Sunday, 9 April 2017

How to deal with an acute injury

It's all about the M.E.T.H!

RICE (Rest, Ice, Compression and Elevation) is a term that is used to supposedly help with treating sports injuries. Ice has been used for many years and helps to relieve pain from the injured area. But the evidence from Bleakley et al, 2004, found it to have an insignificant effect on soft tissue injuries. Athletes that used ice for longer than 20 minutes then returned to sport afterwards actually would be at a disadvantage due to a decrease in performance (Bleakley et al, 2012). Ice stops the inflammatory process and we need this process to happen to improve the healing of soft tissues. Ice and rest may delay healing time so therefore, we need to do the opposite, movement and heat!

Ice is no good for acute injuries like this ankle sprain!



What is the METH-od then?


MOVEMENT – controlled movement of the injured limb can increase blood flow, improve recovery and decrease the number of misaligned bits of collagen fibres (scar tissue) that is formed during the healing process.

ELEVATION – Bring the injured part higher than the heart to assist the movement and allow gravity to help remove the swelling. This will reduce the pressure of the swollen tissue and reduce pain.

TRACTION – This helps to move the fluid and help take the pressure off the injured part. Depending on where the injured part is, a therapist may have to do this part for you. It can help reduce pain when dealing with muscle spasms and compressed joints.

HEAT – Inflammation is the body’s natural response to injury so by applying heat, this will allow to speed up this process. A study was done on the effects of cold vs heat on people with acute low back pain, they found significant evidence that heat wrap therapy and heated blankets decreased pain immediately after application (French et al, 2006). A smaller study demonstrated the same results where pain from DOMS had decreased and function had improved after wearing heat wraps compared to cold wraps (Mayer et al, 2006). 

A long hot bath can alleviate acute symptoms and can aid in healing soft tissue injuries.




When you damage your tissues either by an injury or through DOMS (delayed-onset-muscle-soreness), you are healed by inflammation and other processes. Your body sends inflammatory cells to the recently damaged tissue to help heal them. These cells are called macrophages and release a hormone called Insulin- like growth factor into the damaged tissues. Applying ice to reduce swelling delays the macrophages from releasing the hormone to help with healing.
Inflammation needs to happen as this is how the body protects itself following an acute soft tissue injury. It does this by removing the damaged tissue and then the healing process can begin. The inflammatory process improves blood and lymphatic flow to and from the injured tissues. This is what helps bring healing nutrients and the chemical mediators to help clear out the damage tissue. Some of these mediators will help limit the amount of swelling, which causes an increase in pain sensitivity. Once this fluid is filled up with waste products, it can then be drained via the lymphatic system. The lymphatic system relies on muscles to contract and relax properly to help flush the waste away.

5 signs of inflammation

1.      Swelling
2.      Redness
3.      Heat
4.      Tenderness
5.      Loss of function

So, RICE isn’t good?


Rest doesn’t inspire tissue repair. Inactivity causes muscle weakness and therefore less lymphatic drainage which will not help in the inflammatory phase of healing. It also causes abnormal scar tissue formation which can cause further issues in the other phases of healing. Cross-friction massage can help with this and can be done by a sports therapist.

There isn’t much scientific evidence that ice helps. Ice slows down the removal of waste products and inhibits the development of new cells. Compression isn’t bad but needs to be done at the right time. Compression can be done by using a voodoo floss band (as used by Dr Kelly Starrett). It has been shown to help remove the blood with the debris and bring fresh new blood with those healing properties to the injured tissue. You can floss any part of the body but will need a Sports Therapist to help with this treatment technique. Here is a video on flossing the knee: 


Take home points

  • Inflammation is a GOOD thing. Without it, there’s no tissue repair.
  • Too much rest causes muscles to waste away. The body needs to undergo a mechanical change by doing exercise.
  • Icing before sports and activity has been shown to have negative effects on sports performance e.g. strength, speed, power and agility.
  • Massage, elevation and compression are effective ways to reduce swelling.


References


Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251–261.

Bleakley CM1, Costello JT, Glasgow PD. Should athletes return to sport after applying ice? A systematic review of the effect of local cooling on functional performance. Sports Med. 2012 Jan 1;42(1):69-87.

French SD, Cameron M, Walker BF, Reggars JW, Esterman AJ. A Cochrane review of superficial heat or cold for low back pain. Spine (Phila Pa 1976). 2006 Apr 20;31(9):998-1006.

Mayer JM, Mooney V, Matheson LN, Erasala GN, Verna JL, Udermann BE, Leggett S. Continuous low level heat wrap therapy for the prevention and early phase treatment of delayed-onset muscle soreness of the low back: a randomized controlled trial. Arch Phys Med Rehabil. 2006 Oct;87(10):1310–7.

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