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major part of sports medicine is the rehabilitation of sports
injuries both conservatively and post-operatively.
Although much of this requires the expertise of the
sports medicine doctor, athletic trainer and/or the physical
therapist, there are some basic principles which, if understood,
can help everyone minimize their down time from sports related
injuries.
Its
been said that there are only four words that a sports medicine
doctor has to know in order to practice:
put ice on it. Though
this obviously understates the vastness of the field of sports
medicine, this joke does point out the untility of temperature
modalities in treating musculoskeletal injuries.
Very
often, people present themselves for evaluation in a sports
medicine clinic for one injury or another, say for example an
ankle sprain. Their
ankle may be markedly swollen but have other signs that lead the
doctor to believe that it is a relatively minor sprain.
When asked what treatment they used acutely, patients
will often report applying moist heat to their ankle to reduce
the swelling. Unfortunately
their action had exactly the opposite effect.
Ice
is the “miracle drug” of sports medicine.
Ice serves to reduce inflammation, provide pain relief,
allow for increased range of motion secondary to decreased pain
and decrease swelling in an injured body part.
Ice is universally safe to use on musculoskeletal
injuries and, when in doubt, should be used as opposed to heat.
Ice
or cold works by several mechanisms to accomplish all of the
things listed above. One
of the primary mechanisms of action of ice is vasoconstriction.
This means that when the tissues get cold, the blood
vessels traversing the tissues shrink to a smaller diameter.
This decreases the blood flow to the tissue and
subsequently reduces swelling and edema in the injured area.
Ice
also slows down many of the reactions that take place in the
inflammatory cascade. This
is a “physical” way to accomplish more or less the same goal
as we do “chemically” with the use of non-steroidal
anti-inflammatory medicines.
Sports
doctors often hear the people don’t like to use ice because
they are afraid of getting frost bite.
This is largely a myth.
It would be difficult or impossible to get frost bite by
applying ice therapeutically to an injured body part.
People
are also reluctant to use ice because it can be uncomfortable
when first applied. It
should be remembered though that after a few moments of initial
discomfort, the tissues in contact with the ice will become
numb.
There
are a couple of things to keep in mind when using ice on a
sports injury. First
is that moist cold is better than dry cold.
Get the ice bag wet (assuming you’re using traditional
ice in a bag) and then apply it.
Commercial ice bags work fine too and should be used
according to the directions.
Believe it or not, a bag of frozen corn or peas makes a
very effective and reusable ice bag.
When
applying ice to an injury, a good rule of thumb is to ice 20-25
minutes several times a day.
Most injuries may be iced as frequently as 20-25 minutes
per hour. Ice
should not be left on continuously. Also, care should be taken not to ice the inside of the
elbow or the outside of the knee more than about 15 minutes.
Moist
heat is another extremely useful modality.
Unfortunately though, heat does not have the universally
beneficial effect that ice does.
Like
ice, moist heat can serve as an analgesic to reduce pain.
The difference is that heat does not typically reduce
swelling and effectively vasodilates the blood vessels running
through the heated tissues.
If the area is already swollen or edematous, increasing
the amount of blood flowing into the tissue will only serve to
make matters worse.
Heat
is usually reserved for older injuries where ice can universally
be used for injuries under 72 hours old.
If the injury has not been aggravated recently and has no
active swelling, heat is usually beneficial..
If, on the other hand, there is active swelling or the
injury has been aggravated recently (like during a sports
practice) ice would be a much better choice.
In
treating chronic injuries where play is not restricted but the
injury requires treatment nonetheless, the rule of thumb is heat
before and ice after activity.
Of course, these are only guidelines..
Some specific injuries may be treated with regimens which
are exceptions to these broad rules. However, please keep in mind this take home message......when
in doubt, use ice on musculoskeletal injuries and ask your doc.
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