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Ice, no...heat! No, ICE, no...heat! The "p.r.i.c.e." Of Injuries
One of the most common questions we get asked in the office is: "Dr. Wolff, I just sprained my _______, should I ice it or heat it?" Good question! First, let's define just what is a sprain, and what is a strain. Then we'll see if getting in the hot tub will get you into hot water (ooh, bad pun). As some background for you: Aside from seventeen years in practice, I have been team doctor for College Of the Desert, AAA baseball team, Senior Olympics Basketball, and on. I treat you the same as I do them; your auto accident is no different than their football pileup. Your twisted ankle or strained low back gets the same care. Let's see what the two injuries really are:
Strains - I think we all have a pretty good idea about this one - an overexerted muscle or tendon that might even have some tearing (of the muscle and/or tendon) as well. We have all had them before and we know from experience that they're usually a lot better after about three days of rest.
Sprains are a totally different animal. With a sprain, a joint is affected and it isn't pretty. The tissue that surrounds the joint - the joint capsule - may be damaged, maybe even the joint cartilage, but ligaments are always damaged in a sprain. Ligaments are the tough fibers that connect bone to bone; holding it all together. Ligaments are strong, but they don't like to stretch and they hate to be torn. Sprains differ from strains too because they heal slower, and often require a second and just as important phase of treatment: rehabilitation to restore and prevent problems down the road. FYI: The vertebrae that make up your spine have discs, sure, but when you hurt your back, you almost always sprain one of the joints that connect between back bones.
Now we know that strains are muscle/tendon and sprains are joint/ligament. So what treatment do we do? Sometimes with an injury we will both sprain the joint and strain a nearby tendon or two. The good news is that your initial treatment is the same for the strain as it is for the sprain. So which is it, ice or heat? ......and the winner is ......ice! You're nodding your head, you already knew that, right? But, you've likely been told something like "ice for the first 48 hours, then heat." Mmmmn, that's half right. When we apply ice (and I don't mean the side of a cocktail glass, Mr. L.!) the goal is to reduce swelling to the injured area - muscle, tendon, joint, ligament, whatever. So the key is really:
Ice for the first 4 days, or for as long as there is still swelling
Heat is BAD after an injury. Heat is our enemy because we need to reduce swelling, right? Heat increases swelling, and that slows and even prevents healing from occurring. We have to get the swelling out so we can get the healing in. At the top of this article I gave you a word to remember all the right things to do after an injury: P.R.I.C.E.*
*Protect the area - don't re-injure! *Rest - 4 days of rest will really help; active rest is better yet. You can still ride the stationary bike if you strained a bicep! *Ice - 10-20 minutes with the ice pack directly on the skin, or a piece of paper towel between only! No cloth towels, here. I know we all hate the cold, it's why we moved here! Too bad, so sorry, you have to have to have to ice it down. Just look on the sidelines of any football game, at the throwing arm of any pitcher after the game and you'll see for yourself. *Compress - use an ace-type elastic bandage to help reduce swelling. But, don't use a neoprene - wetsuit-type - pull on support, they trap heat and that's verboten. The compression can come off whenever you need a break from it, but the more time with it, the better off you are. *Elevate - get the injury up and above your heart whenever possible. (Obviously this is highly dependant on just what you injured, so don't bust my chops on this one, ok?). Note to Self: "Icy-Hot" is not ice, not a substitute for ice! (but it is ok to rub on to knock down the pain for a few hours here and there)
Okay, so you turned your ankle getting off the stepladder last week. You remembered my fabulously informative article and rested, iced, compressed and elevated that hurt paw for three days. Is it still badly swollen? If yes, then go directly to your chiropractor or primary care provider (medical doctor) for evaluation. It may be a bad sprain taking longer to heal. Your health care pro will diagnose, and depending on the situation, will provide therapy, X-rays, crutches, splints, etc. The point here is to pay some attention to your body and do the right thing. It's time to get a professional opinion when the injury is not getting better, otherwise you may have permanent problems far greater than the original condition.
Oh, and by the way, chiropractic manipulation of sprained extremities has been shown to cut healing time. This makes sense since as I mentioned above your spine is made up of dozens of joints, the very things that chiropractors adjust to get you better, faster.
I look forward to answering any questions you may have. Email me: firstname.lastname@example.org.