15 May STOP ICING: New Evidence says it impedes healing.
For decades, Athletic Trainers, Physical Therapists, Orthopedists, Chiropractors and other Sports Medicine Healthcare professionals have used ice to treat acute injuries from sprains/ strains to fractures and dislocations. But a closer look back into basic science reveals that by icing we are actually blocking the body’s natural healing mechanisms. Using ice immediately after an injury does help reduce pain. No question. In fact, this is how using ice became so popular. Back in the 1950’s and 60’s, athletic trainers began using ice on acute sprain/strain type injuries. These treatments reduced swelling thereby reducing pain. The response was so dramatic, it became a permanent fixture in the RICE formula (Rest, ICE, Compression, Elevation). Understanding the role of inflammation in injury Let’s take a closer look into what happens when the body suffers an injury to the muscles, tendons, ligaments, fascia, and joints. Inflammation is an essential component in the healing process and vital to the body’s repair mechanism. When a muscle, ligament, tendon or joint capsule is torn( sprain/ strain type injury) the body responds by sending inflammatory cells like macrophages to the injured area. These components of your white blood cells are in circulation at all times. Their job is to release histamine which causes an increase in circulation to the injured area. The purpose of the increased blood flow is to bring more macrophages to break down and eat up the damaged tissue, a process called phagocytosis. The accumulation of these cells and the fluid are responsible for the resultant swelling that accompanies injury. After 24 hours- more macrophages come into the area transporting IGF-1, or Insulin Like Growth Factor. This IGF-1 is responsible for stimulating the formation of new tissue. Acute vs. Chronic Inflammation Acute inflammation following an injury such as a sprain/ strain, fracture or dislocation is a good thing. It is the first and most essential step in the body’s healing mechanism. Inflammation should only last 24-72 hours and should then be followed by Repair and Remodeling phases of healing. These stages can take weeks to months depending on the severity of the injury. With regard to our musculoskeletal system, chronic inflammation is often the result of repetitive motion injury, muscle imbalance and joint dyskinesis (poor joint movement). Chronic inflammation can also result from a toxic diet of pro-inflammatory foods and environmental exposures to toxins and is often a major contributor to many chronic diseases, such as Diabetes, Rheumatoid and Psoriatic arthritis, fibromyalgia, cardiovascular disease and many forms of cancer. For the purpose of our discussion, we will focus on the effects of repetitive motion injuries and chronic musculoskeletal inflammation. Understanding Soft Tissue Injuries With repetitive motion injury comes the formation of fibrous scar tissue. Click here to learn how scar tissue forms. The tightness creates friction and with continued use and exercise, the cycle of friction, tension and inflammation continues in an ongoing cycle. The typical treatment advice has been the use and application of ice for these injuries. But icing may not be the best way. How do we help the body’s natural healing mechanism? If we look to the RICE model, Rest in the form of active rest is essential. Taking the ICE out, we come to compression. Compression assists to move the fluid buildup out of the tissues. This helps flush bad inflammatory mediates and fluid out of the injured area and allows fresh, nutrient and oxygen rich blood flow back in. Movement of the muscles and fascia act as a pump to move fluid in and out of the tissues. Electrical muscle stimulation can be applied to cause micro-contractions around the area to create this fluid movement. As home, Foam roller and lacrosse ball self myofascial release helps to release tightness of the fascia and can actually help to milk out the inflammatory fluid from the tissues. Manual treatments like Active Release Techniques are extremely important and effective as resolving these repetitive motion injuries. It is important to note that home treatments using compression and foam roller can help. But the scar tissue formation needs to be treated manually, and Active Release Techniques is one of the most effective and fast acting ways to resolve these injuries.