For decades it’s been common practice to apply ice to an injury to decrease swelling. The research supporting this approach has been very poor, and lately, studies are showing that ice may actually have a negative impact on healing. Why are so many health care professionals still using ice as a first line of defense after a new injury? The suggestion is that ice slows down the circulation to the area and minimizes the accumulation of swelling. Is this the right reasoning and approach for this? Let’s dig deeper into the topic of swelling.
Inflammation isn’t bad!
There it is, we said it – the inflammation isn’t a bad thing. It’s actually a normal process of the human body, so why would we ever try to stop it?! When we injure a tissue, the body will try to remove the damaged stimulus and start the healing process. Part of this process is to increase blood circulation and lymphatic flow to and from the injured area. This allows for healing nutrients and inflammatory cells to the site of injury and help remove the damaged tissue. The best analogy to describe this is “groceries in and garbage out”. Groceries in refers to the fresh blood to accelerate healing and inflammatory cells to clean up the damaged tissue. However, this does increase the fluid to the site, meaning swelling will be present as well as an increased sensation to pain. Afterwards, there will be a big accumulation of waste (garbage) which will need to be evacuated out of the healing area. This is the role of the lymphatic system, it helps remove all the waste and excess fluid build-up caused by inflammation. Let’s find out more about how the lymphatic system is important in the inflammatory process.
The Swelling Highway – The lymphatic system
Our body uses 2 different systems of circulation. The main one being our actual circulatory system, which includes the heart, arteries and veins. The second system is our lymphatic system. The lymphatic system is a one way system of small bags that help direct fluid to the heart and reach the main circulatory system. The unfortunate thing about the lymphatic system is that it has no self-pumping action. The only way that any lymphatic fluid or accumulated swelling can move through the system is by movement and activity of the surrounding muscles. The muscle activity promotes a squeezing effect on the lymphatic vessels and pushes the fluid/swelling towards the heart. Without movement, swelling will stay still and not be evacuated from the injured area.
Why RICE just doesn’t work
RICE is an acronym that was coined to remind people of certain steps to stop inflammation: Rest, Ice, Compression and Elevation. These steps aren’t effective, here’s why:
Rest means that we are immobilizing the injured area, we aren’t moving. However, we now realize that we need muscle activation or movement for the swelling to be evacuated. Clearly, resting an injured area just doesn’t make sense. There was an article published in the American Association of Orthopaedic Surgeons in 1999 entitled ‘Loading of Healing Bone, Fibrous Tissue, and Muscle: Implications for Orthopaedic Practice’ confirming that moving sooner assisted healing. The article concluded that: ‘Although new approaches to facilitate bone and fibrous tissue healing have shown promise, none has been proved to offer beneficial effects comparable to those produced by loading of healing tissues. For these reasons, patients with musculoskeletal injuries and those who have recently undergone surgery are now being treated with controlled physical activity that loads their healing tissues’. To help an area heal we must stress it, and a simple way of doing that is by activating the surrounding muscles. So not only will the muscle activation help move the swelling away, it will actually help improve the healing process as a whole.
The application of ice to an injury helps to slow down blood flow to the area. This decreases pain but at the detriment of slowing down the evacuation of swelling. Since there is a lack of movement (muscle activity) with ice, it creates a back flow of swelling in the lymphatic system. So instead of decreasing inflammation like most people expect it to do, it actually increases it because it isn’t getting evacuated properly.
The purpose of compression is to provide additional pressure to the lymphatic system to help in the evacuation of the swelling. Using this approach by itself will not help to decrease inflammation. We must use it in combination with some light muscle activity, which will help push things up through the lymphatic system and into the general circulation.
This option helps to eliminate gravity, or the pooling of the inflammation in the extremities. But because the lymphatic system needs muscle activity to push the swelling through the body, this option won’t help in getting rid of inflammation, it’s too passive.
What should be the typical course of treatment following sprains or strains?
When we suffer an injury, having a active approach will provide the biggest benefit for healing. This is as simple as some gentle, pain free movement, as it helps maintain function and movement. The new approach has been given the acronym METH, which is Movement, Elevation, Traction and Heat.
METH: Movement, Elevation, Traction and Heat
Since the lymphatic system has no self-pumping action, it relies solely on the activity of the surrounding muscle to push the fluid through. It goes without saying that we do require some form of movement to help get rid of swelling. If moving a limb proves to be painful, applying a muscle stimulator on to key muscles is a good option. This allows for the needed muscle activity, and assist in the flow of the lymph without causing pain.
Probably the least effective option on its own, because it’s passive. However, combining elevation with some movement will assist the flow of lymphatic fluid away from the injured area and can often provide dramatic results.
Traction helps to take pressure off the injured area. Combine this with movement and it’s a winning combination as it increases the amount of fresh blood to the area. Traction with movement also helps to reduce pain as it takes some pressure off of the injured area.
This one is simple because heat helps to increase circulation. This will increase the amount of fresh blood arriving into the area in question. When we receive fresh oxygenated blood, things can heal much better.
Inflammation Good, Ice Bad
To sum things up, inflammation is a normal thing and we need it to heal an injury. However, ice does not reduce inflammation, it actually makes it worse by creating a back flow of fluid in the lymphatic system. The only thing that ice is useful for is numbing a painful area, or keeping a drink cold. If you want to help the body heal, think of METH – movement, elevation, traction and heat.