Ice Therapy for Strains and Sprains
by Martin Kingston
http://www.massage-therapy-london.co.uk
+44 20 8400 9712 / +44 7710 314432
This article appeared in the newsletter for BodyworkersLondon.com
THIS ARTICLE REFLECTS THE PRIVATE VIEWS OF THE AUTHOR AND SHOULD NOT
BE CONSIDERED A MEDICAL REFERENCE..
You may have heard people say to use RICE when they injure themselves
(Marieb [2004]). It stands for Rest, Ice, Compression, Elevation. Everyone
knows about resting an injury (even though we often carry on and ignore
it). Compression and Elevation make sense for limbs if we want the inflammation
to settle, but why Ice and not heat?
Try it for yourself
Well, next time you hurt yourself, and think it just a strain or sprain,
why not try it to reduce swelling and pain (St.John Ambulance [2002])?
Wrap ice in a tea towel, apply for 3-10 minutes then rest for 20 minutes.
Then repeat until bored…do this particularly in the evening, when
you are not going to use the injured muscles/tendons much more.
Healing and Over-use
The thinking, it seems:
1. Inflammation is a necessary first stage in healing. Histamine is released
by mast cells in response to damage. This makes the capillaries around
"fenestrate" - become full of holes like colanders, so lots
of fluid floods the area. This brings nourishment to help repair, and
slows movement of fluid to reduce the spread of infection. White blood
cells travel upstream to the area, attracted by the inflammatory chemicals,
to eat damaged tissue and bacteria. Inflammation also is good for an "acute"
(recent) injury because it reduces mobility, lessening the chance of further
damage.
2. However, there is not much movement after the initial flush of blood
(to stop infection spreading). Further healing can slow down - no more
nourishment is coming to the area, and dead white blood cells & debris
are not being removed.
3. With repetitive strain (aka "overuse injuries" include RSI,
carpal tunnel, tennis elbow, golfers elbow, etc), where the tissue is
damaged again and again before it heals, a low grade "chronic"
(long-term) inflammation sets in, where the body has repeatedly tried
to heal, but then says "ok, I keep trying to heal, but you clearly
want to be injured, because you keep doing this - so I give up!".
All sorts of pathological complications arise, and many debilitating and
even life-threatening conditions arise from chronic inflammation. At the
very least, there is a constant build up of collagen laid down randomly
(and if you don't exercise the area gently somehow, it will not be laid
in the right lines of force, becoming fibrous adhesions gluing everything
together)
How does Ice help?
Icing will close the branching blood vessel capillaries, allowing pressure
to reduce and some movement of fluid into the lymph ducts, forcing blood
and debris from the area. The lymph will filter this fluid, and get rid
of debris. As the area warms up again, fresh blood with fresh nourishment
comes in. However, without the inflammation to reduce mobility, there
is a risk of further injury,so rest for 30 minutes after. That is why
many people recommended anti-inflammatory drugs ONLY at night when not
moving much.
Keep repeating several times during the day, to give yourself an "oil
change". 2 minutes at a time on bony areas, up to 5 on fleshy areas
- long enough to make the skin pale, but not so long it goes red again
(that is counter-productive - the body has said to itself - "heck
it is cold, I better adjust to make sure the tissue gets oxygen)…
Make sure you wrap the ice in a tea towel so you don't burn the skin
(Read & Wade[1997]).
Check what other people say
Check the internet to see - try "strain" on Wikipedia. A "strain"
is damage to a muscle or tendon, a "sprain" is damage to a ligament.
Icing can be tried for any injury, because there is almost always a soft-tissue
component to the damage and usually inflammation. Except burns - cold
water only - you don't want to lose too much bodyheat with a burn (Fisher[2006]).
So, why not heat? If you apply heat to a recent injury in the first 48
hours or so, you will aggravate inflammation, and risk more pain and slower
healing (Peterson & Renstrom[2001]). Heat alternating with ice can
help in the "post-acute" stage, 48 hours plus after the injury,
if the inflammation has already settled down. It can help to reduce spasm
in tense muscles, and therefore reduce pain.
Of course, this article is no substitute for consulting a properly qualified
medic - as bodyworkers, we are not allowed by law to prescribe or diagnose.
However, as First Aiders, we are allowed to use water and ice, and can
give general "wellness" advice..
References:
Fisher, S [2006] The Book of Medical Emergencies, London, Carlton Books,
ISBN 1 84442 273 9 page 55
Marieb E [2004] Human Anatomy & Physiology, 6th Edition, San Francisco,
Pearson Education Inc, ISBN 0-321-20413-1, page 319
Peterson & Renstrom [2001] Sports Injuries, Their Prevention and
Treatment 3rd Edition, London, Martin Dunitz, ISBN 1 85317 119 0, page
97
Read M & Wade W [1997] Sports Injuries 2nd Edition, London, Elsevier
Ltd ISBN 0 7506 3112 0 page 25
St.John Ambulance[2002] First Aid at Work, 5th Edition, London, St.John
Supplies, pages 250-251
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