emotional support) water bottle and make a conscious effort to drink water regularly, especially if “the grinch” is your new favourite cocktail.

By incorporating these injury prevention tips into your holiday plans, you can ensure a safe and enjoyable festive season for yourself, your family, and friends. Prioritising safety allows everyone to fully embrace the festive spirit without starting off the new year in the ED.

Navigating Injury: The Art of Pacing and Progression

At Peninsula Osteopathy, we understand that injuries can be both physically and emotionally challenging. Whether you’re recovering from a strain, sprain, or a more serious injury, the journey to healing requires a thoughtful and strategic approach. In this blog, we delve into the importance of pacing activities and effectively progressing or regressing rehabilitation exercises, offering insights that can significantly enhance your recovery process.

Pacing: A Key to Successful Recovery

Pacing, often referred to as finding your “activity threshold,” is a fundamental principle in injury rehabilitation. It involves striking the right balance between engaging in activity and allowing your body the necessary rest it needs to heal. Here’s how to implement pacing:

  1. Listen to Your Body: The first step in effective pacing is tuning in to your body’s signals. If an activity causes pain, discomfort, or fatigue, it’s crucial to acknowledge these signals and adjust accordingly.
  2. Gradual Progress: The journey to recovery is not a sprint but a marathon. Start with gentle activities that don’t strain the injured area and gradually increase the duration and intensity as your body responds positively.
  3. Prevent Overexertion: Pushing yourself too hard too soon can lead to setbacks and potentially delay your healing process. Pacing helps prevent overexertion and promotes a gradual return to your usual activities.
  4. Build Confidence: Pacing allows you to build confidence in your body’s ability to heal and adapt. It also reduces the anxiety that can arise from the fear of re-injury.

Progressing and Regressing Exercises: Your Customised Approach

Progressing and regressing rehabilitation exercises play a pivotal role in your recovery journey. These strategies involve tailoring exercises to your current abilities while ensuring that you challenge your body within its limits. Here’s how to effectively utilise them:

Progression: As your body heals and gains strength, progression becomes essential:

  1. Increase Intensity: Gradually add resistance or weights to your exercises. This stimulates muscle growth and strengthens the injured area.
  2. Expand Reps and Sets: Slowly increase the number of repetitions and sets to improve endurance and muscle conditioning.
  3. Embrace Complexity: Integrate more complex variations of exercises. This engages multiple muscle groups, enhancing overall strength.

Regression: There might be times when you need to take a step back to support your recovery:

  1. Reduce Intensity: Lower the resistance or weight to prevent strain, especially if you experience discomfort.
  2. Limit Range of Motion: If a movement causes pain, reduce the range of motion or opt for a modified version.
  3. Utilise Support: Incorporate assistive tools like bands or stability aids to provide support during exercises.

Musculoskeletal injury recovery is a process that demands patience, resilience, and expert guidance. At Peninsula Osteopathy, our expert practitioners are here to guide you through every step of your recovery journey. Pacing activities and skilfully adjusting exercise intensity are two powerful tools that can expedite your journey to healing. At Peninsula Osteopathy, we’re dedicated to providing you with the support and knowledge you need to make informed choices about your recovery. Remember, every step you take towards progress, no matter how small, is a step towards regaining your strength, mobility, and overall well-being.

5 Ways Your Rehab is Helping

Rehabilitation exercises are a staple of injury recovery, however we’re all guilty of letting them fall by the wayside from time to time. This blog will show you the many interesting ways in which your exercises are effective, hopefully inspiring you to persevere with them! (And spoiler alert, its not all about strengthening weak muscles!).

1. Motor recruitment & coordination

Rehab exercises can rewire the brain maps responsible for controlling and recruiting certain muscles and patterns, improving the technique and efficiency of your movement. In early stage rehab, the use of external constraints can decrease the number of potential movement solutions – helping to offload painful areas and teach the body how to utilise pain-free movement patterns.

As you progress, the rehab should gradually increase the degrees of available motion to move from rigid movement to fluid and variable movement – more closely mimicking the requirements of a full and active life.

2. Cognitive restructuring

We often fear certain activities and movements as we believe they can make our injury worse. Frequent low load exercise can help to restructure our relationship with movement. By repeating safe movements we can change the way we think about exercise and physical activity, which allows us to do more of our necessary daily tasks and get back to our loved recreational activities.

3. Nociceptive desensitisation

Nociception is the process of nerves sending messages to the brain from a particular body part that something is harmful. The brain then processes and codes the nerve signal and can create a sensation of pain.

During injury these nociceptive nerves can become more sensitive, due to many factors including inflammation at the injured body part. Exercising the sore body part causes the brain to respond to this demand by acclimating to the sensation, thereby decreasing the body’s pain response to the particular stimuli. The body gets used to the stimulus and it therefore becomes tolerable, no longer eliciting the pain response.

4. Descending pain inhibition

This phenomena is similar to taking medications that are designed to decrease pain, like panadol. Exercise causes nerves and chemicals to be stimulated that have a hypoalgesic effect – meaning they directly dampen the sensation of pain.

5. Progressive strength

Although early rehabilitation isn’t focused on building strength, it sets the foundation for further exercise progression. A good rehabilitation program should always be progressing towards a higher goal. As the aforementioned characteristics are achieved, the exercise prescription should increase its intensity – either by increasing load/weight, increasing volume, decreasing rest periods, or progressing to a more challenging movement.


Rehabilitation exercises are not just mundane routines, but powerful tools that facilitate a holistic recovery journey. They serve as more than just a means to strengthen weak muscles; they actively engage the brain, reshape our perceptions, and recalibrate our pain responses. Through consistent practice, we not only rehabilitate our bodies but also transform our relationship with movement and pain. Embracing these exercises not only aids in physical recovery but empowers us mentally, allowing us to reclaim our lives, one pain-free step at a time. So, let these insights inspire you to persevere with your exercises, for they are not just a path to recovery, but a gateway to a stronger, more resilient you.

Pins and Needles?

Why do I have tingling in my hands?

Hand numbness can be caused by damage, irritation, or compression of one of the nerves or a branch of one of the nerves in your arm and wrist.

Diseases affecting the peripheral nerves, such as diabetes, also can cause numbness, although with diabetes, similar symptoms usually occur first in your feet.

Uncommonly, numbness may be caused by problems in your brain or spinal cord, although in such cases arm or hand weakness or loss of function also occurs.

‘Pins and needles’ (paresthesia) is a sensation of uncomfortable tingling, prickling, itching or skin crawling, usually felt in the hands or feet. The affected area is sometimes said to have ‘fallen asleep’.

A common cause of pins and needles is leaning or lying awkwardly on an arm or leg, which either presses against the nerves or reduces the blood supply to the local area. Changing position usually quickly restores normal feeling as the nerves start sending messages to the brain and spinal cord again.

Symptoms of pins and needles

Common features of pins and needles include:

  • prickling and tingling sensation
  • numbness
  • return of normal feeling a few minutes after changing position.

Hands, arms, legs and feet are the parts of the body most commonly affected.

Pressure-related pins and needles
The nerves of the body send information back to the brain and spinal cord. When a sensory nerve is pressed by being in a cramped or awkward position the messages are interrupted, which can cause pins and needles.

Once pressure is taken off the nerve, functioning resumes. An uncomfortable prickling sensation is caused by the restarting of pain messages from nerves to the brain. This usually resolves within minutes. An example of this is when you hit your elbow and feel a tingling sensation in your little finger.

Pinched nerves and pins and needles

Nerves can be compressed or ‘pinched’ by bones and other tissue. Some examples include:

Carpal tunnel syndrome – the main nerve that services the hand runs through a ring of wrist bones. Inflamed and swollen tendon membranes reduce the amount of room inside the wrist and irritate or compress the nerve. Symptoms include pins and needles, pain and weakness in the hand.

Cervical nerve root irritation – nerves in the neck exit the spinal cord via small holes between the vertebrae. These small holes can be narrowed by inflammation, injury or outgrowths of bone tissue (bone spurs). The nerves are irritated or compressed, causing pins and needles and, sometimes, referred pain into the arms

Sciatica – the legs and feet are serviced by the sciatic nerve, which starts between the vertebrae of the lower back. This nerve can be irritated or compressed due to problems in the lower back or pelvic or buttock area causing pins and needles, and sometimes pain, down the legs.

When to seek medical advice for pins and needles

The occasional bout of pins and needles is a harmless event. However, chronic pins and needles can be a warning of some other underlying disorder.

Always see your doctor if you experience frequent or persistent bouts of pins and needles.

Treatment for pins and needles

Treatment depends on the cause. For example, carpal tunnel syndrome may be treated with rest, splinting and medications such as anti-inflammatory and diuretic medications.

A compressed or irritated nerve may require treatment such as osteopathy, medication or (in some cases) surgery to ease the pressure and allow full nerve functioning to resume.



Fun facts:

• 81% of girls and 78% of boys aged 15 years or over complete sport or physical activity at least once a week.
• 65% and 59% of girls and boys participate 3 times a week.
• 42% of children under the age 15 are involved in some form of organised sport at least once a week outside of school hours.
• The most common demographic for ACL rupture is 15 year old girls.

With rising participation of kids and adolescents in organised sports it is no surprise that the number of injuries we are seeing in this population is also on the rise. If you’ve ever been involved with children you would know that most kids are far more bendy and flexible than the average adult – This is largely to allow us to grow and develop. Through our youth years we have growth plates all over our body that on average aren’t fully fused until we are about 15 years of age – once these growth plates have fused we are considered skeletally mature and growing ceases.

As little ones grow and develop interests in organised sports they are predisposed to a few common injuries – some of these are related to growth spurts and the non-fusing of growth plates at this age however a large number of injuries can be contributed to factors such as:
• Reduced muscle strength
• Lack of/ poor coordination
• Posture/Reduced trunk control
• Poor balance

Injuries can have long term effects, physically and psychologically, and often lead to drop out of sports – however a well planned and executed prevention program may reduce the chance of injuries such as ACL tears, ankle sprain and lower leg tendinopathies by up to 50% in youth!

Neuromuscular training, which can be defined as general and sport-specific strength and conditioning activities and exercises that aim to enhance health and skill related physical fitness components, has been shown to assist in reducing lower limb injuries – particularly in court based sports such as football, basketball, soccer and netball. Like our skeleton/bones our brains are developing and creating new pathways at a rapid rate when we are young, therefore repeated exposure to skill specific training at a young age can have long-standing and positive effects on prevention of injury.

Neuromuscular training provides best outcomes when completed both pre and during season 3 times weekly – Neuromuscular training can be incorporated into warm up for 15-20 minutes of a training session or pre game.

An example of this for ACL prevention may include:
• 2 x 10-12 each leg alternating lunges
• 2 x 6-8 sets of Nordic hamstring curls
• 2 x 10 – 12 reps of calf/heel raises
• 2 x 5 double leg broad base jumps
• 2 x 5 each leg single leg distance hops
• 2 x 5 each leg zig zag hops

It is important to note that for injury prevention to be effective proper biomechanics and optimal form should be taught and closely monitored during a session.

Start your kids with injury prevention habits today to help keep our young ones healthy and active into their adult lives.

Advice in this blog is general only and for more specific advice you should also consult your health professional and/or coach!

Overuse injury – The what, why’s and how’s answered.

What is an overuse injury?

An overuse injury, sometimes referred to as a chronic injury, refers to an injury that is associated with repeated stress or micro-trauma over time. Unlike an acute injury, such as an ankle sprain, over use injuries typically have no specific incident that caused the pain, rather it will typically gradually worsen with activity with a steady increase in pain. Common overuse injuries include tendinopathies, bursitis, stress fractures/bone stress and shin splints.

It is common to see overuse injuries in the athletic population however they can be seen in all population groups – whether your 10 years old starting netball for the first time, 37 and trying to return to a loved past time or 71 and wanting to start walking more, you must know your limits. Overuse injuries are often related to activities that require repetitive stimulus such as long distance running, swimming, occupation demands such as typing and computer mouse use.

What causes an overuse injury?

An overuse injury will occur for a number of reasons and is related to a break down of tissue structure when the load input exceeds the tolerable level for that specific tissue. Common causes of overuse injuries can include:
• A sudden and/or significant increased load; including but not limited to increased intensity of training, increased hours of training, increased frequency of training
• A change to training conditions; including but not limited to addition of hills, change of footwear, change of training surface
• Return to activity after period of inactivity – e.g. start of sporting season return to walking after surgery etc.
• Inadequate rest periods – leads to increased muscle fatigue and therefore increase load/reliance on tendons, bones and other structures.

How to prevent an overuse injury?

Given that the biggest and arguably only cause of an overuse injury is overload it goes without saying that the best chance at preventing an overuse injury is to follow a progressive loading program and avoid going in too hard too soon.

When starting a new exercise routine or looking at increasing your current training regime it is crucial to have a graded and steady increase. This may look like short periods of work in combination with periods of rest when starting running/walking/swimming or other exercise routines. Ensuring you take regular rest days in the early stages of beginning an exercise routine to allow for adequate muscle recovery is another vital key in reducing your risk of overuse and injury.

If you are an avid exercise goer and looking to increase or alter your current regime following the guidelines of progressive overload will limit placing too much demand on your body systems too soon. Progressive overload can be applied by changes to duration/intensity, frequency, exercise technique/execution or external load – in any of these cases an incremental increase of no more than 10% is advised to reduce the risk of overload and injury.

In the case of overuse injuries in day to day life or with work place demands consideration may given to desk ergonomics and/or technique of repeated movements to attempt to reduce strain on specific body parts that may be at risk over overuse.

How to treat an overuse injury?

Unfortunately due to the slow progression and repeated micro trauma of overuse injuries it is often too late for preventative measures by time your pain develops. If you develop pain that you believe may be an overuse injury it is important to seek medical advice to ensure you receive advise specific to your injury and needs.

When visiting your healthcare provider (Osteopath or Myotherpaist etc.) you can expect your practitioner to assess your tolerance to specific loads and determine a management plan to get you back on your way to achieving your goals. Things that may be considered in your long-term management may include:

• Resting without or without the use of a brace or aid if severely intolerant to load.
• Reducing provocative loads and activity – this may look like a 50% decrease in kms walked/run, or reducing frequency of sessions in the gym
• Limiting spring like loads such as jumping that place a large load through injured areas
• Implementing a exercise/rehab regime specific to your goals.

It is important to note that in all cases of overuse injury LOADING with exercise is essential for long-term recovery and prevention of re-injury. An exercise regime tailored to you is likely to include the following:

• Isometric exercises – those that involve holding a sustained position for an allocated time frame e/g. wall sits/planks etc.
• Isotonic exercise – those that involve moving a body part through its range of motions with or without external forces/load
• Plyometric/return to play – If your goals require you to return to sports/high levels of exercise your program will progress to a sports specific return to play plan
that will involve explosive efforts

glute bridge demo

In all cases you can expect a program to progress through different stages in line with what you are hoping to achieve and usually takes between 6-12 months for adaptations to occur – Rest assured this does not mean your pain will persist for this period of time!

In conjunction with a loading program your practitioner will work with you to reduce and manage your pain. This may be done through the use of braces/taping, manual therapy (such as soft tissue massage), Ice, Dry needling and/or anti-inflammatory medications.

When indicated your practitioner will also work to find underlying bio-mechanical imbalances or deficiencies in surrounding areas and guide you with the steps required to address these also – This may include looking at your hip when dealing with an Achilles (lower leg) tendinopathies.

Please note that this advice is generalised and we encourage you to seek further advice if you think you may have an overuse injury – For more specific advise or to get started on your journey to recovery from an overuse injury book an appointment with one of our qualified practitioners today!
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Tennis Elbow – in the non-tennis playing individual!
Tame Your Achilles Tendon Pain!