Have you ever been out for a run or playing a little soccer
with the kids when all of a sudden you tweak a muscle in your leg or roll your
ankle? Your first thought may be,
“I need to go ice this!” Icing an
injury is after all what you have always been told to help get the swelling down
and to dull the pain. In fact, the
oft-disseminated acronym in the sports medicine world is R.I.C.E., which stands
for rest, ice, compression and elevation.
When an idea has seemingly been in circulation forever it
endured the test of time and survived the scrutiny or it just may be due for a
re-evaluation. Dogma is never an
effective argument to continue with a treatment such as icing an injury
especially when you consider what actually happens when you do apply ice.
I think we can all agree that the human body has an amazing
ability to heal it’s self if we allow it to. Inflammation and swelling are the body’s natural response to
an injury.
I think there is some merit to icing acute injuries (it just
happened as a result of a specific action) and cold-water full or partial
submersion for the purposes of recovery after training, but constant use of
icing to dull pain is counterproductive. It essentially numbs the area, but also
limits blood flow, which is the mechanism through which healing agents are
delivered to the site of the injury.
Pain can be our friend. It is a signal to our brain that something is not
right. If we ignore this call by
numbing the pain with drugs or ice it’s similar to covering up the warning
light on your dash that alerts you to a potential problem with your engine.
If you continue to drive the car you will eventually damage
the engine and possibly even blow it out beyond repair. If you ignore the pain in your body and
continue to push your way through an injury eventually you will develop
compensatory patterns to work around the pain and discomfort. These altered body mechanics will
overload areas that pick up the slack for the weak/injured area and a bigger
problem usually ensues. You can
always get a new engine for your car, this is the only body you’ve got so don’t
bury your head in the sand by ignoring the pain!
I am not a rehab and pain management specialist but I do
have plenty of in the trenches experience dealing with my own bumps and
bruises. Cold showers particularly
after a rough workout has always worked for me in managing soreness. I tried snowboarding a few years ago
and I fell down and crashed, often!
I knew I was going to be hobbled the next day unless I took aggressive
precautions. As soon as I got back
to the house I jumped in a cold shower for 5 minutes. I focused on more vulnerable areas around the knee, hips and
lower back. The only area I
neglected was around my wrist joint (from breaking the falls with my hands) and
guess what hurt the next day? My
forearms were on fire but the rest of my body was fine.
Another key ingredient in my recovery in this instance; I
did not sit around and allow my body to get stiff. I continued to move around for the rest of the afternoon and
did some very mild mobility exercises.
Muscle activation helps drive blood in and out of the system. The muscles serve as a pump, they bring
groceries in (nourishment) and flush the garbage (waste) out.
There is basically a three-step process that must occur for
an injury to heal. The first step
in the healing process is the inflammatory response followed by repair of the
tissue and finally remodeling of the tissue. Ice sends the nourishment in the wrong direction so it
prevents or delays step one from occurring. And if the inflammatory response is delayed the other two
can’t happen and recovery takes longer or is never completed. This is why rushing back to soon before
an injury has had the opportunity to heal usually leads to a re-injury.
So what do the pain experts say?
I contacted two rehab specialists in the area and asked for
their opinion:
When it comes to acute
injury, then there is a possibility of inflammation and that is why it is very
important that the player rest that joint and ice it to prevent further damage
and to reduce the swelling. After about 48 hrs then you can use some isometric
exercises without aggressive motion thru the joint and you can use heat if
there is no swelling. That is in general; of course every injury is different.
M. Fahmy, OMPT Specialists
Ice for the first 48
hours, then after that, use heat. Don't stretch the muscle. Once the acute
irritation dies down, we use gentle transverse friction massage to the muscle
belly with it in the shortened position. This restores tissue alignment and
allows the muscle to "fatten" when it contracts. The inability of the
muscle to "fatten" with contraction is usually what causes ongoing
pain after an injury.
S. McLaughlin, Michigan Institute of Human Performance
The consensus is that immediately following a mild acute
injury icing is advised to control excessive inflammation, swelling and
pain. Then after the injury has
settled down after 48 hours don’t just sit around. Light muscle contraction and or gentle massage will help
drive the groceries in and the garbage out and allow the body to repair and
ultimately remodel.
If you constantly have to ice your back, neck or other area
of discomfort to manage pain you should not ignore this signal. Chronic pain is usually the result of
incomplete recovery, over-use or poor posture and muscle imbalances. That pain won’t go away until you get
to the root of the problem. While
inflammation is essential for the repair process chronic inflammation can
slowly chip away at tissue and movement quality. And poor movement in addition to weak muscles and stressed
connective tissue is a recipe for serious pain down the road.
It’s okay to experience a little soreness after a tough
workout, this usually occurs within the first 24-48 hours post training. This
soreness should be mild in nature but can be quite severe if you dramatically
increase the intensity of your training (New Year’s Resolution!).
If you do experience this soreness the protocol is similar
to that of an acute injury:
- · Ice/Cold Showers within the first 24-48 hours
- · Light mobility exercises (think active stretching, not static holds)
- · Gentle massage
- · Treading water in a warm therapy pool is also good option
As a general rule prevention is the best strategy to avoid
pain and soreness:
- · Follow the 10 percent rule: do not increase exercise intensity, frequency, or duration more than 10 percent a week.
- · Allow for weekly mobility/flexibility time in your workout schedule.
- · Cool down after vigorous exercise by jogging, walking, or slow-lap swimming.
- · Use Hot/Cold Contrasts in the shower finish with cold.
Also getting adequate rest /sleep is critical to not only
recovery but also injury prevention as well. Adolescent athletes who don't get
enough sleep at night might be placing themselves at risk for a sports injury,
researchers recently revealed at a presentation at the American Academy of
Pediatrics.
"Adolescent athletes may benefit from additional sleep
as they get older. We'd like injury prevention programs to focus on sleep
education."
Matthew Milewski, MD,
of Children's Hospital Los Angeles [1]
In my 10-14 age group many of the children (particularly the
girls) are experiencing knee pain.
It would be easy to dismiss this pain as nothing more than just the
typical aches that accompany growth and maturation but it is very important to
listen to the child and acknowledge their discomfort. I absolutely want my kids to tell me if they have pain so I
can ask leading questions to determine if it may be something more than just
their “growth spurt.” It’s
incredibly important to catch potential developmental problems in their infancy
when they are much easier to counter-act.
No need to go overboard and worry yourself sick about every little aches
and pain but by watching how they move and listening to them you can learn a
lot.
Treatment of growing pains depends on how much pain your
child has. The following things may ease discomfort and help your child feel
better:
- · Massaging the legs.
- · Stretching the leg muscles. This may be difficult/uncomfortable for younger kids.
- · Place a warm cloth or heating pad on the sore leg. Be careful not to burn the skin and do not use during sleep.
- · Most kids won’t respond well to ice. But if they can tolerate it apply ice wrapped in a towel to the sore area a few times each day. This can help to relieve pain and discomfort.
When Should You Call
the Doctor?
When deciding whether to call the doctor, it's important to
remember that growing pains are almost always felt in both legs. Pain that is
only in one leg may be a sign of a more serious condition. Call your health
care provider if this happens.
It's also important to remember that growing pains affect
muscles, not joints. And they do not cause limping or fever. [2]
In summary if you think icing works for you than continue to
do so for mild injuries. Earlier
studies have found little benefit from icing after exercise, but also few
negative side effects. [3][4] That said icing prior to exercise or sport should
be avoided! That should be
apparent but cooling will negatively affect your muscle coordination, spatial
awareness and dull your motor reflexes. [5]
Next week I will examine nutritional strategies that can be
used to recover from injuries.
Afterthought
Ibuprofen (brand names Advil, Motrin) is a non-steroidal
anti-inflammatory drug (NSAID) commonly used by athletes, both before and after
workouts.
Taking ibuprofen before a workout in order to reduce muscle
soreness has been linked to intestinal leakage and systemic inflammation; when
used chronically, ibuprofen may lead to intestinal permeability, allowing
bacteria and digestive enzymes to leak into your bloodstream regularly.
Using ibuprofen chronically prior to your workouts may also
reduce the absorption of key nutrients, particularly after exercise, which may
make it harder for your muscles to regenerate; further, this practice has not
been shown to reduce muscle damage or soreness. [6]
"We've learned through our conditioning that we just
ignore the pain, or we take a medication to suppress the pain, which is no more
than saying to the body, 'Shut up. I don't want to hear about it,' which allows
the problem to become more advanced. When you take anti-inflammatory and pain
pills for a condition that you're dealing with athletically, all that you do is
set the body up for more damage, because you override the protective mechanism
of your body.” [7]
Dr. Craig Buhler,
Advanced Muscle Integration Technique (AMIT) Practitioner
The best strategies (rest, nutrition, corrective exercise)
to help reduce muscle fatigue and soreness are those that will help to address
some of the underlying causes; drugs do not fall into this category.
Reference:
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