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RICE is not the answer to your pain, HEAT is!


By Jessica Kelner, D.O. - August 24, 2018

You had so much fun running on a new trail yesterday, but you sprained your ankle, again.  Even though it was already starting to swell, you were able to get back to your car okay and drive home.   When you got home, it started to ache and throb.  You wanted the pain to go away, but you weren't sure how to make that happen.  
 
We have all been told before, rest it, ice it, take some ibuprofen, wrap it with an ACE wrap and elevate it (or RICE therapy).  Does this work? Maybe, temporarily, but is this really helping your injury heal in the long run? The answer is NO. 
 
What is the ice, ibuprofen, and the ACE wrap doing? It is preventing your body from healing itself.
 
The ice and ibuprofen are stopping your body's natural inflammatory reaction to the injury. They are putting a halt on the natural healing processes that WERE occuring in your body to attempt to heal your new injury.  Yes, the attempt the body was making to heal itself was hurting, but ... that pain was also telling your body/brain that you were injured and the injured area needs some protection while it heals.  Makes total sense right? 
 
When you stop the healing process from occurring, your injury may not heal properly and your body may not remember it is injured. Well that sounds good, at least at first, until 6 weeks later when you decide to go running again.  So, naturally you step down and roll your ankle again.   Why is this happening?
 
This is happening because the ligaments you've injured never had a chance to heal properly.  The ice and anti-inflammatories prevented blood flow and other signalling processing in the body that were attempting to heal your new injury. The ACE wrap or compression, further prevented blood flow to the area,  preventing nutrients and oxygen from providing your newly injured ligaments with the substrates it needs to heal. Additionally, keeping your injured joint immobilized for an extensive period of time after the initial injury prevented adequate blood flow and encouraged muscle atrophy in the surrounding muscles. 
 
All injuries, including ligament and tendon injuries, involve the process of inflammation. Inflammation is the normal reaction of living tissue to injury. This involves a complex process by which your body's cells, such as platelets and other molecules send out massive signaling messages to the rest of your body to recruit the help it needs to heal the injury. Initially, the swelling you see is the body's natural way of protecting the area. By continuing the move the  joint that is swollen, the swelling will slowly go down and will allow the cellular process of healing to continue. Additionally, as mentioned before, this swelling lets your body (and brain) know this area is injured.  After the initial injury, your immune system becomes activated and will go through a complex process over the next 6 weeks to create new connective tissue and collagen. Collagen is what gives our tissues strength and integrity.  As long as the body is given everything it needs to heal (all the nutrients, oxygen, and adequate blood flow), the body can and will try to heal itself. 
 
Ligaments and tendons will become weak from inadequate repair after an injury occurs because of poor blood supply to the area where the ligaments and tendons attach to the bone.  This is a naturally weaker area in the body that is prone to injury. Due to the poor blood supply in these locations, the immune cells may not be able to reach the affected area resulting in inadequate healing.  Anti-inflammatory drugs and ice further decease the blood flow to the area, making it even more difficult for the body to be able to heal the injured tissue. 
 
What to do instead?
Continue to move the body part as your body tolerates.  Slowly, start to do exercises that will help strengthen the area.  Consult your physician about your particular injury and what exercises are safe to do before starting a rehabilitation program. 
 
Athletic tape (or kinesiotape) will help provide support to the injured ligament and help take some of the stress off of it while healing.  This will also tell your brain your ligament was supposed to be here performing this supporting function. 
 
Heat instead of ice: Heat naturally causes vasodilatation in the body, increasing blood flow to the area, and allowing for adequate oxygen and nutrition to get to the injured site.  
 
Pain control with alternative choices to anti-inflammatories: There are alternative options for pain control such as Tylenol  (please consult with your physician to ask if this is a safe alternative for you)  as well as natural topical creams and medications for pain.
 
I've coined the term "HEAT" to help you remember this.  H- Heat, E - Exercise, A - Analgesia, T- Taping
 
Lastly, if the pain persists and the body is unable to heal the injury on its own,  Prolotherapy is an effective treatment for healing injuries and get rid of pain. Prolotherapy is also known as "ligament reconstructive therapy". It is a safe, non surgical treatment for ligament and tendon injuries, arthritis, chronic pain, sprained ankles, knee pain, and much more.  Through placing a solution at the specific site of injury, Prolotherapy stimulates the body's own natural healing mechanisms to effectively heal the injury. 
 
For more information about Prolotherapy,  you may visit http://form-medical.com/Dextrose-Prolotherapy.
 
Next time you suffer an injury and need some pain relief,  give "HEAT" a try.