Tuesday, June 3, 2014

Is it the end of the Ice Age? When to use heat and or ice...

Written by Dr. E. Serafim

"I can never get it right Doc, when it hurts, should I put heat or ice on it?"

"But there was shrinkage!"

This is the most common  "modality" question presented to me on daily basis & I  always answer the same way...It Depends.  

 There are several items to consider;
-type of pain (chronic vs acute)
-why is it hurting (trauma vs overuse)
-is there any nerve involvement  
we'll address all of them in this week's blog.......

Chronic Vs. Acute
The amount of time your injury has been bothering you will  often help us discern which type of pain you are experiencing.  Acute injuries usually involve trauma while  Chronic pain is defined (but debated) as any pain pattern present for longer than 6 weeks.
The take home message here is that if you just injured yourself (acute) and the area is showing signs of "Acute inflammation" DO NOT USE HEAT on the affected area. If you have one or more of these signs (compliments of nature reviews), you're experiencing a acute episode of pain. In today's busy world many of us choose to ignore pain, but if you Live to move,  read on...
"I'm tough, I can take it"
Pain affects us in ways that both benefit and cause us harm, pain is our body's alarm system. It tells us when something is wrong and limits our movements to prevent furthering the damage that has already been done.  Limiting movement may seem like a good idea, but keeping the theme of the blog should give you an idea of what I'm going to say next. Painful movements change your movement for the worse, creating force multipliers secondary to poor/improper biomechanics, changing your muscle length and causing joint degeneration (arthritic changes) 1. The faster an injured individual can eliminate pain, the less of a chance it has to become chronic (learned).

When traffic is actually a good thing..
Ice (cryotherapy) is a great natural way of turning off the bad effects listed above, which in turn gets the individual one step closer to pre injury status. Pain is carried to the brain mostly on our smallest and most abundant nerve pathways( C fibers). The way cryotherapy works on pain is that if the small fibers carrying pain signals are flooded with signals carrying cold, the pain signals cannot get through for the brain to perceive. This process known as Lateral Inhibition and it's is a great way to intervene in the pain pattern and provide a "reset" for the body. Pain can be learned and that's a contributing factor for chronicity.
.Ice, Ice baby?
For ages the industry standard for controlling the sings of inflammation would be the R.I.C.E. (Rest- Ice- Compression- Elevation) protocol. Recent studies are debating that (2,3,4,5,6) ice decreases edema and speeds healing, and that rest is  detrimental. There's also evidence that rest and ice may actually delay healing. There are new emerging standards for inflammation, like movement tape and cold laser, but stay tuned, because new trends in rehabilitation are becoming the norm. While ice is a great natural way to control pain, we should start moving away from it as a way to alleviate inflammation.

"We've seen dramatic results with our taping"
-Dr. Gene
Heat then?
Any time we can warm up the tissues of the body, they tend to be more pliable. There's consistencies with patients in chronic pain.  Heat can be useful in managing and improving some of the underlying "functional" movement deficits. Muscle imbalance is frequently present; causing improper weight bearing, leading to overuse. With the exception of nerve based pain, heat can be a great way to treat the symptoms of many chronic issues. Nerve pain is typically radiating or a pins & needles experience ,  the only way to know for sure is to be evaluated by a health care professional to avoid permanent nerve damage.

The take home message..
Most of your nagging pain can be helped by mobility activities (mentioned here)  heat is one way to prepare the tissues and provide relief. Most of your "acute" pain can be managed with short periods of ice (10 minutes) followed by a 20 min break. If your pain is shooting or going down an arm or leg, get it checked out (we can help)! Ice can be a natural way of breaking pain patterns & helps to ensure your pain isn't altering your movement, because after all we Live to move!

Please share if you know someone who could benefit from this post!

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders, and is level 2 functional movement screen certified. He teaches continuing education and operates a private practice. More information can be found at Kinetx.org and feel free to like us at our Facebook Page page.

1.Page, P. Frank, C. Lardner, R. Pg. 41-45 

Assessment and Treatment of Muscle Imbalance: The Janda Approach Pg. 41-45

2.Forsyth, A. L., Zourikian, N., Valentino, L. A. and Rivard, G. E. (2012), The effect of cooling on coagulation and haemostasis: Should “Ice” be part of treatment of acute haemarthrosis in haemophilia?. Haemophilia, 18: 843–850. doi: 10.1111/j.1365-2516.2012.02918.x

3.Rajamanickam, M., Michael, R., Sampath, V., John, J. A., Viswabandya, A. and Srivastava, A. (2013), Should ice be used in the treatment of acute haemarthrosis in haemophilia?. Haemophilia, 19: e267–e268. doi: 10.1111/hae.12163

4.Forsyth, A. L., Zourikian, N., Rivard, G.-E. and Valentino, L. A. (2013), An ‘ice age’ concept? The use of ice in the treatment of acute haemarthrosis in haemophilia. Haemophilia, 19: e393–e396. doi: 10.1111/hae.12265

5.Kaminski TW, Hertel J, Amendola N, et al. National Athletic Trainers’ Association position statement: conservative management and preventing of ankle sprains in athletes. J Athl Train. 2013;48:528-545

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