An Orthopedic Surgeon’s Solution for Treating Soft-Tissue Injuries

About the author: Dr. Riley J. Williams III, MD is an orthopedic surgeon, academic, and clinician-scientist specializing in the field of shoulder, knee, and elbow surgery.  Since 1993, Dr. Williams has been affiliated with the Hospital for Special Surgery (“HSS”), the #1 rated Orthopedic Surgery Hospital according to U.S. News and World Report, where he is also Director of the HSS Cartilage Institute.  Dr. Williams is inventor of Therma1™ and Chief Medical Officer, Head of Product Development, and Chairman of the Board of Directors of R2T2 Laboratories Inc., the company that markets Therma1™.  Dr. Williams graduated from Yale College and Stanford Medical School, where he won top medical science research awards.  Dr. Williams is team physician for the Brooklyn Nets and NY Red Bulls, and he has been associated with professional football and baseball teams.

The Science Behind Using Hot/Cold Therapy, Compression and Massage to Heal Soft-Tissue Injuries

I am an orthopedic surgeon, sports medicine physician, advisor to elite athletes, and pro sports team doctor.  I’m also a scientist.  When I invented Therma1, I based it on the science of recovery.

It is well documented that cold therapy or compression reduces inflammatory response. Recent studies indicate that soft-tissue compression combined with local temperature alterations demonstrate significant enhancement in the healing potential of soft-tissue injuries.

It is also well known that heat therapy or compression/massage increase tissue compliance.  Studies show that controlled increases in thermal temperature have a significant effect on the tensile properties of skeletal muscle, which results in increased joint range of motion and reduced muscle tension that help reduce potential muscle strain injuries.  Other studies demonstrate that warm and more compliant muscles absorb more energy than non-stimulated muscle tissue, which results in improved resistance to biomechanical load. 

The Need for a Unique New Therapy Device Turns into an Invention

My observations of scientific evidence, decades of sports medicine experience including thousands of patients and surgeries, and dialogues with sports therapy experts such as pro sports athletic trainers, physical therapists, and chiropractors, led to the invention of the Therma1™ Hot Cold Roller.  The goal of the design was to provide all four critical musculoskeletal therapy treatment modalities (heat, cold, compression and massage) in one portable, easy-to-use device – something that no other product on the market offered.  The U.S. Patent Office recognized Therma1™’s innovative and unique qualities and granted a design patent last year.

The Therma1’s size and shape was designed specifically to make it easier to treat hard to reach spots, as well as help pinpoint trouble spots and deliver trigger point therapy. In my experience, there was a lack of products on the market with this ability.

What Makes the Therma1 Hot Cold Roller Different from...

Massagers or foam rollers?  Its ability to deliver heat and cold therapy

Ice packs and heat pads? Its ability to deliver rolling compression and massage

Continuous-flow cold therapy machines? The dynamic nature of Therma1™ Hot Cold Roller treatment modality makes the likelihood of thermal injury very low.

How to Use Therma1 in a Sports Medicine Setting

• As a natural Performance Enhancement Device (PED) – Use Therma1 before activity to increase tissue compliance.
• To treat nagging injuries, such as:
  • Patellar tendonitis
  • Calf strain
  • Shin splints
  • IT Band syndrome
  • Strains in the forearms, biceps, triceps and neck area
  • Quad and hamstring strains

Therma1™ should be used in regiments of two – ten minutes, usually in combination with static therapy.  The treatment regiments should be repeated throughout the day as desired. 

View videos that demonstrate the Therma1 in action >>

How Therma1 Benefits Athletic Trainers

• Increases patient compliance (one of the leading drags on patient recovery time is noncompliance with prescribed therapies).
• Patients can use it on themselves or athletic trainers can roll the player (patients don’t need to contort the body to apply therapy like other rollers)
• You never have to worry about frostbite or heat burns
• Non-toxic, simply rinse spills if they get on skin

Tips for Buying Therma1 Products:

Therma1™ comes in Recharge and Instant models.

Therma1™ Recharge – Comes with two rollers. The rollers can be placed in the freezer or microwave.

Therma1™ Instant - Provides portability and convenience with its Instant Hot and Cold packs.  Each Therma1™ Instant model comes with one Recharge Roller, one Instant Roller, and a dozen Instant packs. The Instant Roller has a removable end-cap that accommodates a Therma1™ Instant Hot or Cold pack.

When using Therma1 for cold therapy, keep the following in mind:

Therma1™ Recharge (freezer) achieves colder temperatures than Therma1™ Instant (cold pack).  When left in a typical freezer overnight, Therma1™ Recharge reaches sub 10 degree temperatures and holds a sub twenty degree temperature for approximately twenty minutes with recommended intermittent use (two – ten minute increments, followed by two minute “rest”).  For best results when treating acute injuries, use the Therma1™ Recharge when possible. 

If you do not have a Therma1™ Recharge handy, Therma1™ Instant with Therma1™ cold packs can be used to decrease local tissue temperatures; studies show decreases in local tissue temperatures stimulate an effective anti-inflammatory response.  However, I recommend Instant Cold packs be used only when a cold Recharge Roller is not available.

Learn more about purchasing the Therma1 Thermal Therapy Device and Watch Demonstration Videos >>

Remedies for Shin Splints

Shin Splints- an Athletic Trainer’s Perspective

Shin splints is a "syndrome" or "collect-all" term
for a variety of aches and injuries in the lower leg region. Some estimates put it as high as 31 conditions. While it is true that shin splint injuries occur mostly to athletes and those who often run or walk long distances, in my career I have seen the injury occur in football lineman and baseball center fielders that do not necessarily run long distances. I have also heard that changing surfaces, i.e. soccer players going into basketball season, may precipitate the muscle inflammation we call shin splints. But I wonder, if that is the case, why then doesn’t every one of my soccer athletes turned basketball athletes get them? Obviously there must be something different about different athletes.
I have found two predominant conditions that often lead to shin splints: foot/gait patterns of over pronation and tight heel cord muscles. With ankle over pronation (rolling inward), the entire structure from ankle to hip/low back operates at a less than peak efficiency. When muscles chronically work at less than their optimum angle, stress (inflammation) occurs. Secondly, heel cord muscles (gastrocnemius or the calf and the soleus muscle) are critical to smooth propulsion in the walking and running cycle. Calf tightness causes premature heel raising which redistributes body weight along the bottom of the foot and alters muscle contraction timing. Any change that alters what the body perceives as its optimum performance range (which is a floating definition based upon age, genetics, level of conditioning, etc.) will result in breakdown or at the least inflammation and pain.

Since shin splints may represent a variety of ailments, there are likewise a variety of ways to treat the injury. Remember the adage "everything in moderation" so ease into any changes in your exercise routine and as always when it doubt, see a professional.

Remedies for Shin Splints

Rest
Working though the discomfort must be tempered with common sense. "It hurts when I do this", then "don’t do that!"

Ice
Ice has an inflammation reducing capability. Remember that muscles that are angry with you with become inflamed. Inflammation causes pain, which causes inflammation, which causes pain...you get the idea.

Wrap
Sore muscles supported with elastic wraps, tape or neoprene sleeves often feel better. These products can hold in body heat which has relaxing (increased blood flow) results for sore muscles due to greater oxygen delivery.

Medication
The age of the athlete in front of me determines what I say about the use of aspirin or ibuprofen. Typically state laws prohibit medication dispensing in high schools and aspirin is not advised for children. Adolescents must be told "whatever your parents want to give you" while college and professional athletes can make their own decision but should be reminded not to overdo it in an attempt to mask the discomfort.

Foot-shoe Interface
In the case of an overpronator, arch supports may produce some relief, if not, prescription orthotics may be needed. For some it may be as simple as checking the insole in the shoe. Through wear, age and sweat the softness afforded by the insole may become compromised and is resulting in excessive force being transmitted up through the foot-ankle-shin.

Alternative Activities
Use cross training whenever possible to focus on different muscles, different distances and different intensities in order to "rest" the sore shins. Swimming and bicycling are good sore shin alternatives. Take this time to focus on your core strength and overall flexibility.

Warm Up & Cool Down
General warm up involves overall blood flow increase while specific warm up mirrors the demands of the activity. Dynamic warm up is a blending of these two by large muscles movements related to the activity. Warm muscles move better and are less likely to be injured. When you are done, do some simple large muscle movements on your way over to pick up the ice bag for your sore shins.

Stretching
Stretching with both straight and bent knees for 30 seconds each several times a day alleviates many cases of sore shins. Since the calf muscle does most of our propulsion and is more powerful than the shin, it usually wins the "argument". Once they get short and tight, the shin muscles are forced to function at a slightly altered angle and they do not like it...thus the pain.

More Athletic Trainer Perspectives on Shin Splints:

Here’s what other athletic trainers have to say:

• Kent Scriber, ATC Ithaca College, Ithaca, NY: Aside from the traditional care (rest, ice, stretching, and gradual return to participation), I have found that providing some sort of arch support is helpful. It seems most of these lower leg problems are triggered by some sort of biomechanical issue. Therefore taping, providing a foam or felt pad, or a more permanent orthotic often alleviates symptoms.
• Jennifer Wuyscik MS, ATC, LAT and John Geist, ATC, LAT, Knoch HS, UPMC Sports Medicine, Saxonburg, PA:
  • Jennifer: Like Maria Hutsick, I have also had several athletes, predominantly female soccer players, who have had chronic exertional compartment syndrome, which can in its beginning stages mimic shin splints. Since presenting a case study at NATA in 2010 on this topic, I have had 2 additional female soccer players and 1 male soccer player with this condition. Two of the three have had to have surgery before the end of their high school careers to be able to continue playing.
  • John: My basic thought regarding "shin splint" pain is monitoring the pain during activity and the duration of the pain after activity. Does it go away after 3, 6, 9 hrs., etc..? or does the pain linger on into the next day’s workout? Any increase in pain or duration of pain would lead me to limit the athlete’s activity and/or refer them for further evaluation/x-rays. If the athlete’s pain dissipates within a short period of time after their workout or if the athlete can start their day with pain not being any worse than the day before, I am usually comfortable allowing that athlete to continue. I also (encourage) icing, stretching both (calf muscles), checking foot biomechanics, and adding arch supports, if needed. I will take my cleated athletes (primarily screw-ins) out of their cleats for a period of time and have them workout in (athletic flats.
• Maria Hutsick, ATC, Medfield High School, Medfield, Ma.: Another area to look at especially in female athletes is the issue of compartment syndrome. Many girls end up with chronic pain and numbness and tingling in the lower leg/foot region. Further investigation results in symptoms such as muscle hardness in the lower leg, pain after or during exercise, and the symptoms may progress. This is usually an issue that shows up in 10th or 11th grade. By the time they get to be freshman in college they may need surgery to continue playing.

More Professional Input

Mayo Clinic's Definition of Shin Splints 

Class Notes, chapter 19 from Westfield HS, Houston, TX 

East Brunswick HS, East Brunswick, NJ 

Products to Ease the Pain of Shin Splints

 For products to help care for shin splints, go to www.esportshealth.com and look at

• Calf and Shin
• Podiatry: Wraps, Supports, Padding
• Rehabilitation: Hot/Cold Therapy
• Tape & Wraps: Compression Wraps & Sleeves

Phil Hossler, ATC has been an athletic trainer on the scholastic, collegiate and Olympic levels. He has authored 4 books and numerous articles and served as an officer in state and regional athletic training associations for 20 years. He is a member of four halls of fame including the National Athletic Trainers’ Association’s.