What does ice do for injuries?

[Mut]

according to first aid practice, ice is used in the first 24 hrs for 15 minutes every 2 hrs and then in the second 24 hrs for 15 mins every 4 hrs.

Personally though I am not a fan of ice and prefer TCM lotions and potions to work on sprains, strains and the like. But if in doubt as to what it is see the docter.

[DeusTrismegistus]

Chris, I read somewhere a while back that inflammation begins the process where certain chemicals are released that tell the body to send healing mojo to the affected area and that reducing inflammation slows that down or stops it. I am not sure if that would be more of a problem with NSAIDs than ICE but I would think NSAIDs would be worse.

[fuga]

Greg, heal up, buddy, and let us know what it is after you see a doctor.

Chris, thanks for the ongoing expertise/education about the body and injuries. I consistently learn a lot from your posts and appreciate that you share what you know.

[Chris McKinley]

Deus,

The presence of increased levels of histamine and prostaglandins as well as immunoglobulin-triggering proteins released due to rupture of the cellular membranes of damaged tissue cells are the primary markers for stimulating an immune/healing response to injury. These are all released into the bloodstream immediately upon injury and build up to a maximal local concentration within minutes. After this point, no further triggering is necessary.

Inflammation doesn't begin that process; it's a side effect of it. Once that response has been triggered maximally, say, within 5 to 7 minutes, the body will continue to attempt to heal the injury from then on. You're right in that NSAIDs have a much stronger inhibitory effect on histamine production especially, but when you balance the slight lag in onset of the healing process that using ice causes versus the days or weeks (in some cases) delay that inflammation itself causes, there really is no comparison.

Much of what we're discussing is as much a function of correct timing as anything. The proper order of events in treating a non-laceration, non-hemorrhaging injury is:

(First 72 to 96 hours)
1) Immediate immobilization.
2) Transport to a medical facility for diagnosis.
3) Ice or, more ideally, a cold compress to reduce unnecessary levels of swelling (some swelling, enough to trigger the immune/healing response, is unavoidable).
4) Mild compression to stabilize the injury site.
5) Elevation to reduce edema and to encourage return of veinous blood.

(Later, depending on the individual injury and recover time)
6) Vasodilating compounds, such as jows, linaments, etc. and/or mild heat may begin to be applied to nominally increase localized blood flow to encourage the healing process.
7) After 3 to 4 weeks, mild and incremental movement in the range of motion of the injured site.
8) After another 2 to 3 weeks, mild and incremental resistance exercise can be introduced to the surrounding musculature to both rehabilitate the atrophied muscle and to greatly increase the localized blood flow to speed healing.

That's the basic rundown. If you'll notice, there is no ice "versus" jow, or heat "versus" compression, or whatever. It's all good if it's used at the appropriate time. Likewise, every one of those things can be bad if used improperly.


P.S. No problem, Pete. Glad to be able to help out.

[CaliG]

Greg, heal up, buddy, and let us know what it is after you see a doctor.

Chris, thanks for the ongoing expertise/education about the body and injuries. I consistently learn a lot from your posts and appreciate that you share what you know.

I contacted the hospital and they just recommended RICE. They said it should heal itself within a week, otherwise I should come in.

It seems like the worst is over 36 hours later it looks swollen but it's not very obvious and it doesn't hurt.

Altogether I used the ice for less than a minute. It would be nice to know what to do next time ahead of time, so I appreciate everyone's feedback.

Btw Pete, I'm hoping to see the Russians next Tuesday. I was supposed to go tonight but this happened.

[Ian]

If ice slows, constricts, binds, causes muscles, tendons and blood vessels to contract, injures you etc. why do I feel my best after an ice bath?

Serious question.

[Chris McKinley]

Ian,

It's impossible to objectively answer your completely subjective question. Perhaps you enjoy the sensation of the return of fresh blood flow to all your muscles after the bath as you warm up?

[CaliG]

Thanks Chris,

What do you think of putting on jiaos immediately after an injury?

G

[Chris McKinley]

Because jows usually operate as vasodilators, they increase blood flow to the injury site. That can be a bad idea immediately following the injury, since that would increase internal bleeding and leaking of intracellular fluid into the surrounding tissue. Additionally, it would promote edema of the local area, i.e., inflammation, which as I've already mentioned, will dramatically slow down the healing process compared to when inflammation is minimized. Therefore, it's generally a very bad idea. Now, after a few hours or days, that's another story.

Theoretically, if you happened to find a jow with no vasodilators in the recipe, and even better, if it contained mild vasoconstrictors or analgesics, you could begin to apply it considerably earlier. Still, until you know what the nature and extent of the injury are, palpating/manipulating it is itself a bad idea, jow or no. Also, you'll want to get a diagnosis as soon as possible, so hold off on the jow till you know what the doc says. If it's a very mild injury, do the ice and elevation thing for a couple of hours minimum before you start thinking of rubbing anything into the injury site.

[Brady]

Interesting, I love talks like this that has well researched science and traditional viewpoints.

Interestingly, countries like Germany have been doing no worse for sports related injuries without the protocol of using ice. Ice is great if there is a huge issue (aka limb nearly severed) but for small internal injuries more and more comparative studies show it's benefits are not all they are purported to be.

Personally, I think certain injuries with edema will benefit from increased blood flow to the site, and have found this to be true in practice. Would never ice an ligament sprain or muscle strain, for example. This usually leads to longer rehab periods. edit: I mean this in athletes with otherwise healthy systems, not people who I suspect have some chronic background.

Ian, besides what ice does to circulation, it also overrides pain input so feeling better after an ice bath may be due largely to this.

Chris, do you believe inflammation (acute, that is within 2 weeks of injury) is not helpful? I think it can be a very helpful aide to the healing process, and so long as it does not not turn to pitting edema (via proper blood flow) it has every indication to help the healing process.

A couple links:
http://emj.bmj.com/cgi/content/abstract/25/2/65
http://www.pubmedcentral.nih.gov/articl ... tid=522152

[Chris McKinley]

Brady,

RE: "Chris, do you believe inflammation (acute, that is within 2 weeks of injury) is not helpful?". How are you defining helpful? I've already gone over exactly what it does. Stabilization of the injury site is best handled medically rather than relying on the edema to limit mobility and provide stabilization to prevent further injury. If the edema lasts for 2 weeks, for instance, then healing is postponed dramatically, since proper blood flow both to and away from the injury site cannot occur optimally.

I'm not sure if you're guilty of it here or not, but it's often a mistake of reasoning when this issue comes up to set blood flow reduction (via ice or a cold pack, for instance) against blood flow increase (via heat, vasodilators, movement, resistance exercise, etc.) as if the choice were entirely mutually exclusive when it is not.

I've already outlined the optimal timeline for the most effective use of both modalities in treating non-laceration, non-hemorrhaging soft tissue injuries. Both have their role to play and used with optimal timing, the use of both produces superior results to either alone or to the non-employment of both.

To sum up overly briefly: you want to reduce (not eliminate) blood flow immediately following an injury so as to keep inflammation below a threshold where it will interfere with proper blood flow to the injury site and to minimize the spread of intracellular fluid and residue from damaged tissue, which can also hamper optimal blood flow. You will also want to stabilize the injured area to prevent further injury and to minimize agitation of damaged tissues. From several hours to days later, once the healing process has been triggered and the majority of the initial inflammation has subsided, blood flow can be encouraged to the area via heat, vasodilators and/or possibly the continued use of anti-inflammatories. Once movement of the injured area becomes possible without significant pain, slow light movement through a limited range of motion should be performed a few times a day as well. Eventually, possibly several weeks later, very light resistance exercise through a limited range of motion can be introduced as well to induce even more healing blood flow throughout the injury area.

[oldtyger]

From my own training in Western medicine, RICE is the standard method. I've generally been taught to use ice for 15 minutes every hour while awake for the first 24 to 48 hours. Then consider going to heat. Ice first help the swelling, heat to help the healing process. When our bodies are injured in certain ways, like a sprain, the initial response is inflammation--which causes swelling. Ice causes vasonconstriction and this will slow down blood flow to the area and also the release of inflammatory chemicals. Elevation because gravity will pull the fluid that has accumulated in the surrounding soft tissue to a lower part of that limb--where it might also cause swelling and if there was some bruising the bruise will migrate also. The body has to resorb the fluid eventually but at least getting the swelling down and away from the injured area will reduce the discomfort. Compression is used to again reduce the swelling--if you bandage a swollen or about to swell joint, it can not swell as much due to the physical constraints of the dressing. NSAIDs are also useful to help reduce inflammation. Pain killers like opioid narcotics help decrease the pain by working on pain receptors but will do nothing to speed healing or decrease the inflammation.

In my own experience, different physicians have different ideas. I think people respond differently as well. I suggest trial of ice or heat or both sometimes to see what works. Personally I usually do better with heat first. I don't have enough TCM experience/knowledge to comment from that perspective.

Rich

[Brady]

Brady,

I'm not sure if you're guilty of it here or not, but it's often a mistake of reasoning when this issue comes up to set blood flow reduction (via ice or a cold pack, for instance) against blood flow increase (via heat, vasodilators, movement, resistance exercise, etc.) as if the choice were entirely mutually exclusive when it is not.

I've already outlined the optimal timeline for the most effective use of both modalities in treating non-laceration, non-hemorrhaging soft tissue injuries. Both have their role to play and used with optimal timing, the use of both produces superior results to either alone or to the non-employment of both.

To sum up overly briefly: you want to reduce (not eliminate) blood flow immediately following an injury so as to keep inflammation below a threshold where it will interfere with proper blood flow to the injury site and to minimize the spread of intracellular fluid and residue from damaged tissue, which can also hamper optimal blood flow. You will also want to stabilize the injured area to prevent further injury and to minimize agitation of damaged tissues. From several hours to days later, once the healing process has been triggered and the majority of the initial inflammation has subsided, blood flow can be encouraged to the area via heat, vasodilators and/or possibly the continued use of anti-inflammatories. Once movement of the injured area becomes possible without significant pain, slow light movement through a limited range of motion should be performed a few times a day as well. Eventually, possibly several weeks later, very light resistance exercise through a limited range of motion can be introduced as well to induce even more healing blood flow throughout the injury area.

I disagree that reducing blood flow to the area immediate post injury is a necessary, or even advantageous methodology. And as I said, the timeline for the modalities you previously described is the tried and true traditional way, but recently there is a movement towards change that is showing to be at least as effective in acute injury management. Most athletic trainers I know, especially outside the US, who are well researched on this topic use Biofreeze (a topical anti-analgesic), edema massage, early ROM, and assistive taping as opposed to cryotherapy with soft tissue injuries. The results have been quicker return to activity with less potential complications.

[Darth Rock&Roll]

Ice - slows blood flow and reduces swelling.

the end.

[dtactics]

Chris,

What's your view on ice dowsing? We practice that in Systema and I'm not totally comfortable with the idea. I know of students going out in dangerously low temps dowsing with a bucket to prove their manhood. The cons seem obvious.