Heat or Ice or Both?

[Marie1479]

I just tapered and my shoulders are a bit sore. It usually lasts a 3-4 days. Both ice and heat feel good but which is really better?

[yogabonnie]

It is my understanding if you INJURED something it's ice for 48 hours then alternate heat and ice. So I think you can do whatever feels best! I'd probably go with both. and a little longer with the heat! I USED to take ICE BATHS!! when I ran and biked and now they say hot baths work just as well. WHAT???? so all that shivering for nothing...although it made me feel tough!

[Marie1479 in reply to yogabonnie]

Thank you so much for your quick reply. I can’t even imagine taking an ice bath!

[PMRpro Ambassador]

What suits you - I just stiffen up if I use ice.

[Soraya_PMR in reply to PMRpro]

Ditto.

[GOOD_GRIEF in reply to Soraya_PMR]

It might not work for others, but when something hurts I use a gel pack from the freezer, and when something is stiff I use a heating pad or patch.

To keep either in the spot I want them, I use Velcro strips, either wrapped around or stuck to old sweats. The patches, of course, go right on the skin and stay put most of the time.

[Marie1479]

I would actually like to know what PMR does to the muscle itself. What exactly makes the muscles stiff?

[PMRpro Ambassador in reply to Marie1479]

Not really clear - but logically physiology suggests that since it is a vasculitis (inflamed blood vessels) the blood flow through those vessels is reduced which, in turn, reduces the supply of nutrients and oxygen to the muscle fibres and the removal of the waste products of metabolism/exercise. Somewhere along the line the mitochondria are involved I am sure.

The use of pred improves the swelling, increases blood flow and so function. I found that gentle movement and warmth both improved function - because both would increase blood flow.

[Marie1479 in reply to PMRpro]

Thank you for the explanation! Funny it’s been 2 years and I never really understood exactly what was going on in my body.

[PMRpro Ambassador in reply to Marie1479]

You probably are not alone!!!!!

[PMR2011 in reply to PMRpro]

With it being a blood flow issue I would think heat would be best as that dilates blood vessels and encourages more flow and exchange of cellular nutrients. Cold constricts which helps reduce swelling hence best after an acute injury. And anyway, heat just feels nicer in the cold Maine winters!

[Carrollee in reply to PMRpro]

Hi pmr pro. Enjoyed the explanation of pmr pain/stiffness. Do you have a similar explanation of the workings (or not workings) of steroid myopathy. Am struggling with the weakness and limits (seizing etc) it creates. My rhuemy has sent me to a physio, took 5 months to get the appointment and saw her last week. She's going to sort out a regime for my next appointment with her (may). I have a couple of excercise for my shoulders in the meantime, both have rotator cuff injuries due to the steroids. Just trying to get my head round what the steroids are doing that is different to the pmr. Thanks cc 🤗

[PMRpro Ambassador in reply to Carrollee]

healthfully.com/steroid-myo...

Does that help at all?

There is no myopathy in PMR - it isn't clear what causes the myopathy in steroid treatment and it usually happens in high dose therapy rather than at lower doses and is more likely with what are called fluorinated corticosteroids such as methyl prednisolone (Medrol). I was on Medrol for about 9 months at PMR-type doses and within a very short time my leg muscles wasted quite badly. Once I was taken off the Medrol and switched to prednisone and started walking as much as I could (not a lot but every little helps!) the muscles came back. Realy we should be given targeted exercises right from the start of steroid treatment - but although it is mentioned in the guidelines I don't think I know of anyone who got such exemplary management! The Leeds group is currently looking at the role of simple exercise in management of PMR. Doesn't have to be much - walking for legs and light weights for arms is often enough.

[Carrollee in reply to PMRpro]

Thanks. I was on high dose but now down to 71/2. Been on them 3 years. I don't have a car so I have to walk and am used to doing that, it's just the ability to do it comfortably is deteriorating. I think I injured my shoulders pushing my father in a wheelchair over rough ground etc. It's not til you push a chair that you realise how awful the pavements are especially driveways where the pavement dips down and drags you and the chair with it. Will see what the physio comes up with next visit. On the up side the reason it took awhile to get an appointment is because they wanted a band 7 physio to treat me due to the pmr/steroids so I felt encouraged that they had taken all of that into account and a more experienced person was going to take me on. cc 🤗

[PMRpro Ambassador in reply to Carrollee]

Lord - pushing an empty wheelchair in a hospital corridoor in the UK would be too much for me! Are you still needing to do that?

Hmmm - just because they are Band 7 doesn't necessarily make them know more about PMR! Hope she steps up to the plate though.

[Carrollee in reply to PMRpro]

PMRpro. Will be pushing a wheelchair on Tuesday thru a hospital carpark and up to a neurologists office. Let's hope I survive and my father gets a proper diagnosis after all this effort. I now believe he has Parkinson's after 5 years of deteriorating from a fit, vibrant, busy, energetic man with a sense of humour and a twinkle in his eye to a person who can only just shuffle and is slow, stiff, depressed etc. Didn't realise you can have it without a tremor. None of the docs twigged either, had to discover it myself. All the best Maria1479 sorry to have hijacked your post a little. Hope the shoulders are improving. I think I will be putting hot, cold and anything In between on mine after Tuesday. All the best everyone cc 🤗

[PMRpro Ambassador in reply to Carrollee]

Apparently 35% of Parkinson's patients never have tremor. Bit like the "it can't be GCA if you haven't got a headache" line I suppose.

I do hope you get an answer - at least knowing what it is means they can do something to help. But a 5 year downward trail without an answer is appalling.

[enan-illuc]

Hi Marie1479,

I use both a cold pack and heat. If it is 'real bad' I use a cold pack, if it is tightness I use heat. Have you tried a EMS machine. It is Electric Muscle Stimulation and seems to work well. You can get one at most drug stores or on Amazon.

Enan

[piglette in reply to enan-illuc]

I use a TENS machine rather than an EMS one. I felt EMS machines were for athletes and TENS were for crocks like me!

[PMRpro Ambassador in reply to piglette]

What's the difference? OK - just looked

drhonow.com/drhonowblog/201...

[Sandy1947]

In physical therapy they use heat and it is wonderful. Weekly massage is on a heated table. Cold is too shocking to my delicate system!

[Marcy47]

I use a microwaveable heat pad. I made up a bag with ties to put it in and tie it round my waist either on my hip or on my buttocks as that is where I get pain and stiffness. I can then carry on with chores with both hands free.

[Marie1479]

Thank you everyone. I went to the chiropractor after work. He gave me an ultrasound treatment, Heated pads and stim, and pressure point massage. I’m feeling much better today 😊