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Ice therapy - Part 2

Ask Your Chiropractor

with Dr Chris Davis

Sunday, August 03, 2014    

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This is the second in a three-part piece exploring the several benefits of cryotherapy.

THE optimal management of an acute injury can be remembered using the acronym RICE: Rest, minimise movement of the injured body part; Ice, apply a cold pack; Compression, light pressure wrap to the affected body part can help minimise leakage of blood and swelling; Elevation, raise the body part up so that the pressure from the blood and tissue swelling in the affected area is reduced as the fluids drain from the area by gravity.

As stated last Sunday, icing the injured tissues helps by limiting the leakage of blood and serum from the capillaries into the adjacent tissues. Ice also prevents localised swelling. In contrast, heating tissues causes the capillaries to widen, which can cause an increase in the leakage of blood from the capillaries and add to the localised swelling and pain. It is important to note that the blood that leaks into the tissues will later lead to inflammation, which slows the healing process.

Since sports activities or a rigorous workout can cause repetitive micro-injuries, ice is also advised immediately after a recovery workout, so that leakage of serum and/or blood from any capillaries that are disrupted during the workout is minimised.

I often recommend that my patients use ice packs on the affected joint in order to minimise inflammation and reduce pain, especially with a newly inflamed joint.

This can be helpful for many forms of arthritis, including rheumatoid arthritis, gout, osteoarthritis, pseudogout, ankylosing spondylitis, and many others.

It should be noted, however, that icing can cause temporary stiffness to the local tissues. Accordingly, heat applications can sometimes work best early in the day by relaxing the muscles around the joints, while ice applications at the end of the day can minimise the inflammation resulting from the daily activities, and allowing the tissues to heal while the body is resting.

No matter what the cause, when in doubt, it is always most advisable to go with ice.

Advising superficial heat applications is outdated. Clinical presentation and simple scientific and common logic strongly dictate that ice cools and calms, while heat inflames. Anyone who has tried to fight fire with fire knows it is futile. Even a child knows that fire will not burn ice, which is the solid form of water.

There are certain deep heating techniques that when applied appropriately can promote healing, but that is a different situation; such as, when old scar tissue needs to be broken down and allowed to heal correctly. Scar tissue is randomly placed, has weaker tensile strength and many more pain receptors than healthy tissue. This is why injuries such as joint and sports injuries tend to be chronic and constantly exacerbated. Once this deep heat treatment, such as therapeutic ultrasound, is applied, in essence, the weak scar tissue can be broken down and we get back to an acute-type stage of injury, without the initial pain levels; and, once more, ice will be the best application for the same reasons mentioned previously.

That being said, I must remind the reader that even though ice is non-toxic and has no legitimate negative side effects when used properly and locally, it is still only a way to manage pain in most instances. It does in fact have some healing promotional properties, but if the nerve supply to the area of injury is experiencing interference, such as from a bone or motion segment out of place putting pressure on the nerves, then the core problem causing the symptom needs to be removed. If you don't address the core problem you may simply be replacing the pain pills with the ice; albeit, you won't be damaging your organs by doing so.

There are very few instances where it may be suggested or indicated that ice should not be used. These include not using ice directly on the eyes, or directly on the chest or over the heart, for obvious reasons. There is a miniscule percentage of the population that is actually "allergic" to ice and experiences pain when it is applied. Also, if someone has extremely high blood pressure, there is a small chance they could be oversensitive to cryotherapy; however, when used in small localised areas, ice should not significantly affect blood pressure. If you have high blood pressure and use ice, it is advised to monitor your pressure closely during the treatment period and sometime afterward, to be safe.

As with any therapy, if you experience serious effects that would be considered emergency in nature, seek emergency or crisis medical care immediately. As I have always said, medicine has its place in life-threatening situations. Just keep in mind that even if a drug saves your life, it still does a modicum of harm, being toxic by its nature.

Don't forget to "Ask Your Chiropractor" every week where your questions may be published and answered in subsequent articles. Address questions to: Dr Chris Davis, the Spinal Mechanic and lead doctor, at movethebone@gmail.com; or, Dr Michael Harvey, director, at dr.michael_harvey@yahoo.com.

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