Should I Ice or Should I Heat Now?


There is a great debate about heat versus ice for pain. Everyone has experiences and recommendations that guide their decision making. My hard and fast rule: use which ever sounds like it would feel better! There are many reasons I have this rule but the biggest is: if it doesn’t feel good it is not going to help! If you are still unsure, here are some basic guidelines you can use to help you decide . . .

Ice is best used within the first 72 hours of an acute injury:

An Acute Injury is when an event happened and you knew immediately that you were injured or something wasn’t right.

  • if you have bruised your knee running into a opposing team player,
  • twisted your ankle landing from a jump shot,
  • strained your back or shoulder throwing from the outfield . . .


Heat is best used when you have muscles that feel tight or sore and stiff:

  • if you slept funny and woke up with a stiff neck,
  • if you walked a lot yesterday and today your hip is sore,
  • if you were working in the garden over the weekend and midweek you have a backache . . .


There are also some conditions that prefer one over the other.

Conditions that like ICE:

  • Tendonitis
  • Ligament Sprain
  • muscle strain
  • Swelling

Conditions that like HEAT:

  • Arthritis
  • stiff joints
  • back aches
  • muscle spasms
  • stress, anxiety


You have an open sore, stitches, infection, blood clot, cancer, circulation problems or sensation problems.


You have circulation problems or sensation problems, aversion to cold.

And those are just some of the reasons my rule is: USE WHICH EVER SOUNDS BETTER! Always ask your PT for clarification about your specific situation if you have questions!

What does Quality mean to you?

In the business of Physical Therapy (PT) staying in the black can be a daily struggle. Insurance reimbursement is changing and to stay afloat businesses need to make money. Unfortunately these two pieces of the puzzle tend to oppose one another in the healthcare industry. So what are the options?

There are many, but I would like to talk about just one. The one that impacts clients the most and the reason that I am starting ZPT . . .

Quality of care

This is the most important aspect of my industry and I suspect that most folks would say the same. As consumers of healthcare services we all deserve to receive effective care, in a timely manner for a fair price. This is what ZPT offers.

  1. Examination, evaluation and treatment from a doctor of physical therapy who is a board certified specialist in orthopaedics.

  2. Care based on current research, 20 years of clinical experience and each clients input.

  3. Appointment scheduling to meet your needs. Individual care without time or visit limits.

  4. Pricing that meets industry standards and the ability to submit claims to your insurance company for reimbursement.

  5. Focus on client outcomes and client satisfaction.

Quality of care is why I have started ZPT. I want to meet the needs and exceed the expectations of this community. If you have an injury, pain or difficulty functioning, I can help you experience the value of quality care!

Stay tuned for information on many physical therapy topics!

Be Well! Roxi

National Falls Awareness

Isn’t it a funny coincidence that National Falls Prevention Awareness Day “falls” on the same day as the first day of fall?

But it is the perfect time to talk about improving balance in your life. Moving from summer to fall we experience a balancing of the sunlight and moonlight hours. There is a shift in the rhythm of our routines, maybe even a complete reorganization of them! As you balance your commitments this fall, consider adding physical balance to your routine.

The CDC reports that about one third of people aged 65 years and older will fall each year. This increases to 50% of people 80 years and older. Only 15% of these falls are unavoidable! The other 85% are due to combinations of the following risk factors:

  • Strength, Balance and Mobility deficits

  • Medication errors and mismanagement

  • Vision, Inner ear, or Cognitive impairment

  • Depression

  • Effects of multiple medical conditions.1

A Physical Therapist can help you evaluate your risk of falling by examination and evaluation of your:

  • Medical history – including nervous system disorders such as Stroke or Parkinsonism, history of fall, and more

  • Current medications

  • Vision and vestibular systems

  • Vital signs

  • Footwear and feet

  • Strength, flexibility, coordination, balance, gait, posture

We also perform a home safety assessment and a quick screen of your cognitive abilities.2
If a concern is found a Physical Therapist can address limitations in:

  • strength

  • flexibilty

  • coordination

  • sensation

  • balance

  • gait

  • visual tracking

  • inner ear function

We also educate clients on how to reduce your fall risk and your fear of falling. Finally, we refer clients to the appropriate medical profession for consultation regarding medication, cognitive and medical issues as they are not within our scope of practice.3

After Physical Therapy, there are many wonderful community programs for balance training to help you maintain your balance!

Wishing you a Fall-Free Fall!

Additional resources you may find helpful

My Resources




Concussion Discussion

My kids are kind of accident prone. Maybe no more than the average kid these days but much more than I was as a kid! They have had multiple casts on multiple body parts among other injuries. The most frightening thing we have faced however is concussions – my son has had two in three years.

Luckily, I spent the first ten years of my career working with brain injury so I am familiar with these types of clinical presentations lending a degree of comfort to dealing with a concussed kid. Unfortunately, I spent the first ten years of my career working with brain injury so I am familiar with these types of clinical presentations causing me to become extremely neurotic when dealing with a concussed kid!

In 2013 I began learning a little more about the role that physical therapists can play in concussion diagnosis and treatment. With the fall sports season starting, it behooves me to share some of this information with you.

What is a concussion?

An injury to the brain that disrupts how it normally works, caused by a hit or jolt to the head that causes the brain to move around inside the skull.

How do you get one?

The most common mechanism of injury is colliding with another player or the head hitting the ground no matter what sport or activity in which the child is involved.

In football there is additional risk due to head to head contact when tackling.

What are the signs/symptoms of a concussion?

  • Physical = nausea, vomiting, dizziness, blurred vision.

  • Cognitive = memory, concentration issues

  • Emotional = irritability, excessive crying or laughing, mood swings

  • Sleep disturbances

  • Essentially your chid just seems a little off.

Who is most at risk?

  • Kids are more at risk than adults  – their brains and bodies are still developing and therefore are more sensitive to the neurochemical changes that occur during a concussion

  • Girls are more susceptible than boys – they make less testosterone and therefore the  size and power of their neck muscles will be less than boys.

How can a concussion be prevented?

  • Safe play – sportsmanship and proper technique.

  • Proper conditioning and training – in the off season and participation in more than one sport to develop multiple skill sets.

  • Use the proper protective equipment.

The bigger issue is the risk of Second Impact Syndrome  

This occurs when a concussed athlete returns to play before he or she is completely recovered. Astonishingly, 50% of concussions go unreported because either the incident is not recognized as a concussion or the athlete doesn’t report symptoms because they want to stay in the game.

 What to do if you suspect a concussion?


  • Head to the ER or MD – no imaging can ID a concussion but it can rule out other things

  • Have a plan for symptoms management and monitored return to regular activity – school and sport

  • Follow the 4 Step Return to Academics then the 5 Step Return to Sports Protocols under the supervision of a professional familiar with concussions = MD, PT, ATC

For answers to your specific questions please email me at

Be Well!  Roxi

Life Lessons . . . Sarcopenia

I’ve been absent from blogging for about a month. We went to Germany for vacation. Upon returning home it took a week to adjust, as usual. We had multiple appointments and the kids started school. I mention all this not as an excuse but because it has helped me to learn a life lesson. The kind of life lesson that you embrace in your head (because you teach it to others) but have never truly embraced in your heart, as a way of life.

In Germany we walked an average of 8 miles a day, touring the cities and towns. For the first few days I was stiff and sore ~ yoga (und bier) helped. My knee (plagued with 30 years of patellofemoral tracking issues) was killing me for a day or so. By the third or fourth day I woke feeling young, strong, vibrant ~ 18 years old again!! No achy joints, no struggling to get up from a chair, no jolting of my frame when running across the street!

 The life lesson I learned in Germany. . .

 . . . Exercise Keeps You Young.

 Related to this topic is Sarcopenia or muscle loss that occurs with aging. In our 30’s we begin to lose muscle mass and thus muscle function, which equates to strength and coordination. Those of us who are physically inactive (think desk job or long commutes)  can lose as much as 3-5% per decade in our 30’s and 40’s, 10-20% in our 50’s and up to 30% in our 60’s.  Another life lesson . . . Use it or Lose it!

 The treatment for Sarcopenia? Resistance Training! Unsure of where to start? Development of a strength training program is easily done by your Physical Therapist. He or she will help you select the best exercises and dose them based on scientific evidence, identify your movement patterns and teach you correct form to decrease your risk of injury.

 Final Life Lesson for today . . .

. . . Practice What You Preach!

As for me, I am putting these lessons into practice by

  • Committing to walk my dog at least 1 mile daily.

  • Doing at least 15 minutes of yoga daily save for my hour session once a week.

  • Doing Pilates once a week.

  • Creating a plan to incorporate consistent strength training.

I invite you to join me.

Be Well!  Roxi

Annual Exams

How many of us have annual exams by our physicians, ophthalmologist, dentists? Most of us are so busy that these appointments rarely top the priority list but does that mean they are not important? Absolutely not! I am embarrassed to admit that altho I work in the healthcare profession I see my dentist for a cleaning yearly (although it should be every six months), my internist every year to year and a half for a wellness exam and I can’t recall the last time I saw an ophthalmologist – but it is on the top of my list currently!!

The other person we should be seeing for regular exams is our Physical Therapist. Physical Therapists are your movement specialists. We are the experts in normal and abnormal body mechanics, re-education of normal movement and functional movement training. The Vision of our professional association states PT’s are  “Transforming society by optimizing movement to improve the human experience.”

Reasons to see a physical therapist include:

  • Injury including muscle or tendon strain, ligament sprain, fractured bones, pain, and many more.

  • Post surgery including ligament reconstruction, tendon repair, joint replacement and many more.

  • Chronic or recurring injury or disease that limits your ability to function or move the way you want.

But have you ever thought about seeing a PT for:

  • A fitness consultation

    • Improving flexibility, strength, endurance

    • Improving balance, coordination

  • Enhancing sports performance

  • Injury prevention

  • A postural consultation

“Physical therapists have the education, experience, and expertise necessary to provide a broad health screening to allow tracking the patient’s health status over time.”

 The goal of ZPT is to be your PT for life! You have a medical doctor, a dentist and an eye doctor. Why not have a doctor of physical therapy?

Click here to inquire about annual exams!

Be Well! Roxi