Ice, Ice… Maybe Not?

Welcome back to this week’s blog post!

Applying ice to pain has been the go-to for so long, but why do we do it, and is it beneficial to us to apply it?

For decades now, icing has been the go-to treatment for pain and swelling post-injury. The rationale? Icing has been utilized to numb the affected tissue and to decrease blood flow to the region via vasoconstriction, which is when the body narrows blood vessels to limit blood flow in the injured area.

The problem with that? Applying ice to an injured tissue slows the body’s ability to remove congestion in the affected tissue (swelling), which hinders long-term healing. Essentially, robbing the long-term for the temporary relief.

One thing I like to ask people is, “Do you want pain relief, or do you want optimal recovery? Both are not possible simultaneously; you will sacrifice one for the other.”

So, you ask, “If not ice, how do I reduce swelling and decrease my pain?” There is an old protocol for post-injury, formerly known as RICE (rest, ice, compress, and elevate). Our increased understanding of physiology supports an updated protocol that can be known as MINDFUL (Movement, Inspire/ Inform, No NSAIDs/ Nutritional support, Force/ loading the tissues, Unity in therapeutic alliances, and Lymphatics). I will explain these steps in more detail, but the overall gist is to move the tissues to optimize your recovery and give you the power back in your hands to recover from an injury rather than feeling like a victim.

Tissues are dynamic; that does not necessarily mean that they move, but they are constantly rebuilding, rewiring, and adapting to the stressors (both good and bad) that we put on them. When we have an injury, the body immediately shifts into the healing phase and remodels the damaged tissue. The problem? Icing halts this process, delaying optimal healing. So simply resting the injury makes no sense from a physiological perspective. We must reintroduce movement to the damaged tissues as soon as possible to allow optimal tissue remodeling and repair. This movement does not necessarily need to be full weight-bearing, but it does need to move as close to normal as possible to allow the tissues to remodel according to their normal functions.

So, ice dampens your body’s ability to heal but acts solely as an analgesic reducing pain temporarily. In a sense, robbing Peter to pay Paul, in that yes you can decrease pain but at the expense of your recovery. Below we will discuss some steps you can begin to take on your own to optimize your recovery post-injury.

WHAT TO DO IF YOU ARE INJURED…

Previous clinical recommendations have been that within the first 72 hours of an injury, you should apply ice to an injury to reduce swelling, there is little evidence to actually support this does anything to reduce swelling at all. Improving lymphatic flow/ drainage reduces swelling, this is primarily accomplished through movement and light tissue manipulation (i.e. Lymphatic massage- using 1-2 pounds of pressure and lightly rubbing the affected tissue moving towards the heart).

STEP ONE MINDFUL HEALING – MOVEMENT

Step one of our “MINDFUL” acrostic for recovery is MOVEMENT. As we stated earlier, tissues are dynamic, they are constantly remodeling based on the stresses we place on them. For musculoskeletal injuries, this means tissues that are designed to withstand loads of movement and the forces we expect our bodies to undergo. Logically, it makes no sense that in the remodeling phase post-injury that movement should be avoided. Now I am not saying that if you roll your ankle that you should immediately return to play but propping it up for 4 to 6 weeks makes no physiological sense and leads to randomized tissue recovery. Unless there is full-thickness tissue tear, even wiggling your toes after rolling your ankle will help reduce swelling post-injury.

STEP TWO MINDFUL HEALING – INSPIRE/ INFORM

Step two of our “MINDFUL” acrostic is to inspire/ inform. This is a step we at Peace of Health Chiropractic Wellness Clinic like to emphasize, and that is inspiring our patients that there is hope of recovery and presenting the path back to their wellness journey. Our goal is to help give you back the “reigns” on your healthcare journey, enabling you to dictate your recovery. All too often in current medicine, a patient is given a diagnosis, and the treatments are done to them until their course of care is complete. That is not how we operate at Peace of Health Chiropractic Wellness Clinic, while we love treating you, we want to see you succeed as much as you do. When a patient becomes empowered in their care, magic truly happens, their entire outlook on life changes, the perception of their diagnoses is reshaped into something that they can take charge of rather than something that they “have” as a condition.

STEP THREE MINDFUL HEALING – NUTRITIONAL SUPPORT/ NO NSAIDs

NSAIDs, non-steroidal anti-inflammatories, most common NSAIDs are Ibuprofen, Meloxicam, Naproxen, and Aspirin, these work on a specific enzyme called cyclooxygenase (COX). This enzyme is involved in the normal inflammatory pathway that occurs throughout the body. Pain, or nociception, is the body’s perception of the degree of inflammation in a tissue. Think of pain perception as like your fuel gauge on your dashboard. Your fuel sensor is the nociception nerves, nerves that feel pain, your fuel gauge on your console is your brain, the “low fuel indicator light” is your body’s pain threshold. As we discussed earlier with ice application, halting this inflammatory process hinders the optimal healing process. A natural alternative that exhibits a different mechanism while not hindering the healing process is turmeric. Many practitioners the world over have touted curcumin, the active ingredient that is most studied for its anti-inflammatory properties, as being among the best natural anti-inflammation source, is not as effective as whole root turmeric. At Peace of Health Chiropractic Wellness Clinic, we recommend Ortho Molecular Products’ “Traumeric” as it is whole-root turmeric that has synergistic effects to reduce inflammation, along with other ingredients like Bromelain from pineapple, Quercetin Dihydrate an antioxidant, and Rutin that also acts as a powerful antioxidant and cytoprotective properties (protects cells from further damage).

STEP FOUR MINDFUL HEALING – DECOMPRESSION

Step four is decompression; this is where we seek to alleviate the compressive forces that have developed within the injured tissue. Decompressing the affected tissue helps mobilize the body’s nutrient delivery to aid the recovery/ healing process. Think when there is a massive car accident on the highway and lanes are shut down, this is similar to when a tissue is inflamed during its natural healing process. However, this can create a “traffic jam” by not allowing the normal repair and healing process to occur. Decompression of these tissues is like opening those lanes back up to allow your body to heal naturally and at its most optimal level. We do this by restoring proper blood flow to the affected tissue, I usually recommend the application of heat and/ or Epsom salt bath soaks as the heat creates vasodilation (enlarging of the blood vessels). This improved blood flow to the affected tissues helps supply the injured tissue with the nutrients needed to repair the damaged tissues.

We further stimulate this decompression phase with continued use of RockTape/ Kinesiology Tape with the specific purpose of improving circulation and assisting the lymphatic flow through the affected region, further assisting in the transport of removed damaged tissue by the body and ushering in materials for repaired tissues. The application of kinesiology tape helps provide support to injured tissues, such as an ankle, a knee, or a shoulder (like a flexible brace). As an added benefit, kinesiology tape via the improved circulation can help bruises heal even faster!

STEP FIVE MINDFUL HEALING – FORCE/ LOAD

As stated earlier, tissues adapt to the stresses we place upon them. The most obvious tissue is bone, bone remodels based upon the loads placed upon them, this is why weight bearing exercises aid in bone density formation. This process in bone is known as Wolff’s Law. So now we must properly load the affected tissues through their normal range of motion to optimize the tissue remodeling process, this essentially acts as a “blueprint” for tissue remodeling that tells the body how it should remodel the damaged tissue. During this phase/ step of the process, specific exercises to reintroduce strength and tissue integrity to the damaged tissue.

STEP SIX MINDFUL HEALING – UNITY IN THERAPEUTIC ALLIANCE

Step six is the easiest step to understand and is, simply put, the various providers to help you throughout the recovery process. At Peace of Health Chiropractic Wellness Clinic, this is the combination of chiropractor and massage therapists. Your specific case might entail a medical doctor, physical therapist, etc. This is to help ensure that one practitioner fully understands your care process and neither practitioner is interfering with nor negating the effects of the other. We fully encourage and want to ensure that we establish open lines of communication with any and all of your healthcare providers.

STEP SEVEN MINDFUL HEALING – LYMPHATICS

The lymphatic system is absolutely paramount to your capacity to heal properly, that is why we focus so heavily on proper lymphatic motility throughout your healing process. Throughout your recovery process you might experience some swelling, or edema. This is when self-lymphatic massage is recommended. The light application of touch to your affected tissue (only 1-2 pounds of force is required for lymphatic movement) extending from the affected tissue and moving towards the heart. When dealing with lymphatic drainage, water intake is also crucial as it helps “flush” metabolites from the tissue so that your body may properly mobilize them to either be processed and recycled or excreted. Neglecting water intake can sometimes make a person feel nauseous or make them ill. Aim for a minimum of sixteen ounces of water over your normal daily amount. For more information on proper hydration recommendations, check out our other blog post “The Importance of Hydration.”

  That’s all in this discussion! Thank you for stopping by and making your health a priority!

Yours in Health,

Dr. Grant Shelton, DC

Doctor of Chiropractic at Peace of Health Chiropractic Wellness Clinic