Saturday, October 29, 2016

When to Ice an Injury

Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.” – Gabe Mirkin, MD, March 2014


Why Ice Delays Recovery
Author Gabe Mirkin, MD
 
When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression, Elevation) for the treatment of athletic injuries (Little Brown and Co., page 94). Ice has been a standard treatment for injuries and sore muscles because it helps to relieve pain caused by injured tissue. Coaches have used my "RICE" guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.

In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage (The American Journal of Sports Medicine, June 2013). A summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains (The American Journal of Sports Medicine, January, 2004;32(1):251-261).
 
Healing Requires Inflammation
When you damage tissue through trauma or develop muscle soreness by exercising very intensely, you heal by using your immunity, the same biological mechanisms that you use to kill germs. This is called inflammation. When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing. The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal. However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.
The authors of one study used two groups of mice, with one group genetically altered so they could not form the normally expected inflammatory response to injury. The other group was able to respond normally. The scientists then injected barium chloride into muscles to damage them. The muscles of the mice that could not form the expected immune response to injury did not heal, while mice with normal immunities healed quickly. The mice that healed had very large amounts of IGF-1 in their damaged muscles, while the mice that could not heal had almost no IGF-1. (Federation of American Societies for Experimental Biology, November 2010).

Ice Keeps Healing Cells from Entering Injured Tissue
Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014). The blood vessels do not open again for many hours after the ice was applied. This decreased blood flow can cause the tissue to die from decreased blood flow and can even cause permanent nerve damage.

Anything That Reduces Inflammation Also Delays Healing
Anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by:
• cortisone-type drugs,
• almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)),
• immune suppressants that are often used to treat arthritis, cancer or psoriasis,
• applying cold packs or ice, and
• anything else that blocks the immune response to injury.

Ice Also Reduces Strength, Speed, Endurance and Coordination
Ice is often used as short-term treatment to help injured athletes get back into a game. The cooling may help to decrease pain, but it interferes with the athlete's strength, speed, endurance and coordination (Sports Med, Nov 28, 2011). In this review, a search of the medical literature found 35 studies on the effects of cooling . Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running. A short re-warming period returned the strength, speed and coordination. The authors recommend that if cooling is done at all to limit swelling, it should be done for less than five minutes, followed by progressive warming prior to returning to play.

My Recommendations
If you are injured, stop exercising immediately. If the pain is severe, if you are unable to move or if you are confused or lose even momentary consciousness, you should be checked to see if you require emergency medical attention. Open wounds should be cleaned and checked. If possible, elevate the injured part to use gravity to help minimize swelling. A person experienced in treating sports injuries should determine that no bones are broken and that movement will not increase damage. If the injury is limited to muscles or other soft tissue, a doctor, trainer or coach may apply a compression bandage. Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10 minute application once or twice. There is no reason to apply ice more than six hours after you have injured yourself.

If the injury is severe, follow your doctor's advice on rehabilitation. With minor injuries, you can usually begin rehabilitation the next day. You can move and use the injured part as long as the movement does not increase the pain and discomfort. Get back to your sport as soon as you can do so without pain.

Checked 10/13/16

http://www.drmirkin.com/fitness/why-ice-delays-recovery.html

Friday, March 18, 2016

Differentiating Tendonitis and Tendonosis





Correct diagnosis is the most important step when looking for care and treatment tendon injuries.  The correct treatment in tendon injuries (tears, tendonitis, tendonosis) and acupuncture treatment at  muscle tendon junctions, bone tendon junctions and the related muscles, can make a world of difference for collegiate and professional athletes who have a urgent timeline and need to get back in the game.

 

In this article published by the Pacific College of Oriental Medicine, acupuncturist Mark Kastner breaks it down.

The Misdiagnoisis Of Tendonitis


By Mark Kastner, LAc
Tendonitis is the single most diagnosed chronic connective tissue disease in Western medicine. It affects every major joint within the body and can make the most well conditioned athlete limp to the sidelines, as the pain can be overwhelming. Whether it afflicts a professional golfer or weekend tennis player, tendon pain is a huge problem affecting all sports.
In our everyday lives, tendon pain also creates major problems. According to statistics of Workers Compensation injuries in California, repetitive motion disease (aka tendonitis) is the leading diagnosis for claims and disability in the state. Over the years, studies have begun to shed new light on this age-old problem, and it is my belief that acupuncture is positioned to play a major part in helping to solve this pattern of chronic pain.

Monday, January 25, 2016

Acupuncture Sports Medicine Apprenticeship

This weekend in the San Francisco Bay area, I had the incredible opportunity to assist Whitfield Reaves during the first weekend of his Acupuncture Sports Medicine Apprenticeship program. Acupuncturists came from as far as Toronto and as close as San Francisco. It was a small very focused group. We covered a lot of ground in three days of training with close supervision of precision needling techniques. 

 If you are an acupuncturist looking to develop your skills in the treatment of sports injuries and pain, I highly recommend this course. It will change your practice and your capacity to help your patients.  



San Francisco Bay Area, California

The Acupuncture Sports Medicine Apprenticeship Program

In January, 2016, we will begin another program on orthopedic and sports acupuncture in Oakland, California. This course is limited to twelve practitioners, and the mentorship-style group includes two to three experienced practitioners to assist Whitfield Reaves with instruction and supervision. The site in on the San Francisco Bay in Alameda, near the Oakland airport, and a ferry ride from downtown San Francisco. Practitioners may take these three-day weekends individually or all three as a program.
  • Weekend #1: January 22, 23, & 24, 2016 – The Neck, Shoulder, and Upper Extremity WAITING LIST
  • Weekend #2: February 19, 20, & 21, 2016 – The Low Back, Hip, and Pelvis WAITING LIST
  • Weekend #3: March 18, 19, & 20, 2016 – The Lower Extremity LIMITED SPACE
This program has several openings! Inquire now.
Cost: $900.00 per weekend, with a $300.00 deposit needed to hold a space.CEUs: These three courses are each approved for 20 PDAs/CEUs by the NCCAOM and the state of California.Site: The Hampton Inn and Suites, Oakland Airport, in Alameda, California

www.whitfieldreaves.com



Rugby World Cup Sevens 2018 in SF will offer Acupuncture!

So excited to be a part of the Rugby World Cup Sevens 2018 at AT&T Park in San Francisco.  I will provide sports acupuncture therapy...