University Health System Blog

Dr. Tony Chang answers the question: “Acute tendinitis pain: Should I apply ice or heat?”

Tendonitis is inflammation of a muscle tendon. Tendons lie at the ends of muscle and attach muscle to bone. If a tendon is inflamed, pain occurs with movement of the muscle or joint.

If tendinitis is an acute injury or the onset is less than 48 hours, applying ice to the injured area is a good choice for treatment.

Ice helps numb the injured area, reducing pain. It also constricts blood vessels (vasoconstriction), limiting blood supply to the injured site which may help decrease swelling. By reducing swelling, there are decreased levels of inflammatory substances that can reduce further tissue injury. Cold treatment can also decrease muscle spasm which may help the tendon healing process.

If an injury is in a more advanced stage of healing usually after four or five days heat treatment can be used.

Heat increases local blood supply (vasodilation), bringing healing cells to the area and potentially relaxing tight muscles. This increase in blood flow to an area of longer term injury is thought to promote healing.

If tendinitis is chronic in nature, there is no strong scientific evidence to support the use of either heat or ice for pain improvement.

However, applying heat to a long-term injury to promote blood flow before exercise and ice to the area to reduce swelling after exercise may be an effective strategy in treatment for chronic tendonitis. The focus of chronic injuries should be on eccentric rehabilitation exercises.

Of course, preventing injuries before they happen is best. Proper stretching and warm up before placing any physical demands on your body is the utmost of importance. Be in tune with your body and pay attention to what you body is telling you. Stop exercising if you start to feel pain.

Tony Chang, M.D. is a fellow of sports medicine at the University of Nevada School of Medicine in Reno. He sees patients at the University of Nevada, Reno Student Health Center, the Family Medicine Center and Nevada Athletics and spends time with community physicians in the care of athletes and individuals following exercise regimens.

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Dr. Tony Chang answers the question: “Are energy drinks with high caffeine amounts okay for athletes?”

In our sports world today, athletes may look for that extra edge—a way to boost energy, improve endurance, quicken reaction speed and counter drowsiness. Many athletes will consume energy drinks unaware of the health and legal hazards.

In 2003 the National Collegiate Athletic Association (NCAA) instituted a list of banned drug classes, including stimulants, anabolic agents and street drugs that are prohibited for use by NCAA athletes. Two common ingredients in energy drinks, taurine and guarana, were banned.

Caffeine is considered a restricted substance and not a banned substance.

The NCAA declared that athletes cannot have a caffeine concentration higher than 15 micrograms per milliliter (mcg/ml) in their body.

Doses of 3-6mg/kg, which do not produce urine concentrations that would result in disqualification, have been found to be ergogenic.

One cup of regular coffee contains 100mg of caffeine and a can of Red Bull contains 115mg of caffeine, while the equivalence in urine within two to three hours is 1.50 mgc/mL and 1.73 mgc/mL respectively.

In a healthy and average sized man, the NCAA limit may be reached by consuming five regular cups of coffee a few hours before drug testing. There may be variations of caffeine content in each product, as well as, metabolic differences unique to each athlete.

Therefore, the safest action is to avoid consuming caffeine-containing products during athletic events.

Energy drinks, which are often loaded with caffeine, sugar and herbal stimulants, may pose various health risks, including:

• The caffeine in energy drinks can increase blood pressure and heart rate.  It has the potential to trigger dangerous cardiac arrhythmias;
• The caffeine in energy drinks can cause irritability, restlessness and nervousness. Excessive caffeine is also associated with headaches, tremors, nausea and insomnia;
• The caffeine in energy drinks may also be linked to increased risk of dehydration during exercise, which can lead to hampered performance as well as heat illnesses; and
• The high sugar content in most energy drinks can contribute to undesired weight gain, and sugar high crashes.

In addition, excessive amounts of energy drinks have been associated with manic episodes, seizures, chest pain, heart attacks and sudden cardiac death.

I recommend against the consumption of high-caffeinated energy drinks prior to activity. Many of these drinks contain NCAA banned substances such as taurine and guarana.

I also do not recommend drinking more than two cups of coffee prior to activity based on the adverse effects of high caffeine as stated above.

Tony Chang, M.D. is a fellow of sports medicine at the University of Nevada School of Medicine in Reno. He sees patients at the University of Nevada, Reno Student Health Center, the Family Medicine Center and Nevada Athletics and spends time with community physicians in the care of athletes and individuals following exercise regimens.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Tony Chang answers the question: “Is heart rate a concern while exercising during pregnancy?”

The recommendation regarding the safety of exercise in pregnancy has evolved throughout the years. It has been a subject of debate for many years due to the lack of clinical research available and fear of litigation for poor recommendations.

In 2002 the American College of Obstetric and Gynecology guidelines addressed both recreational and competitive athletes for the first time. The new recommendations said that athletes without complicated pregnancies can remain active during pregnancy and should modify their routines as medically indicated and with medical supervision as needed.

A year later the Society of Obstetric and Gynecology of Canada in conjunction with the Canadian Society of Exercise Physiology issued guidelines stating women without contraindications in pregnancy should be encouraged to exercise without any limitation even on rate of heart beat.

The guideline for safe exercise only applies to normal, uncomplicated pregnancy. Keep in mind, however, that if you have a history of complicated pregnancy, exercise at high levels may not be healthy.

Pregnant women should not exercise if they have a history of premature labor, previous surgery on the cervix, significant heart disease, pregnancy induced high-blood pressure, or persistent vaginal bleeding during pregnancy.

It’s good to check with your doctor and limit high-intensity exercise if you have a history of severe anemia, poorly controlled high-blood pressure prior to pregnancy, history of seizure disorder, or history of thyroid disease.

At any time during your exercise training, you should stop if you feel dizzy, short of breath, have a headache, chest pain, noticed vaginal bleeding, decrease baby movement, or have amniotic fluid leakage.

See your doctor prior to restarting your exercise regimen

Tony Chang, M.D. is a fellow of sports medicine at the University of Nevada School of Medicine in Reno. He sees patients at the University of Nevada, Reno Student Health Center, the Family Medicine Center and Nevada Athletics and spends time with community physicians in the care of athletes and individuals following exercise regimens.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Scott Hall answers a question from Kate in Toledo, Ohio: “I’ve started running again after a few years off. Now I have lower hip pain. Is this common and should I stop running?”

Hip pain like this is common in runners. It’s often related to the hip flexor muscle group.

Adjusting activity is recommended by cross-training to allow the body to heal the problem.

Physical therapy is sometimes beneficial as well. If persistent, I recommend seeing a sports medicine specialist.

Scott Hall, M.D. is an assistant professor and director of sports medicine at University Health System and the University of Nevada School of Medicine Department of Family and Community Medicine in Reno. Dr. Hall is board-certified and holds a Certificate of Added Qualifications in Sports Medicine. He has served as a team physician for several professional and scholastic sports teams. He currently serves as team physician for Damonte Ranch High School in Reno.

Have a question? University Health System doctors answer select questions from readers like you.

Dr. Scott Hall answers the question: “When should I use a hot pack or cold pack to treat a sports injury?”

Generally cold packs should be used after an acute, or sudden, injury.

Cold acts to reduce pain and swelling. Good results are often seen when cold is applied directly over the injured area shortly after the occurrence. Ice is generally used, but there are other good substitutes, including frozen vegetables and cold packs.

One should remember not to apply the cold pack too long as frostbite may occur. I recommend keeping the pack on the injury 20 minutes on and then removal for 20 minutes before re-application.

Heat may be used after the acute injury to promote increased blood flow and decrease residual stiffness.  Individual comfort should guide the duration and intensity of heat.

Heat packs are commonly used and various types are available at pharmacies and shopping malls.

Scott Hall, M.D. is an assistant professor and director of sports medicine at the University of Nevada School of Medicine Department of Family and Community Medicine in Reno. Dr. Hall is board-certified and holds a Certificate of Added Qualifications in Sports Medicine. He has served as a team physician for several professional and scholastic sports teams. He currently serves as team physician for Damonte Ranch High School in Reno.

Have a question? University Health System doctors answer select questions from readers like you.