Ice or heat for injuries?

acupuncture fire iceA question I am often asked in clinic is “Should I use ice or heat on this injury?”.

The icing controversy

The conventional viewpoint is that it’s best to ice an injury in the first few hours and to apply heat to a chronic (long-lasting) injury. Ice, along with rest, compression and elevation (R-I-C-E), is seen to limit swelling and inflammation for the first 24-48 hours following an injury. However, the use of ice has recently been questioned by some in Western medicine, and has never been advocated in Traditional Chinese Medicine. In clinic, what we tend to see is that people continue to ice injuries long after this initial period, and that this can lead to problems.

This is particularly true for tendons and ligaments, as these structures naturally have less blood supply than muscles. So ligament and tendon injuries are particularly likely to become longstanding if we interfere with the already low blood flow.

So among some sections of the sports injuries world, for tendon and ligament injuries, RICE has been superseded by M-E-A-T (movement – exercise – analgesia (pain relief) – treatments (that promote blood flow).

Conventionally, ice application is recommended immediately after an injury under the premise that it helps the coagulation process, limiting bleeding from damaged blood vessels. The second reason put forward for icing an injury is that ice can ease inflammation. Thirdly, it has a numbing effect so can help relieve pain.

So let’s look at these aspects in turn.

Stopping bleeding immediately after an injury certainly makes sense. But how long is the window of opportunity for this? One animal study suggests that critical period for preventing secondary injury (from swelling due to bleeding around the injury) may be much shorter than we originally thought – somewhere from 30 minutes to 5 hours, with the first 30 minutes being the most critical.

It’s generally accepted that too much inflammation is a bad thing. But some animal research shows that interfering with inflammation after trauma may be detrimental. It could actually slow down healing. Researchers have found that injured cells produce the inflammatory hormone IGF-1 (insulin-like growth factor-1), which significantly increases the rate of muscle repair. In mice bred to not produce IGF-1, healing after an injury was slower than in normal mice.

How about pain relief? In 2004, researchers looked at all the available studies to try to determine the effectiveness of ice after injuries and surgery. As part of this, they looked into pain relief. They found that while ice helped to reduce pain, the majority of studies showed that compression alone was just as effective. They also noted that there wasn’t much good-quality research into this area.


How Traditional Chinese Medicine sees cold

In Chinese Medical theory, too much cold is not a good thing. In fact it is seen as the root of many problems, with the cold becoming lodged in the tissues, leading to ongoing stiffness and pain.

Of course, in ancient China there were no freezers. Only those who lived in cold or mountainous regions would even have had access to ice. So people needed other ways to treat injuries. Traditional Chinese Medicine has a whole toolkit of techniques to help heal injuries. For acute injuries, a form of massage incorporating acupressure points (tui na), as well as acupuncture and moxibustion (a herbal heat treatment on specific points) can help relieve pain and reduce swelling. For chronic injuries that are slow to heal, as well as the above therapies, techniques such as Tai Chi can be very useful in gently promoting movement and freeing up the area. These forms of treatment correspond much better to the MEAT viewpoint than the ICE protocol – Tai Chi for movement and exercise, acupuncture for analgesia (pain relief), and acupuncture/massage and moxibustion for treatments that promote blood flow, thereby promoting rather than hindering the body’s natural healing mechanisms.


How does heat help after an injury?

Heat is certainly useful in the chronic phase of an injury, as it relaxes the area, promotes blood flow and relieves pain. I generally recommend patients apply warm packs after any swelling has gone down. Another approach is to use ginger soaks or compresses, which also have a warming action. [Link to ginger poultice article]

When used correctly, heat is also very useful in the acute phase of an injury. If you come to see me in the first couple of days after minor trauma, I will perform a full assessment of the injury. Then I will usually burn small cones of moxa, derived from the leaf of the mugwort plant, to apply heat to specific points around the site. I can also teach you how to use this technique at home between clinic visits, to maximise the rate of healing. When used in this way, moxa actually has a slight cooling effect (by encouraging local sweating), but is much gentler than ice. It encourages local blood flow and reduces pain, allowing you to gradually get back to the activities you enjoy. Other moxibustion techniques are useful once the inflammation has started to subside and we are concentrating on regaining range of motion.

Gentle acupuncture using very fine needles at specific points is also helpful in triggering the body’s healing mechanisms.


Heat or cold for injuries – summary.

  • See if you can avoid ice if possible, especially for injuries likely to involve ligaments and tendons rather than muscles – in other words the sinewy parts of the body: ankles, knees, wrists/hands. If you are going to use ice, restrict it to the first 24-48 hours. Make sure any cold compress / ice pack is well wrapped in a towel to avoid injuring the skin from excessive cold. Use for no longer than 20 min at a time.
  • Heat is more useful after this stage, along with gentle mobilisation, depending on the extent of the injury. Be guided by your body and stop any movements that make the pain worse.
  • If you can get in to see an acupuncturist in the first day or so after the injury, this is very useful and may allow you to avoid using ice and speed up recovery.

Neck and shoulder pain.

acup-shoulder-painMany of us live with permanently stiff shoulders or a neck that seizes up from time to time. Our modern lifestyle is a major culprit, with computer work (especially on laptops) putting a lot of strain on the neck and shoulders. Out-of-control stress levels don’t help either. One of the worst environments for neck and shoulder pain is a high-pressure work environment with badly set-up computers and cold air flowing down on you from air conditioning. With this sort of combination of stress, poor ergonomics and the tendency to tense up the shoulder muscles in response to cold, it’s not surprising that so many people suffer from stiff neck and shoulders.

Other things that can trigger neck and shoulder pain are prolonged driving, freehand writing or drawing, occupations involving a lot of repetitive use of the arms (hairdressing comes to mind), and playing some musical instruments.

So what can be done? Obviously it’s important to address anything in your lifestyle that might be contributing, which could involve a rethink of your work or leisure patterns. I’ve included a list of other tips at the end.

But what if your shoulders and neck are still sore after doing everything you can to relax them? This is where acupuncture comes in.

Japanese acupuncture uses several needling techniques to melt tension in the neck and shoulders. Another technique that is great for neck and shoulder pain is moxibustion – the use of a warming herb on the tight, painful areas. Cupping is also very useful. But much of the treatment is done away from the local painful region– as it is just as important to treat the constitutional pattern that Oriental medicine sees as causing disruption to the flow of energy, as we see this as underlying the neck and shoulder pain. This ensures that treatments will have a lasting effect.

We usually see an improvement within 4-6 weekly treatments, and when this happens we scale back the frequency of sessions as your body “relearns” this state of reduced tension. Eventually most people will just need the occasional top-up session every few months or so during periods of particularly intense activity or stress.

Tips for relieving neck and shoulder stiffness:

  • Make sure your desk is properly set up. Many offices these days have ergonomic guidelines and it’s also possible to have an expert review your set-up.
  • Give your neck and shoulders a break by taking lots of breaks from computer work, or other intense activities like writing freehand, drawing, music practice or driving. Aim to have a break where you get up, walk around and stretch after every 20 min of typing etc.
  • If at all possible, avoid sitting in air-conditioning, or wear a scarf (or a top with a collar that covers your neck).
  • Warmth helps most people with this sort of pain, so try hot showers or heat packs.
  • Try to build some type of relaxation into your day, like meditation, yoga or Tai-Chi. Another really useful strategy is to focus on becoming aware of shoulder tension as it builds up and repeatedly and deliberately relax and drop your shoulders. Tricky to do at first, but it gets easier with time.
  • It is also often possible to strengthen other muscles in the upper body so that your traps don’t take all the strain. If you go to a gym, ask one of the trainers to show you how to strengthen these muscles.


Top 7 Naturopathic Tips to Avoid The Winter Blues

Box Of TissuesWinter has well and truly set in and with it a host of colds and flu, not to mention the winter blues (or SAD as it is also known). This time of year, it is important to keep your immune system functioning as optimally as possible. There are an abundance of things we can do to both boost our mood and maintain our immune systems, and fight nasty bugs as we come into contact with them.

Here are my top seven tips to keep the winter blues away:

1. Exercise and Sunlight

One of the first things we do when the cold hits is to go into hibernation. While it feels good to stay snug and warm inside its one of the worst things we can do for both our immune system and happiness. A minimum of 40 minutes of good cardio exercise (where you get a red face and puff a bit) 4 times a week works wonders. Exercise helps produce ‘feel good’ hormones as well as boosting the immune system.

We are blessed in winter in Australia by clear blue skies most of the time. Make time to get out into the sunshine a few times a week. Even if it’s just sitting in the park at lunchtime or a couple of walks outdoors on the weekend. Your immune system and mental health will thank you for it.

Vitamin D deficiency is surprisingly common in this country, and can affect both your mood and immune system, so consider discussing Vitamin D supplementation with your healthcare practitioner if you think you may be deficient.

2. Get Cooking

Incorporate the following foods into your winter cooking, especially soups, casseroles, stir fries and slow cooked dishes:

  • Garlic – antiobiotic and antiviral
  • Ginger – warming
  • Chilli – warming
  • Onions – antioxidant and antiobiotic
  • Miso soup – supports healthy bacteria in the digestive system, profoundly affecting immune function

3. Olive Leaf Extract

This herb (botanical name Olea europaea) is used to enhance the immune system through its antiviral, antimicrobial and potent antioxidant activity. It particularly works well when combined with other immune boosting herbs such as Echinacea and Andrographis.

Olive leaf treats the symptoms of:

  • Reduced Energy
  • Colds & Flu
  • Upper Respiratory Conditions
  • Anxiety & Tension
  • Sinusitis
  • Sore Throats
  • Fevers

4. Vitamin C with Bioflavonoids + Vitamin A + Zinc

An essential nutrient combination for boosting the immune system and keeping the respiratory tract healthy. A large number of trials with intakes of up to 1g of vitamin C and up to 30mg of zinc are available. These trials document that adequate intakes of vitamin C and zinc improve symptoms and shorten the duration of respiratory tract infections including the common cold.

Bioflavanoids are a type of antioxidant naturally found in foods high in vitamin C, and seem to enhance the action of the vitamin.

If you don’t like taking supplements, then a fresh juice of pineapple, lemon, carrot and ginger will provide a good amount of Vitamin C and Vitamin A, along with the warming properties of ginger.

5. Steam Inhalations

Steam inhalations with essential oils of Thyme and Eucalyptus, help to promote the removal of excess mucous in the nose and chest as well as being strongly anti-microbial therefore helping to kill off any secondary bacterial infection of the respiratory tract.

It’s simple: to a bowl of boiling water add 2 drops of thyme oil and five drops of eucalyptus oil. Place a towel over the head and deeply inhale through one nostril at a time, while blocking the other. Do this until the steam has completely evaporated (approx.5-10 minutes). Blow the nose as required during the process.

If you have a vapouriser, adding a few drops of Citrus, Bergamot and/or Lavender oils can help boost your mood throughout the day with their sunny scent.

6. Herbal Tea

Herbal teas have the benefit of directly targeting specific problems as well as providing much needed hydration in winter, when cold water is not very appealing. Yarrow, Elder and Peppermint tea is a great mix for colds and flu. Ginger is also excellent for those who suffer with cold hands and feet, as it is a potent stimulator of the circulation. Slice some fresh ginger root and steep in a cup of boiling water with lemon slices and honey.

7. Wash Your Hands

Frequent hand washing can be one of the most effective means of cold and flu prevention. If not always near a bathroom with running water and soap, then carry a gel sanitiser in your car or purse and use when in public places.