Cool It, Boys 

Once and for all, is it heat or ice? My brother insists that putting heat on a freshly sprained ankle makes it heal faster, but I'm pretty sure that's wrong. It's supposed to be an icepack, right?

—Gordon

Now might be an excellent time to challenge him to a little one-on-one in the driveway. Chances are, while picking off a rebound from the basket, he will get a chance to test his theory. In that event, you'll have the perfect opportunity to break the news that he is quite wrong. And by using a heating pad, your brother will likely be too incapacitated by swelling and pain to catch you and apply the nipple cripple. It's just that kind of torture that could force you to renounce ice as the devil's work.

When we're talking about musculoskeletal injuries like bruises, strains and sprains, ice is certainly the best choice. Traumas like these produce capillary bleeding, spasm and inevitable swelling—all of which reduce oxygen to the surrounding tissue, worsen pain and lengthen healing time. This inflammatory response is nature's bubble wrap, an ingenious strategy to protect and cushion the damage, topped off with a generous helping of pain to discourage practicing more lay-ups. Prompt application of cold (known as cryotherapy) has the ability to constrict blood vessels, reduce swelling and speed recovery. In exchange for this minor miracle, we are expected to do a four-step bubble wrap of our own.

The RICE technique is not a Condi-esque method to deny all evidence of an injury, thus misleading the body into a regrettably aggressive response, but an easy-to-remember acronym for delivering strain/sprain first aid. Rest, Ice, Compression and Elevation are the four basic steps that should be started immediately following injury. The first directive, rest, is advice that's harder to follow than a Keanu Reeves movie. In the case of an ankle, rest may require using a splint, crutch or cane to minimize the chance of further damage. Ice, as noted, is a simple way to reduce pain; mounting evidence indicates it is unsurpassed for quickening rehabilitation. Multiple studies in sports and emergency medicine journals have shown that cryotherapy stabilizes an injury, reduces edema (swelling) and allows for early weight bearing on sprained joints. A maximum application time of 20 minutes each hour is the most critical guideline. This sacred rule keeps a complex survival mechanism from leaving you in a worse condition than you began (trust me on the details).

Compression works with the ice to minimize seepage of blood and other fluids into the injured area. Although fluid naturally accumulates around the damage as part of the cushioning plan, the trade-off is delayed healing from the additional time required for its removal—just as in New Orleans, keeping an area from flooding lessens the time needed for rebuilding. Compression bandages and elastic wraps can serve double duty by holding the cold source in place while applying pressure. Begin bandaging below the injury site, wrap the bandage tightly in the direction of the heart; take care not to cut off circulation (blue tingling toes are a clear sign to unwind the mummified ankle and give it another shot). Remove all compression wraps at bedtime. So, unless constructed by the Army Corps of Engineers, your bandaging should hold excess fluids outside the site of injury and accelerate the healing process. The final piece, elevation, assists the process by easing return of blood to the heart, minimizing pooling in the ailing limb. Day and night, with brief breaks, elevate the limb by resting it on pillows at least 12 inches above the heart.

As spiritually satisfying as it is to point out a brother's ignorance, he cannot be faulted for his heat misconception, as quite a few of us have this wrong. The use of heat during the first 48 hours, while feeling heavenly when applied, has hellish consequences. Heat increases inflammation and swelling, not to mention recovery time. The opposite is true after these first two days, or in chronic conditions; using heat later (the sacred 20 minute rule still applies) is exceptionally effective in encouraging circulation and removing waste products associated with healing.

Gordon, I'm sure this won't be the last disagreement you'll have with your brother, but at least you've won this one. On the other hand, I expect you may wake up to a clammy, melted coldpack on your bare chest. In the interest of family harmony, I can't condone shortening his crutches while he's asleep, but I suppose I could accidentally mention it.

Dr. Ed Rabin is a chiropractor practicing at Life Chiropractic Center in Boise. Send bubble wrap and health-related questions to theantidote@edrabin.com (on the Web at www.edrabin.com).

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