Is ice beneficial post injury?

I had a conversation with a coach earlier this week who was asking me about ice. He had conversations with other coaches who had read the book, Iced by Gary Reinl, and he wanted to get my opinion. Since I have not read the book I felt that in order to give an informed opinion I should do some research. I looked at an interview with Gary about his take on ice and then searched medical journals to see whether ice had been tested and what the outcomes were. I was a little surprised at the lack of studies that specifically study ice in the many applications that it has been prescribed for.

In school we are taught that ice has an effect on the inflammation process and that the inflammation process is a problem and should be decreased as soon as possible in order to speed recovery. When tissue is damaged, the body sends microorganisms to the injury site to fight the inflammation and part of that process is tissue swelling. Ice helps to decrease the blood flow to the area in order to slow this process down. One of the main arguments against ice in the acute inflammatory process is that this inflammation is actually beneficial to the body. Inflammation is the body’s way of breaking down tissue and laying the groundwork for recovery and an interruption to this process can be potentially detrimental.

Acute sprains: Ice has been the mainstay of treatment, along with the remaining letters of the acronym, RICE, for years. When I reviewed the effectiveness of RICE on outcomes, there are very few well controlled studies and the main conclusion is that more needs to be done to study the effect of RICE on treatment outcomes and return to play decisions.

Pain control: Ice has an analgesic, or pain relieving, effect on injuries. Applying ice to an acute injury can help to decrease the pain associated with the injury in the first couple days. Ice does appear to aid in recovery the first 48 hours post surgery.

Tendon injuries: Chronic tendon injuries are characterized by a breakdown and a change in the tendon itself, without the presence of inflammation. Ice is used for pain associated with the condition, but should not be used for inflammation.

Delayed onset muscle soreness: Ice may have an effect on the pain associated with DOMS as a result of activity, but it does not shorten the time of discomfort. The main treatment for DOMS is light exercise.

During the course of the research I learned that rest and immobilization can cause the collagen fibers that repair an injury to align themselves in a haphazard manner and that moving the joint post injury can get these fibers into better alignment. I want to stress that this is for sprains and strains and not fractures or dislocations, which need different management. It appears that immobilization for a day followed by movement can also help improve healing in the hamstrings that are more significant than a mild strain.

 

In light of this research review I will make some changes in how I recommend athletes manage an injury:

I will recommend ice as a pain modifying treatment to be used for 10 min to decrease pain in the first 48 hours following an injury and to move the joint as they are able. I will still recommend compression and elevation for swelling in conjunction with movement.

I will recommend that athletes lightly exercise if they are sore.

For chronic conditions I will recommend soft tissue work and eccentric exercise.

Hip flexor tightness

I was talking with a  friend of mine who is having hip pain and wondering what to do for it. She has been seeing a practitioner for active release, but is not sure what to do on her own to help keep it from being too tight. Tight hips are a common malady in the population since so many of us sit throughout the day which puts our hip flexors in a shortened position. In order to restore normal motion focus on these things:

 

Strengthen the glutes: your muscles act as opposites, so if your hip flexors are tight it means your glutes are not tight enough. Focus on bridges, squats and lunges to strengthen them.

 

Reverse lunge with overhead reach: I really like this one for stretching the quads, hip flexor and abdominals. Perform a reverse lunge and reach both arms up as high as you can and hold for a few seconds, then switch legs. Perform 3-5 reps each.

 

Kneeling stretch: get into a half kneeling position and reach your same arm as the knee on the ground in the air, push forward and raise your foot for a greater stretch. Hold for 60 sec.

 

Self-release: Get into a half kneeling position and apply pressure over the hip flexor then lean forward at your hip to relax the muscle and then extend your hip and sit up straight to increase pressure. Perform 2-3 sets of 10 reps.

 

Acute Achilles Tendon Rupture

This morning I had the opportunity to assess a semi pro football player who injured his ankle. Upon exam he has a clinical picture consistent with an Achilles' tendon rupture. That got me thinking of the treatment options for these injuries and is surgical or non surgical treatment preferred?

I did some research and it appears that there is no clinical significance between surgical or non surgical treatment. Non surgical care has a slightly higher incidence of re rupture, but surgical has great her incidence if complications including nerve damage and infection. Both outcomes show improvement at 6 and 12 months but less than the non-injured side, as expected. 

Two treatments that seem to help regardless of surgery or no surgery are a functional brace instead of casting an early rehabilitation. 

Active individuals who want to return to activity may lean more toward surgical treatment. 

Hamstring injuries

I was visiting a friend over the weekend who injured his hamstring a couple of months ago and is still having discomfort.

He asked me for some help and this is what I discussed with him. 

Hamstring injuries are tough: they are a main leg stabilizer and decelerate your hip and knee. When they are injured they heal weaker and shorter. Treatment is dual phase, increase the extensibility to restore normal motion and increase strength. My favorite exercises combine these things. 

Airplanes or single leg Romanian dead lifts. Hinging off the hip with the knee in one position puts stress on the hamstring to eccentrically strengthen it. 

Single leg drops help to improve the flexibility of the hamstring. 

Russian hamstrings are a very tough exercise and excellent for increasing the strength in the hamstrings. Once again the focus is on eccentric strengthening.