Tag Archives: injury

Why Ice and Anti-inflammatory Medication is NOT the Answer

This is a reprint from Stone Athletic Medicine:


In July I posted a blog discussing The Overuse of Cryotherapy. The controversy surrounding the topic made it one of the most popular blogs I’ve written. What is surprising to me is that a controversy exists at all. Why, where, and when did this notion of anti-inflammation start? Ice, compression, elevation and NSAIDs are so commonplace that suggesting otherwise is laughable to most. Enter an Athletic Training Room or Physical Therapy Clinic nearly all clients are receiving some type of anti-inflammatory treatment (ice, compression, massage, NSAIDs, biophysical modalities, etc). I evaluated a client the other day and asked what are you doing currently – “Well, I am taking anti-inflammatories and icing.” Why do you want to get rid of inflammation and swelling? I ask this question for both chronic and acute injury!

The Stigma of Inflammation:

Editor in Chief of The Physician and Sports Medicine Journal (Dr. Nick DiNubile) once posed this question: “Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?” Much like a fever increases body temperature to kill off foreign invaders; inflammation is the first physiological process to the repair and remodeling of tissue. Inflammation, repair, and remodel. You cannot have tissue repair or remodeling without inflammation.  In a healthy healing process, a proliferative phase consisting of a mixture of inflammatory cells and fibroblasts naturally follows the inflammatory phase (1). Researchers headed by Lan Zhou, MD, PhD, at the Cleveland Clinic, found that in response to acute muscle injury, inflammatory cells within the damaged muscle conduct phagocytosis, contribute to accumulation of intramuscular macrophages, and produce a high-level of Insulin-like growth factor 1, (IGF-1) which is required for muscle regeneration (3). IGF-1 is a primary mediator of the effects of growth hormone and a stimulator of cell growth and proliferation, and a potent inhibitor of programmed cell death. Similarly, in 2010, Cottrell and O’Conner stated “overwhelmingly, NSAIDs inhibit or delay fracture healing” (2). And you want to stop this critical process of healing by applying ice, because inflammation is “bad”?

The Anecdotal Rationale for Ice:

Somewhere along the line the concept that ice facilitates healing became conventional wisdom. Sorry, that wisdom is wrong. I had someone tell me the other day, “We need to ice, because we need to get the swelling out.” Really? Does ice facilitate movement of fluid out of the injured area? No, it does not. The lymphatic system removes swelling. The Textbook of Medical Physiology says it best: “The lymphatic system is a ‘scavenger’ system that removes excess fluid, protein molecules, debris, and other matter from the tissue spaces. When fluid enters the terminal lymphatic capillaries, any motion in the tissues that intermittently compresses the lymphatic capillaries propels the lymph forward through the lymphatic system, eventually emptying the lymph back into the circulation.”  Lymphatic drainage is facilitated by contraction of surrounding muscle and changes in compressive forces that push the fluid back to the cardiovascular system. This is why ankle pumps work so well at removing swelling.

Inflammation is a necessary component in the first phase of phase of the healing process. Swelling is controlled by the body’s internal systems to attain homeostasis. If swelling is accumulated it is not because there is excessive swelling, rather it is because lymphatic drainage is slowed. The thought that ice application increases lymphatic flow to remove debris makes no sense. Gary Reinl, author of “Iced! The Illusionary Treatment option gave me a good analogy. Take two tubes of toothpaste, one is under ice for 20 minutes, the other is warmed to 99 degrees. In which tube will the toothpaste flow fastest?  It does not take an advanced physics degree to know that answer.

What might surprise you is that ice actually reverses lymphatic drainage and pushes fluid back to interstitial space. A study published in 1986 (yes, 1986, is old, but this is a foundational study) found when ice is applied to a body part for a prolonged period of time; lymphatic vessels begin to dramatically increase permeability. As lymphatic permeability increases fluid will pour from the lymphatics into the injured area, increasing the amount of local swelling (5). Ice can increase swelling and retard debris removal!

The Acronym RICE is Bogus:

The acronym RICE is bogus in my opinion. First, Rest is not the answer. Rest does not stimulate tissue repair. In fact rest causes tissue to waste and can cause abnormal gene transcription of collagen tissue. Evidence has shown that tissue loading through exercise or other mechanical means stimulates gene transcription, proteogenesis, and formation of type I collagen fibers (See studies by Karim Khan, Durieux, Mick Joseph, and Craig Denegar). Our body has all types of cells. When a cell is born it has no clue what type of cell it will eventually become. This infancy cell – for lack of a better term – is called a progenitor cell. Progenitor cells can be changed to a specific cell type. Load in tendon tells our body to turn a progenitor cell in to a tenocyte. Load in bone tells a progenitor cell to become an osteocyte. Ever wonder why myositis ossificans (calcification or bone growth in muscle) develops? The direct, repeated trauma turns progenitor cell currently living within muscle to an osteocyte. Subsequently, we develop bone growth within muscle.

The other reason RICE is bogus is obvious; Ice. Ice does nothing to facilitate collagen formation. Ice will not influence progenitor cell development. Ice does not regenerate tissue. Ice does not facilitate healing – it inhibits natural healing process from occurring. Ice does not remove swelling; it increases swelling and lymphatic backflow.

Closing thoughts:

Bottom line, ice and NSAIDs are over utilized. I am not saying never, but I am saying ice is not a magical cure all that fixes everything and is required for healing. It is not the gold standard that it has come to be. My goal with this blog is to get individuals to stop and think before immediately turning to ice and NSAIDs. Is it really the best option? Is it necessary for this injury at this stage? I understand it is not the only form of treatment clinicians use, but ice certainly is the most heavily used. Go ahead, I will wait while you look at your treatment logs.

My goal is to get this trend reversed one clinician and one patient at a time. Have you seen the video discussion between Kelly Starrett, DPT and Gary Reinl? If not I recommend you watch it. It’s fascinating. I am glad to have expert minds like Kelly and Gary in this fight with me.

I ask health care professionals to do one thing, just try it. Pick one client with chronic musculoskeletal pain, skip the ice, skip the NSAIDs and try to use light exercise as a repair stimulus. Then, try skipping the ice on a client with an acute mild injury. The outcomes might surprise you.


Benefits of Low Level Laser Therapy

Clinical and experimental studies have provided evidence that lasers can increase nerve function, reduce the formation of wounds, increase the metabolic activity of neurons, and enhance myelin production (Bagis et al., 2002). The non-invasive nature of laser photo therapy enables treatment without surgical intervention. Low level laser therapy began to be used in the regeneration and functional recuperation process of peripheral nerves in the 1970s. 

Many doctors dismiss cold laser therapy as quackery, which is one of the reasons I have used it so much on myself, family, and friends before I used it on animals that can’t give me verbal feedback. One friend said it did little for her carpal tunnel pain, and went ahead and had surgery. Everyone else reported moderate to complete relief.  On myself, it sometimes takes 7-10 sessions for pain to be gone from an injury that has caused chronic pain.

Low Level laser therapy has been used for at least 30 years for pain reduction and tissue repair. There is strong evidence it works and new research is constantly being conducted to refine it. 

It works by blocking pain fibers and slowing the transmission of pain messages. This pain blockade allows for a reduction in inflammation and for tissue regeneration. 

In one way, LLLT acts like a local anesthetic and reduces pain signals going to the brain. After several treatments the nerves in the affected area become less irritable and pain lessens, allowing muscles to relax and healing to take place.

While some conditions are curable, some need ongoing maintenance and people need to return for a treatment every three months. While not everyone responds to the cold laser,  it is used to treat a variety of conditions including neck and back pain, acute and chronic pain, migraine, wounds, arthritic pain, fibromyalgia and lymphedema.



State of the Art Pain Relief

Lasers have been studied since they were invented in the 1950’s. Every day I receive notifications of new studies and discoveries of the ways low level laser therapy can stimulate cells to heal.

Studied by NASA and long preferred by professional and Olympic athletes who need to get back into the game as soon as possible, laser technology for treatment of acute and chronic pain associated with neck, back, and other musculoskeletal issues is now becoming popular with the general public.

This state-of-the-art approach to pain treatment applies specific wavelengths of light to promote tissue repair and reduce inflammation in a noninvasive, nonsurgical way. The treatment is painless and for most patients offers relief after just a few appointments.

Why has it taken so long for cold laser therapy to be taken seriously? One difficulty is that the effects can be subtle, failing to provide a clear picture of so called “photobiomodulation” — that the light was somehow triggering novel, positive biochemical activity. A second difficulty is associated with pain therapy, which is a field often associated with fraudulent medical claims.

That’s precisely why a new paper published in the prestigious peer-reviewed journal Science Translation Medicine is so important. The study was performed by a team of researchers at Harvard University’s Engineering, Medical, and Dental schools. The paper offers one of the most conclusive and careful control set experiments ,whose results show clear evidence of photobiomodulation in rats. But what makes the paper truly groundbreaking is that it offers, for the first time, a hypothesis regarding a mechanism by which photobiomodulation may occur in mammals.

A major benefit of laser technology for the treatment of pain is that it can eliminate the need for long term anti-inflammatory usage, steroid injections and other invasive pain treatments, and for many patients, allows them to avoid surgery altogether.

Pain relief usually can occur as fast as 1 minute, decrease in inflammation in 1 hour, and tissue repair begins in one day.

An acute injury requires one to five treatments and for a chronic injury five to 20 treatments. The sooner an injury is treated, the faster it recovers. The recommended frequency for treatment is usually two to three times a week.

I love receiving feedback after your cold laser session, so feel free to leave a testimonial.  Thank you!


How to Reduce the Risk of Injury

What if I told you there was a simple way to reduce the risk of injury, increase mobility and flexibility, and increase blood flow to muscles? Before a workout or a horse show event, myofascial release can optimize your performance, and that of your horse, and greatly reduce the risk of strains, sprains, fractures,  or tears.

Restrictions and tensions of the soft tissue (muscle, fascia)  do not show up on standard hospital imaging and many patients  (both human and animal) suffer pain and injury because their pain cannot be diagnosed.

If a muscle is tight or stiff, moving it too fast can result in an injury. Fascia wraps around the entire muscle and every soft tissue in the body. When properly softened and stretched through massage, the entire structure of the body can function smoothly and safely. The investment of pre-activity body work can save months of costly rehab.


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How Do You Get an Edge on the Competition?

Equestrians spend a lot of money on the latest improvements in tack, supplements, and training sessions, but one of the most cost effective ways to reduce injuries, speed up healing and recovery time,and increase circulation and blood flow is to have the right body work done on your performance horse.

Massage helps your horse recover from the last work out and get ready for the next one. Massage prior to an exercise routine should be part of your warm-up. It allows for a freer range of motion. There are so many benefits to sports massage: it can relieve pain, help in rehabbing from an injury, reduce stress, increase relaxation, and ease the aches and pains that come from travel to shows. Body work can become your secret weapon. I see it all the time!




Massage for Injuries

When an injury first heals, massage can be essential for returning the body to its pre-injury state. Massage can also help with an old injury and the compensations and wrong patterns that can develop as a result. Undoing long standing distortions from old injuries will take more sessions of body work than newer injuries.

If left untreated for too long, muscles affected by injury can spread to many other muscles (and the way they move) in the body. When working on a new horse, I often find myself uncovering many layers of dysfunction, as each contracted muscle leads me to another. It can take several sessions to restore balance, and if the muscles have been very tight for a long period of time, it is very likely that the skeleton has been pulled out of alignment. Deep tissue massage and chiropractic done in conjunction with each other will be needed to restore symmetry and full motion.

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Motion is an Essential Part of Life

Movement is an essential part of life, and all movement comes from the contraction and then relaxation of muscle. All motion: walking, breathing, eating, sitting, is a result of muscular activity. Even the beating of our heart is produced by muscle function. The ability of a muscle to shorten and then to be stretched, and the elasticity to return to its normal shape after those actions, determines how successful an athlete (whether 2 legged or 4 legged) will be.

Between 40% and 50% of a person’s body is muscle.  Horses muscles make up about 60% of their body weight. Problems with muscles are not always obvious. Sometimes you will only see a change in posture or mood.

Massage can be used to prevent injury as well as to assist the body repair muscle fibers that have been damaged. Often muscles will the first indication there is something wrong and that a more serious injury is imminent. A muscle contains many fibers and as it contracts and relaxes some of these muscle fibers can become stuck and form a spasm.

The longer a muscle spasm is left unattended, the harder it is to remove. Regular body work is some of the best insurance to keep yourself and your horse partner in peak performance shape.

Horses are Becoming Resistant to Antibiotics

Antibiotic resistance a threat to horse drug arsenal

By on May 05, 2013 in Health, News

Antibiotic resistance is rapidly becoming an issue in the equine world, a new white paper has warned.

It warns that tighter controls could be imposed on medicines in a bid to prevent antibiotic resistance. Such controls could ultimately mean certain antibiotics would no longer be available for use in horses.

To slow the development and spread of multi-drug resistant bacteria, it is imperative that all parties involved practice the careful use of antibiotics, according to the paper produced by the American Association of Equine Practitioners’ Equine Research Coordination Group.

The group, comprised of organizations and researchers that support equine research, is chaired by New Zealand-born equine orthopedic specialist Dr Wayne McIlwraith, who is based at Colorado State University.

Antimicrobial resistance is a type of drug resistance whereby bacteria are able to survive exposure to an antibiotic.

It is inherent to the use of antimicrobials, according to Dr Harold McKenzie III, who is associate professor of medicine at Virginia Tech’s Marion duPont Scott Equine Medical Center.

“Any time antimicrobials are used, there is an inherent selection process whereby the bacteria exposed to the antibiotic will be inhibited or die, but a few bacteria will likely survive,” he said.

“Ultimately, if this process continues, only resistant bacteria remain.”

Due to the frequent use of antimicrobials in humans and animals some bacteria are becoming resistant to many antibiotics, a situation known as multi-drug resistance (MDR). Continue reading

Why Rest is Not Always Best

Rest is important and necessary after an injury. After that it is counterproductive: it allows muscle spasms to become permanent. The longer a spasm is allowed to persist, the longer this occurs: fluid is drawn to the area that is in spasm, which is the body’s way of protecting and healing an injury. That fluid is sticky and after a period of time, the muscle fibers become “glued” together. The only way to un-stick the muscle fibers is with manual manipulation and then exercise. With cross fiber friction, a massage technique, the muscle fibers that are stuck together can be released. I always have animals walk after their bodywork to maintain the loose, easy motion that was achieved during the session. An increase in range of motion, and a decrease in pain should be seen immediately.

Why I Love the Product Traumeel

I was introduced to Traumeel by Lyn Simard, a horse trainer in Oregon. She had a massive, deep purple bruise on her leg. She rubbed on some Traumeel, and the next day when I saw her, the bruise was gone. That was 20 years ago, and I’ve been using it ever since. It is mostly comprised of Arnica, but contains other healing herbs as well.

I had an experience recently that reinforced my loyalty to this product. I was at the May Woodside Horse Trials with several clients. One is a chunky (about 900 lbs) pony and his then 10 year old, very light weight, rider. Let’s just say she weighs around 70 lbs. She was warming up on Thursday, the day before her dressage test, when her pony slipped and fell on top of her. In his struggle to get back up, he rolled over her three or four times, with his saddle on. He could not seem to get up off of her. Luckily, there was a firefighter right there at the arena, and he ran in, and helped the pony to his feet. I feared the worst for the rider and for the pony too. It appeared that miraculously they were both just bruised. The only blood  flowing came  from a torn cuticle! We slathered the little girls’ bruises with Traumeel. I went over the pony and found what I feared might be a torn muscle in his shoulder. It turned out to just be swelling from where the saddle had dug in as he rolled around.  We put Traumeel there too. The next day, they both were good to go. While it was not the best show for either one of them, they managed to finish on a number.

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