IT HURTS!! HEAT or ICE?
As your therapist, one of my most important roles in your recovery is teaching you the fundamentals of proper healing. Healing of injured tissue is a physiological process that can be inhibited by many factors. Pain management strategies, activity modification, and proper exercise are three such factors that need to be examined.
All new injuries or aggravation of old injuries need to be addressed with the acronym P.R.I.C.E. – Protect, Rest, Ice, Compress, Elevate. We will talk about the protection aspect in the next section on activity modification. After an acute injury, there is resulting tissue trauma and inflammation. Inflammation is part of the healing process as the body attempts to bathe the injured tissue with protein rich fluid as well as cells that cleanse and repair the injured tissue. Inflammatory cells can be present up to 21 days after an injury, but are the most prevalent during the acute inflammatory stage i.e. first 7-10 days. Uncontrolled inflammation is what delays healing and it is what we attempt to control with R.I.C.E. Ice should be applied for 10-15 minutes only in order to prevent frostbite. You can use soft, gel cold packs, bags of frozen peas or ice, or submerge the injured part into an ice water bath. You can ice every hour if you wish, but at a minimum of 2-3 times per day, for at least the first 7-10 days. Remember that the inflammatory process (in the controlled environment) can last 21 days. The adage “ice for the first 48 hours only” does not make physiological sense. Icing is not only anti-inflammatory, but it is also a great pain reliever. You should also consult with your physician regarding an anti-inflammatory medicine. Examples would be medicines such as Aleve 2x/day or 600-800mg of ibuprofen i.e. Advil or Motrin 3x/day for at least 7-10 days. Compression and elevation of the injury helps to prevent uncontrolled inflammation as well. Athletic taping, neoprene or Acewrap sleeves for ankles or knees, and back braces are examples of compression as well stabilization of an injury. Heating tissue can be relaxing and pain relieving, but it also causes the blood vessels to dilate, hence, increasing the flow of fluids to the area. If you wish, heating for 15-20 minutes can be added after the first 7-10 days as long it does not increase the swelling.
Protecting the injury will prevent uncontrolled inflammation, thus encouraging proper healing. Pain is a warning sign. It is your body’s attempt to remind you that something is wrong. Pushing “through the pain” is NEVER a good idea. When a lower extremity joint is injured and walking becomes painful or limited, we advise and instruct patients in using crutches or canes. This is a temporary modification of activity in order to prevent reoccurrences of pain as the body is healing. Our patients use an assistive device as long as is needed, but most typically for the first 7-10 days. Proper posture and body mechanics are also very important in removing the stresses to an injured back or spinal condition. Remember that causing pain during activity is like taking a hammer and “banging” on the injured tissue. Take frequent breaks and pace your activity as to not provoke your pain. It is important to wean slowly back into walking or running. We will help to guide you in that process.
Proper exercise can be initiated after the acute inflammatory stage. Movement of joints and tissues during exercise causes a mechanical “pumping”. This “pumping” can help to “push in the good and push out the bad”, prevent post-traumatic stiffness, and encourage a quicker return to function. Proper technique in these early stages would entail pain free, high rep, and low weight exercises. We will guide you in that process. Creating a global circulatory effect via pain free cardiovascular exercise is also beneficial to healing as it helps to cleanse and nourish the injured area.
I hope that helps!!
Chris Dukarski, PT