November 2011 – Ice your injury

As the winter weather gradually rolls in, the last thing that you may feel like doing is putting ice on your body. When injured, however, this may be exactly what you need.

The body’s first response to injury is inflammation. This is a natural and necessary response by the body to injury. It serves to remove any harmful bodies or dead tissue at the injury site. Importantly, it facilitates and activates tissue repair and it prevents further injury.

Inflammation can, however, often be extremely painful and disproportionate to the degree of injury.  In these cases, it is desirable to ease the inflammation enough to make the injury more comfortable without eliminating it fully, so that tissue repair can continue.

You may be familiar with the acronym R.I.C.E. This stands for: Rest, Ice, Compression and Elevation. It is the Ice component of this first aid response to injury and, particularly, it’s anti-inflammatory effect that I want to discuss in this month’s blog.

It is helpful, first, to understand why an area becomes inflamed and what the stages of inflammation are.

When a tissue is injured, a collection of chemicals are either released by cells or formed from precursors in the blood. These include prostaglandins, histamine, chemotactic factors and kinins. These and other chemicals cause dilation of local blood vessels and increase the permeability of those vessel walls so that healing immune cells can pass through them and into the site of injury. Immune response cells are chemically attracted to the injured site.  This results in a build-up of cells, some of which produce a protein exudate as they ingest damaged tissue. The increase in cell numbers and exudate at the site of injury draws fluid to the area by osmosis causing it to swell.

This process produces a number of signs and symptoms including heat, redness, swelling, pain and loss of function.

  1. The area becomes hot – first from the increased blood flow and then from the increased metabolic rate that results from the accumulation of blood. This accumulation of blood produces redness.
  2. The area swells from the excess fluid.
  3. The area becomes painful due to chemical stimulation of nerve endings, as well as from the build-up of pressure from swelling. Prostaglandins intensify and prolong this pain sensation.
  4. Both the swelling and pain result in a loss of ability to use the injured tissues, preventing further tissue damage.

Ice, when applied locally to the injury, has an extraordinary anti-inflammatory effect. It works by causing constriction of the local blood vessels reducing blood flow to the area. It also cools the area so that the rate of metabolism is lowered and the heat, redness and swelling are reduced as the inflammation subsides. The cold has a numbing effect on nerve endings so that the perception of pain is reduced.

As long as the injury is healing, the inflammation will return, but regular icing can keep it to a manageable level.

Overall, the ice helps to moderate the bodies healing response so that discomfort and limitation of function can be kept to a minimum whilst the healing process continues.

Anti-Inflammatory drugs, such as ibuprofen, are also extremely effective at reducing inflammation and are a good alternative when ice cannot be accessed. Anti-inflammatories reduce inflammation by inhibiting prostaglandin production. However, they carry side effects and are not safe for use by everyone. Anti-inflammatories weaken the digestive system’s protective bicarbonate layer causing indigestion, ulcers and stomach upset. As well, anti-inflammatory drugs thin the blood and can trigger asthma symptoms. For this reason you should always consult a pharmacist or doctor before taking any anti-inflammatory medication.

The great benefit of using ice over anti-inflammatory drugs is the fact that the ice works only locally, without any of the side-effects associated with medication and without affecting any other body systems.

Frozen peas make a great ice-pack as they easily mould to the shape of any injured area and they are easily re-used. The ice pack should be wrapped in a towel or cloth to protect the skin from the extreme cold. The pack should be applied for 10 minute intervals and every hour.

There is a school of thought that believes prolonged application of ice (more than 20-30 mins) has a pro-inflammatory effect by causing dilation of the blood vessels (similar to what happens with hypothermia). For this reason the ice should not be applied for more than 15 minutes.

Ice, along with rest, compression and elevation can be enough to control a minor injury through a quick recovery without treatment. If the pain or swelling persists for more than a few days then visit your Osteopath and have a thorough assessment, treatment and injury rehabilitation. If you suspect that you may have a fracture then you should visit A & E and get checked out there first.

Stay injury free!

 

Geoffrey Hogan (M.Ost)
Registered osteopath

 

 

 

 

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