Tag Archives: muscle

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.

Cold Laser for All Animals and People

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Cold laser therapy offers a wide range of options for tissue therapy, wound healing, pain management, and improved circulation. Cold laser therapy is a game changer for many pets suffering from painful injuries. This technology allows us to successfully treat many injuries including tissue damage, inflammation, wounds, and even scars with minimal invasion.

The technology has been used in Europe since 1970 to promote healing, but has only been approved by the FDA for use in the U.S. since 2002. It is only recently, though, that U.S. veterinarians have begun using it to treat many different conditions that affect pets today, such as fractures, ligament and tendon injuries, post-surgical incisions, arthritis, nerve injuries, sprains, muscle strains, abrasions, lesions, and more.

Cold laser therapy is non-invasive and makes use of light in order to stimulate activity or regeneration in cells in addition to increasing blood circulation. Unlike hot laser treatments that target tissue deep beneath the skin’s surface, cold laser therapy treats injuries or damage on or near the surface – without the risk of cutting or burning from the lasers. Most conditions require between three and eight treatments, though I have seen great improvement after the first laser session. Most animals enjoy their seession: many fall asleep or thoroughly relax.

The Body Remembers

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The nervous system remembers the pain and trauma of an injury. With your horse, you might see this as stiffness at the beginning of a workout, or extreme caution. When a rider tells me their horse just “doesn’t want to jump anymore”, I suspect muscle pain and get to work looking for it.

Trauma accumulates in the body, starting at birth. Have you considered how much trauma there is for a foal during the birth process? The results can set up tight muscle patterns that last a lifetime, unless manually removed.

Myofascial release aims to relax contracted muscles, improve blood and lymphatic circulation, and stimulate the stretch reflex in muscles. Often I stand back after just one bodywork session and see that the body is already reorganizing itself. The body looks less chopped up into sections and more of one flowing form. During a session the body of the horse is educated in the process to move the way it is supposed to: in balance and without restrictions. If the connective tissue that covers every muscle, bone, nerve, blood vessel, and organ in the body is free of restriction, the horse will move and behave in a completely different way.

Myofascial therapy relieves soft tissue restrictions that cause pain. Some causes of chronic muscle pain are easier to diagnose than others: trauma from birth or a fall, cumulative posture misalignment , a compressed nerve from poor saddle fit, etc.

When pain is caused by Myofascial tightness the diagnosis can be difficult, as fascia restrictions do not show up on MRI scans or X-rays. Yet, those restrictions can play a significant role in creating pain and malfunction in the structure of the back and legs. Every horse (and dog and human!!) should experience pain free movement that can result from having restrictions removed.

Preventing Injury in Your Riding Horse

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What would your horse be like if all his muscles were in a state of relaxation, free from tension? Deep tissue massage, stress and trigger point therapy, and myofascial release
will help the connective tissue become more elastic, thereby allowing the muscle to return to its natural shape.

It is very important for horses to maintain a comfortable and free range of motion. If certain muscles are tight, other muscles in the body will compensate and take up the extra workload. They may be ridden like this for weeks, months or years, until the body can no longer call on extra resources because it does not have them. This ultimately leads to ruptures of soft tissues and thickening of the tendon and ligaments, which eventually can cause permanent dysfunction of the affected area.

Muscles attach to bones in pairs of opposites, and cross one joint or more. Muscles free from tension will carry out the function of keeping joints in alignment. This allows joint fluid to flow evenly within the joint, and this reduces unnatural wear and tear of joints.

Each muscle is attached to bone by tendons. Muscles are designed to take 90% of workload and tendons the other 10% The muscle is where the elasticity is. If the muscle is not functioning properly then the tendons will take more load and can eventually tear.

Equine massage therapy is a very powerful tool in injury prevention for horses.

How the Body Regulates Muscle Tension

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Tendons connect muscles to bone. There are groups of cells within a tendon, where the fibers of the muscle meet the tendon, called Golgi tendon bodies. Made up of strands of collagen, the Golgi organ also contains nerve tissue. The major function of this organ is to sense muscle tension when a muscle is contracted, sending signals to the brain about how much force is being exerted.

Golgi tendon organs and muscle spindle cells work together to prevent injury to muscles. The more the muscle tries to stretch and the faster it tries to stretch, the more the Golgi tendon organs cause it to contract.

These nerve cells and fibers can be influenced by massage. Golgi tendon organs react to sustained pressure such as trigger point therapy and stress point therapy, by telling the muscle to relax.

The Importance of a Gentle Warm Up

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Probably the biggest problem I observe is riders demanding a “frame” from their horse within moments of mounting. Using hands to force the head and neck into a fixed shape causes damage that is difficult to reverse. Without a good period of time that allows the horse to stretch, warm up muscles, and find their balance under the rider, muscles and fascia tend to get stuck into adhesions.

Superficial fascia is the connective tissue that is found beneath the skin. This tissue links and covers blood vessels, nerves, muscles, and bones. The fascia and muscle combine to form the mysofascial system. Adhesions limit muscle movement which interferes with performance. Adhesions can also cause severe pain, reduced flexibility, and tender trigger points.

To release adhesions, I use a technique called ‘myofascial release.’ This technique involves applying gentle but sustained pressure on the soft tissue. During this technique, it is also important to target the fascia. This helps to lengthen and soften the fascia and break up the adhesions and any scar tissue that is present between the bones, muscles, and skin. Scientific evidence shows that myofascial release offers relief from different types of joint and muscle pains. Flexibility and movement is then restored.

More Benefits of Equine Massage

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My job description: using my hands to free soft tissue to encourage length, motion, and geometrical balance in the muscles, tendons, and ligaments. I have to be extremely observant, since communication with animals is non-verbal, to figure out how they can be better aligned and balanced.

After a session, most animals are both relaxed and energized. Since I see a bodywork session as a collaboration between me and the animal (not me imposing something upon them) they are always happy to see me again.

One of the reasons it is so important that muscles and fascia be relaxed and elastic is that if muscles are tense, when the hoofs hit the ground, more concussion will be taken by the joints. This is a set-up for injury and early degeneration of the joints. Healthy muscles make sure that the impact when the hoof hits the ground is distributed throughout the body. Supple muscles are able to absorb the force of the feet hitting the ground much better than tight muscles.

Become Involved in Your Own Health Care!

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Pain is the primary reason people seek medical treatment in the United States. The majority of this pain occurs in the musculoskeletal system. It would seem essential that medical professionals have in depth knowledge of this subject. If not, your doctor might fall back on old standards of care for chronic muscle and joint pain, such as anti inflammatory meds, possible antidepressants, and sleep medications. None of those “cures” get to the underlying cause of pain, and all have toxic side effects. Did you know that anti-inflammatory drugs inhibit the healing and tissue regeneration process? Nonsteroidal ani-inflammatory drugs, the number one prescribed drug for chronic pain, can cause tremendous damage to tissues. Why not try myofascial release, or trigger point therapy?

In 1998, a study was completed to assess the competency of recent medical school graduates in musculoskeletal medicine. 82% of the recent graduates failed the exam. The study went on to report that the average time spent in medical education in orthopedics was 2 weeks. One third of all medical school graduates had no orthopedic education. Because the results of the study were so shocking, it was repeated in 2002. A passing score was set at 70%. 78% of recent medical graduates failed to demonstrate basic competency in musculoskeletal medicine.

Needless to say, it may be very difficult to find help for your lower back pain, muscle pain, or joint pain. I am not a doctor, but I have found many ways in my studies and experiments (on myself, friends, and animals) to relieve pain using nutrition, supplements, low level laser therapy, myofascial release, and sports massage. Not only can pain be eliminated, but wellness and disease prevention can all be achieved with safe lifestyle changes.

Care of Your Equine Athlete

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People often make comments to me like “You must have really strong hands” or “Your arms must have big muscles”, but Trigger Point Therapy, Myofascial Release, Stress Point Therapy are all fairly gentle practices. Accuracy, through knowledge of anatomy, reduces the need for brute strength. The massage is deep, with firm pressure, stimulating endorphins, and the horse often helps me by leaning into my hands.

Trigger Point therapy targets areas of stress where muscle attaches to bone. The treatment specifically targets areas of constriction that refer pain signals to other parts of the body. Myofascial release is related to trigger point therapy, but focuses on tightness , or other disorders afflicting the fascia, a membrane that surrounds the muscles and may restrict their motion. What makes my work so exciting is that I can switch methods as I move around the horse, using what is needed for each area of the body.

All animals need to have their bodies in balance to live long and active lives. For show horses it makes the difference between winning and being withdrawn from the competition Tight muscles can affect posture, and poor posture can cause spinal misalignments. The reverse is also true — spinal alignments can lead to muscle strain.

Massage therapy should also be part of the process of rehabilitating from injuries, regaining lost range of motion, or coping with chronic pain conditions. Body work for your horse can produce dramatic results in a short period of time: one of the many reasons it is so exciting for me to go to work!

Help Your Pets Without Drugs

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Low Level Laser Therapy causes tissues to heal faster – muscle, skin and nerve – 66 percent faster, according to an FDA study. The study took 100 patients complaining of neck and shoulder pain. Half were treated with a useless red light (placebo group) similar to that on a computer mouse or grocery check-out, and the other half received LLLT. The treatment group beat the placebo group by 66 percent! That’s 66 percent faster and more complete relief – a remarkable margin. Similar studies have been passed by the FDA for carpal tunnel, wounds, and scar tissue.

Laser therapy is a non-toxic alternative to drugs. Animals with arthritis, skin conditions, injuries, and post surgical wounds can be safely treated with the cold laser. By avoiding over-use of medications, animals (and humans) will have more energy as they heal. There are no risks to this treatment, which is why I use it so much with my clients.