Dr. Richard Honaker

Fire and Ice: Recovering from Racquetball Injuries

Are you confused about whether to use ice or heat for your racquetball injuries? Do you know how much to use and for how long? Let’s try to straighten this out. Injuries to soft tissues result in swelling. This swelling causes tissue damage by blocking oxygen delivery to cells and by the release of chemicals which cause further cell damage. Reducing this initial swelling is critical in order to improve your recovery time. This swelling, along with pain, encourages muscle atrophy and joint stiffness, further prolonging recovery. Here’s what you should do.

Application of cold decreases the initial swelling, bleeding, pain, and inflammation of the tissues. The damaging, imflammatory response and cellular injury from swelling is reduced by cold applications. Heat does just the opposite. It increases and encourages blood flow and reduces muscle spasm and joint stiffness. Heating tissues accelerates metabolism and improves the flow of lymphatic fluid and blood.

After an injury you should start with ice. Initially apply it constantly for one to two hours after the injury. Then use it 30 minutes per hour hour during the first 24 hours. An ice pack on top of wet towels is more effective than dry towels. Alternatively, you can use ice massage in slow, circular strokes for 10 to 20 minutes per hour. This is done by freezing a small paper cup of water and then peeling off the bottom of the cup so that the ice can be massaged like a roll-on deodorant.

During the second 24 hours, neither ice nor heat should be applied. This should be a time when you start gradual range of motion exercises to loosen stiff tissues and assess the degree of pain and discomfort. During the third 24 hours, you should resort to heat. Moist heat is best. You can use a hydrocollator pack or a moist towel insulated with plastic or Saran wrap and then covered with a heating pad. Heat should be applied for 30 minutes every hour or two. Whirlpool baths are a wonderful alternative.

When you return to play, it is a good idea to warm the area before playing. Use heat for 30-45 minutes before your match. Immediately after your match, apply ice for one hour. Do this the first couple of matches when you restart paying.

A final note about chronic and recurrent injuries. Residual and persistent joint stiffness, swelling, and discomfort is often best treated by “contrast therapy,” which is alternating cycles of hot and cold. Use hot applications first, followed by cold applications for 20 minutes each. Do this for two hours, twice daily as needed.

As with any injury, you should seek medical care from your physician to be sure your injury is only minor.

By Richard A. Honaker, MD, who had been an avid right-handed racquetball A player since medical school in the 70s, until two rotator cuff surgeries forced him to go southpaw, swinging like a never-ever while moving like an advanced player. His fitness and court sense came through, as he played his way back into his club’s top leage in one year. Dr. Honaker is a senior physician, former president of Family Medicine Associates of Texas, and co-founder of the Jefferson Physician Group, a prominent Primary Care IPA in Dallas, Texas.