Sports Injuries

For individuals into sports, fitness enthusiasts, and those that engage in physical activities, musculoskeletal injuries are common. Can using ice tape help during the initial or acute phase of injury decrease inflammation and swelling to expedite recovery and return to activities sooner?

Ice Tape

After a musculoskeletal injury, individuals are recommended to follow the R.I.C.E. method to help reduce swelling and inflammation.  R.I.C.E. is the acronym for Rest, Ice, Compression, and Elevation. (Michigan Medicine. University of Michigan. 2023) The cold helps to decrease pain, lower tissue temperature, and decrease swelling around the site of the injury. By controlling the inflammation with ice and compression early after injury, individuals can maintain the appropriate range of motion and mobility around the injured body part. (Jon E. Block. 2010) There are different ways to apply ice to an injury.

• Store-bought ice bags and cold packs.
• Soaking the injured body part in a cold whirlpool or tub.
• Making reusable ice packs.
• A compression bandage can be used together with the ice.

Ice Tape is a compression bandage that provides cold therapy all at once. After an injury, applying it can help decrease the pain and swelling during the acute inflammatory phase of healing. (Matthew J. Kraeutler et al., 2015)

How The Tape Works

The tape is a flexible bandage that is infused with therapeutic cooling gel. When applied to an injured body part and exposed to air, the gel activates, generating a cold sensation around the area. The therapeutic medicinal effect can last five to six hours. Combined with a flexible bandage, it provides ice therapy and compression. The ice tape can be used straight out of the package but can also be stored in the refrigerator to increase the cold effect. Depending on the maker's instructions, the tape should not be stored in the freezer as this can make it too hard to wrap around the injured area.

Advantages

The benefits include the following:

Easy to Use

• The product is easy to use.
• Take out the tape, and start wrapping it around the injured body part.

Fasteners Not Required

• The wrap sticks to itself, so the tape stays in place without using clips or fasteners.

Easy to Cut

• The standard roll is 48 inches long by 2 inches wide.
• Most injuries require enough to wrap around the injured area.
• Scissors cut the exact amount needed, and store the rest in the resealable bag.

Reusable

• After 15 to 20 minutes of application, the product can be easily removed, rolled up, stored in the bag, and used again.
• The tape can be used multiple times.
• The tape begins to lose its cooling quality after several uses.

Portable

• The tape does not need to be placed in a cooler when traveling.
• It is easily portable and perfect for a quick ice and compression application immediately after an injury.
• It can decrease pain and inflammation and kept at the workplace.

Disadvantages

A few disadvantages include the following:

Chemical Odor

• The gel on the flexible wrap can have a medicine odor.
• It is not quite as powerful smelling as pain creams, but the chemical odor could bother some individuals.

Might Not Be Cold Enough

• The tape works for immediate pain relief and inflammation, but it may not get cold enough for the user when applied right from the package at room temperature.
• However, it can be placed in a refrigerator to increase the coldness and may provide a more therapeutic cooling effect, especially for those dealing with tendinitis or bursitis.

Stickiness Could Be Distracting

• The tape could be a bit sticky for some.
• This sticky factor can be a minor annoyance.
• However, it just feels sticky when being applied.
• A couple of flecks of the gel may get left behind when removed.
• The ice tape can also stick to clothing.

For individuals looking for a quick, on-the-go cooling therapy for injured or aching body parts, ice tape may be an option. It could be good to have on hand to provide cooling compression if a minor injury occurs while participating in athletics or physical activities and relief for overuse or repetitive strain injuries.

Treating Ankle Sprains

General Disclaimer *

The information herein is not intended to replace a one-on-one relationship with a qualified healthcare professional or licensed physician and is not medical advice. We encourage you to make healthcare decisions based on your research and partnership with a qualified healthcare professional. Our information scope is limited to chiropractic, musculoskeletal, physical medicines, wellness, sensitive health issues, functional medicine articles, topics, and discussions. We provide and present clinical collaboration with specialists from various disciplines. Each specialist is governed by their professional scope of practice and their jurisdiction of licensure. We use functional health & wellness protocols to treat and support care for the injuries or disorders of the musculoskeletal system. Our videos, posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate to and directly or indirectly support our clinical scope of practice.* Our office has reasonably attempted to provide supportive citations and identified the relevant research studies or studies supporting our posts. We provide copies of supporting research studies available to regulatory boards and the public upon request.

We understand that we cover matters that require an additional explanation of how it may assist in a particular care plan or treatment protocol; therefore, to discuss the subject matter above further, please contact Dr. Alex Jimenez or contact us at 915-850-0900.

Dr. Alex Jimenez DC, MSACP, CCST, IFMCP*, CIFM*, ATN*

email: coach@elpasofunctionalmedicine.com

Licensed in: Texas & New Mexico*

References

Michigan Medicine. University of Michigan. Rest, Ice, Compression, and Elevation (RICE).

Block J. E. (2010). Cold and compression in the management of musculoskeletal injuries and orthopedic operative procedures: a narrative review. Open access journal of sports medicine, 1, 105–113. https://doi.org/10.2147/oajsm.s11102

Kraeutler, M. J., Reynolds, K. A., Long, C., & McCarty, E. C. (2015). Compressive cryotherapy versus ice-a prospective, randomized study on postoperative pain in patients undergoing arthroscopic rotator cuff repair or subacromial decompression. Journal of shoulder and elbow surgery, 24(6), 854–859. https://doi.org/10.1016/j.jse.2015.02.004

Chiropractor, Dr. Alexander Jimenez looks the anatomy and physiology Morton’s neuroma, and reviews evidence-based clinical examination tools and management techniques.

A Morton’s neuroma is an enlargement of the nerve branches of the intermetatarsal spaces of the forefoot. The nerve between the third and fourth metatarsal bones (80-85%) are commonly affected and less commonly is the nerve between the second and third metatarsal bones (10-15%) (see Figure 1)(1).

Importantly however, since no nerve damage has been sustained, a Morton’s neuroma doesn’t present as a typical neuroma. Therefore, more appropriate terms such as ‘intermetatarsal nerve entrapment’ or ‘Morton’s entrapment’ may be more suitable as the nerve becomes compressed between the metatarsal heads of the forefoot(2). However, while the term ‘entrapment’ should be acknowledged, Morton’s neuroma will be the term used here as this is the term used in the literature.

Morton’s Neuroma is a condition, which is diagnosed more frequently in females, and although the incidence rate is higher in the 40-50-year-old age group, those in their teens and twenties can also be affected(3). A Morton’s neuroma is often diagnosed in athletes that wear tight fitting footwear or in those who place high loads on the feet such as in ballet dancers or runners(4). In particular, runners who have increased extension of the third metatarsophalangeal joint relative to the fourth metatarsophalangeal joint have an increased incidence of Morton’s Neuroma(4). Although the precise causes of Morton’s neuroma are unclear, most expert authorities agree that repetitive trauma to the plantar digital nerve (positioned between the transverse intermetatarsal ligament and the surrounding fascia) during physical load is likely to be a key factor.

Signs & Symptoms

It is essential to be aware of the clinical signs and symptoms that patients may describe during a subjective examination. These may include a dull or sharp pain, numbness or tingling, burning sensation, cramping, or walking with the feeling of ‘a stone in the shoe’(1). Walking and wearing tight-fitting shoes may exacerbate the symptoms, whereas the removal of footwear together with rest and massage is likely to alleviate the symptoms(4). It is important to recognise that a patient may describe different pain presentations throughout the day. Following compression (perhaps from tight fitting footwear or following heavy loading) pain may be intense for five to ten minutes, followed by a dull ache for two to three hours(5).

Assessment & Diagnosis

A Morton’s neuroma can be clinically assessed through a variety of tests. Researchers from the University Hospital of Leicester have studied the sensitivity and accuracy of different clinical tests used for diagnosing a Morton’s neuroma(6). (The ‘sensitivity’ of a test can be explained as the proportion of people who test positive for a condition among those who actually have the condition.)

The tests (see Figure 2 and Table 1) included:

• The thumb/index finger squeeze (96% sensitivity, 96% accuracy)
• Mulder’s click (61% sensitivity, 62% accuracy)
• Foot squeeze (41% sensitivity, 41% accuracy)
• Plantar percussion (37% sensitivity, 36% accuracy)
• Dorsal percussion (33% sensitivity, 26% accuracy)
• Light touch and pin prick (26% sensitivity, 25% accuracy)

Of note however is that while the thumb index finger squeeze test was more sensitive in diagnosing a typical Morton’s Neuroma, the Mulders click test was a significantly more effective test in diagnosing the larger neuromas.

A Morton’s neuroma can be diagnosed using either an ultrasound or an MRI (magnetic resonance imaging) scan. A systematic review and meta-analysis carried out by two researchers from the University of Genoa selected 14 studies (from 277 identified articles) that measured the diagnostic accuracy of a Morton’s neuroma(7). No significant difference between diagnostic ultrasound and MRI was found to exist in the accuracy of diagnosing such a lesion. It could be argued however that an MRI is more sensitive at identifying other disorders that ultrasound is unable to identify (such as those outlined in Box 1). Merve et al did however establish that the specificity for MRI was lower for Morton’s neuroma (68%) compared to ultrasound (88%)(1). Specificity can be defined as the amount to which a diagnostic test is specific for a particular condition.

Non-Surgical Management

All non-surgical means should be explored before more invasive techniques are used to manage this condition. It is well known that a metatarsal pad can be used to offload the intermetatarsal space during loading(8). In addition, high-heeled shoes should be avoided as well shoes with a thin sole also as they may increase compression forces in the region of the bottom of the foot. If a foot pad is not effective after three months of use the current NICE (National Institute for Clinical Excellence) guidelines recommend referral to an orthotist to prescribe custom made orthotics(8). If footwear modification and orthotics are ineffective then referral to a consultant with a special interest in the foot is justified.

Surgical Management

It is commonly aired view within the scientific literature that conservative means for treatment of Morton’s neuroma are ineffective, and that steroid injection or surgical excision are more effective – or indeed, the only solution. To test this, researchers randomly assigned eighty two patients who had been diagnosed with Morton’s neuroma to either a footwear modification (with orthotics) only group, or footwear modification with a steroid injection at the initial assessment(10).

NB: The first three tests of this study are detailed in Table 1 due to their higher sensitivity and accuracy.

Overall, there was a significant difference between the two groups at three, six and twelve months follow up, with the patients receiving footwear modification plus steroid injection being more satisfied. At the 12-month review, 83% of patients who received a steroid injection were either pain free or had had relief of pain. This is in contrast to 63% of patients who had orthotics with footwear modification. However, when the results obtained for twelve months were analysed in depth, they weren’t statistically significant to those obtained in the footwear modification only group.

Barratt and colleagues have suggested that although steroid injections may provide temporary relief, their long term effectiveness is questionable(2). The damage to the surrounding fatty tissue and the plantar plate (a thickened ligament that functions to prevent the toes from hyper- extending) is possible over the long term. In addition, alcohol injection techniques should be avoided to prevent damage to neural and surrounding tissues, and have been shown to have poor long term results.

A variety of surgical techniques have been described for treating this condition such as excision of the neuroma or intermetatarsal ligament release(5). To excise the lesion, an incision can be made either on the top or the sole of the foot, each presenting with varying complications(5). One complication with an approach from the bottom of the foot is the formation of scar tissue, which may be painful when subjected to pressure. A further restriction is that weight bearing is limited for two weeks, whereas an incision from the top of the foot allows for early weight bearing(3).

A normal recovery protocol following surgery on the top of the foot, is two weeks in a post-operative shoe, with removal of stitches after two weeks. After three to four weeks a patient can transfer into a normal shoe and then resume sport within four to six weeks(5). An incision from the bottom of the foot however requires the stitches to remain in for an extra two weeks, and therefore extends the recovery protocol.

Despite the potential for a number of complications following surgery for excision of a Morton’s Neuroma, studies suggest that 80-96% of patients report they are satisfied with the overall outcome(5). Some of the complications that did occur arose from the formation of keloid scarring (2.2%), which presents as hard or rubbery areas raised above the level of the skin surface, which may be shiny and hairless. A keloid scar can be painful or itchy and sometimes doesn’t present until months after surgery. Furthermore, it may restrict movement at a joint. It is also reported that more than 30% of cases reported numbness in the relevant toes and present with a positive Tinels sign(11). In addition, there is a risk of wound infection as reported by 1.1% of cases(5). Moreover, there is a risk of recurring formation of the neuroma, and patients should be informed of this.

Summary

In summary, while the results for a Morton’s neuroma are promising following surgery, in the opinion of this author, it is the role of the physiotherapist or sports therapist to effectively treat by exploring all conservative options before referring for surgery. If surgery is indicated, it is recommended to maintain overall body conditioning through non-load bearing exercises during the rehabilitation period.

References
1. Pain Phys, 2016, Feb, 19: E355-E357.
2. http://www.aens.us/images/aens/ AENSGuidelinesFinal 12082014.pdf
3. Ochsner Journal, 2016, 16, 471–474.
4. Int J of Clini Med, 2013, 4, 19-24.
5. http://www.aofas.org/PRC/conditions/ Pages/Conditions/Mortons-Neuroma.aspx
6. The J of Foot and Ankle Surg, Aug, 2015, 54, 4, 549–553.
7. Euro Radi, August, 2015, 25, 8, 2254–2262.
8. https://cks.nice.org.uk/mortonsneuroma#!scenariorecommendation
9. Man Thera, 2016, 21, 307 – 310.
10. Am Ortho Foot and Ankle Soc, July, 2005, 26, 7, 556-559.
11. ACO, July, 2002, 10, 1, 45-50.

Kinesio taping method is a therapeutic technique that offers an approach of supporting the individual and rehabilitating the condition or affected area. Kinesio tape can stimulate or relax muscles, depending on the technique and type of tension that is put on the body. It raises the skin in microscopic increments that aid in lymphatic drainage.

It decreases inflammation and swelling reducing pressure in the area, allowing the blood and lymphatic fluid to flow naturally and more effectively in and out of the affected area.

Kinesio Tape:

• Reduces inflammation
• Promotes better circulation
• Prevents injury
• Facilitates healing
• Re-educates the neuromuscular system.

This helps the body return to homeostasis. It can be applied in a variety of different configurations, but usually, applications are single:

• I
• Y
• X 

Kinesio Taping

There are unique taping shapes specialized to address certain areas of the body and conditions. Providing stability and support for the body’s joints and muscles, it does not restrict the body's range of motion. The technique\s are designed to address soft tissue injury/s by manipulating the area and promoting natural healing, alleviating pain, reducing swelling, and providing all-around relief.

Kinesio Taping can Treat

A variety of conditions benefit from Kinesio taping. Chiropractors and physical therapists use it for:

• Ankle sprains
• Back strain
• Carpal tunnel syndrome
• Herniated disc
• Lower back strain
• Patella tracking
• Plantar fasciitis
• Pregnancy
• Pre-surgery edema
• Post-surgery edema
• Rotator cuff injury
• Tennis elbow
• Whiplash

Athletes use it for additional support and injury prevention.

Taping and Chiropractic

The tape uses the body’s own natural healing process with many individuals finding it, as the preferred treatment for many conditions. When combined with chiropractic care, Kinesio Taping is highly effective. A chiropractor may use a variety of techniques, depending on the condition or injury.

They can use spinal manipulation, physical therapy, massage, electrical stimulation, ultrasound, heat, and ice, combining them with recommendations for lifestyle and diet modifications. As aforementioned it encourages the body to heal itself, thus eliminating the need for medication/s  their undesired and invasive surgery. Kinesio Taping is safe, natural, and a perfect complement to chiropractic treatment.

Foot Levelers Orthotics Reduce Low Back Pain