There is so much misinformation out there when it comes to how to handle acute injuries or trauma like after surgery. Whether you are treating athletes and seeing a high number of acute injuries, or a therapist in a clinic managing post op cases, the process of healing is a complex, integrated, and important thing to understand so that you are maximizing your patients ability to heal, instead of getting in the way.
Fact is, human beings are very good at healing. Think about it, if you were to buy a new car, the best day of that car’s life, is the day you drive it off the lot. It will not, and can never be, better than that day with use. Even though many clinicians use car metaphors to explain human function, the reality is, our bodies can get better with time, given the right circumstances, care, and stress.
I tell my athletes all the time, injuries can be UNFORTUNATE OPPORTUNITIES to learn about your body, how to treat it right, and move forward with a heightened awareness of the process. It is our job as clinicians, not to FIX the problem, but to FACILITATE their recovery by educating, and providing resources, in addition to our treatment methods. The best results happen, when you combine the RIGHT treatment, with education and support…
For today, let’s just talk about the 3 things NOT to do when dealing with an acute injury or coming off a surgical procedure.
#1. BURY THE INJURY IN ICE – This is perhaps the most common intervention method used in hospitals, physical therapy clinics, athletic training rooms, and as an at home remedy for anything that hurts. It is also, perhaps, one of the worst things you can do to an injury consistently over time. Now, there is a time and place for everything, including icing, but the way it is doled out as a silver bullet treatment across healthcare, and worse, WIDELY accepted as the “correct” thing to do, absolutely boggles my mind. Why does it boggle my mind, you ask? Because over 50 years since the famous RICE acronym was introduced, there still is little to no scientific evidence to support its use and role in the treatment of acute injuries. The term RICE, which stands for Rest, Ice, Compression, and Elevation, was coined by Dr. Gabe Mirkin in the 1970s, and in 2014, Dr. Mirkin recanted his statements, and apologized to the medical community based on the current evidence!!! Yet, this inexpensive, easy to get, and misunderstood modality, still persists in healthcare every single day.
Here’s the skinny. Ice, or cryotherapy, while an effective pain reducer, also is a vasoconstrictor, meaning it restricts capillary flow to the affected tissues. To keep this simple, vascular flow is important to deliver nutrients, oxygen, and immune factors like monocytes, to the area to begin the healing process. Burying their injury in ice only serves to further limit their bodies ability to deliver the necessary components of healing to the area of injury.
But Mike, what about getting rid of swelling and inflammation!?
Is the response I am most often met with… and usually, I answer this question, with another question…
Why is inflammation a bad thing?
You see, we have been programmed by outdated science, to think that inflammation is the enemy. It’s not. In fact, it’s step one of the healing process. Inflammation is part of our Immune systems response to injury…AND YOU CAN’T SKIP IT! You can, however, slow it down, which just delays the inevitable. So when you slap that ice and electric stim on a patient, you are basically just re-arranging the deck chairs on the titanic, and wasting their time, and your own. So unless you are in a lot of pain, save the ice for your post work cocktail…
#2. IMMOBILIZATION OR “JUST REST IT” – This kind of piggy backs off of reason #1. Immobilization is SOP (Standard Operating Procedure) in pretty much every doctors office, of any kind, that deals with an acute injury. Again, depending on the situation, immobilization may be required, like in the case of a bone fracture, or other more complicated structural compromise, as well as, post operative scenarios. Outside of that, however, immobilizing something like, let’s say a mild ankle sprain or muscle strain, is only going to further compromise the bodies ability to heal… and is the main issue when giving a blanket statement of treating ALL injuries the same way. Easier and cheaper for the clinician and the business, but not necessarily in the best interest of the patient…
You see, in order to evacuate swelling, again a normal, necessary process of inflammation, your body needs to activate the lymphatic system. The lymphatic system is basically where your circulatory and immune systems meet and mingle, and is the waste removal system of the body. Swelling, in essence, is a process that occurs when these systems collide in response to injury and yes, in many cases, needs to be managed…not ceased altogether.
However, our lymphatic system, doesn’t have its own “heart” or pump…it relies on movement, and muscle contractions to create the pressure to drive lymph through the system, and deliver all that cellular waste and debris back to the blood stream, so it can be filtered out and evacuated. Throwing that ankle in a boot, or cam walker, while protecting the injury, perhaps, also takes away the bodies ability to pump that swelling out, and thus, creating a situation where all you will have is MORE SWELLING, which limits ROM, increases pain, increases the need for pain meds, and further extends the time of recovery. To me, and the current body of evidence, the juice just isn’t worth the squeeze… Again, there is a time and place for everything, but if the goal is an expedited recovery with the best possible outcome, shutting everything down definitely isn’t the answer…
#3. TAKING ANTI-INFLAMMATORY DRUGS – Another one of those tricky SOP tactics doled out at every doctors office across the country, and shockingly even more prevalent in team sports. It’s all too common when someone comes in with an acute injury, or post surgical patient, they have been given, or are recommended to take anti inflammatory drugs like NSAIDs, which stands for Non-Steroidal Anti Inflammatory Drugs.
Why is this an issue? Well for basically the same reasons as above! The upside to drugs, which is small at best, is that they are easy, and can be effective for pain and even swelling. The downside, is the treasure trove of side effects that come with that little pill. In fact, many other countries have BANNED NSAIDS like Dexamethasone, a drug still very popular in the US, because of the stark increases in risk for cardiovascular compromise. True story…after my knee surgery in 2004, I was given a prescription for VIOXX, a drug that a few years later, was taken off the market for killing people…In addition, there have been NUMEROUS studies showing the myriad of potential negative side effects on health that come with using NSAIDS. Other deleterious effects include, Kidney/Renal dysfunction, Liver compromise, Gastrointestinal ulcers, increased risk of miscarriage in expecting mothers, and of course, risk of anaphylaxis. To this, I am often met with the following statement from clinicians of various backgrounds…
“BUT… if they only use them for a short period of time, then its ok…”
To answer this, I defer to Dr. Judy Racoosin, the Deputy Director of the FDA, Division of Anesthesia, Analgesia, and Addiction who stated that when it comes to NSAIDS, “There is NO period of use shown to be without risks.”
For many clinicians, I may have just slammed 3 of the most commonly used methods of the treatment of acute injuries and post-surgical scenarios. You may be asking, if not this…then what?
A NEW METHOD
Thats why I put together my new Online course, The End of The Ice Age: A Modern Approach to Acute Care. This course, geared towards clinicians of various backgrounds but also a must for any parent, coach, or doctor who wishes to go the extra mile for their patients and children! I go into much greater depth of the physiological reasons behind avoiding these discussed tactics, in addition to examining the current body of scientific evidence, and using that information to come up with modern, evidence informed strategies for helping our patients in the short term, while keeping long term prognosis in mind. Strategies, that in my opinion, are EVEN MORE EFFECTIVE anyway… The course comes with TONS of included resources for you to use to help your patients with greater care and precision than ever before…
Don’t believe me? You can check out the first 2 chapters ABSOLUTELY FREE and take a look for yourself, I’ll even go one step further and offer you a SPECIAL discount on the full course, just for checking out the preview!
https://themovementunderground.thinkific.com/courses/end-of-the-ice-age-a-modern-approach-to-acute-care-of-injuries
