Injuries

Acute Injuries

An acute injury should be treated promptly to reduce the chances of it leading to chronic problems. The sooner you treat an injury, the better. If you have heard a “pop” or “snap,” seek medical attention for a diagnosis. It is possible to tear a muscle, tendon, or ligament, or break a bone without knowing it. If the swelling and bruising don’t go down within a few days, get a diagnosis.

For the past 60+ years the standard treatment recommendations for injuries has been “RICE”:

Rest the affected body part.

Ice to reduce swelling, help prevent bruising, and increase blood flow to the area. You can use a cold compress (cold water with ice cubes in a gallon baggie works well), or if it is your lower leg/foot or lower arm/hand, you can submerse it in ice water, no more than 10 minutes total per time. You can take it in and out as needed to your tolerance. Ice off and on for at least 48 hours.

Compression, such as with an ace bandage (but not so tight as to cut off circulation!). If it throbs or just feels too tight, rewrap it more loosely. This technique is for acute injuries only, unless otherwise instructed by your medical provider.

Elevation of the affected area reduces bleeding and swelling.

I included this advice in my book “Trigger Point Therapy Workbook for Knee, Leg, Ankle, and Foot Pain.” But now some health care providers and researchers are questioning how these recommendations were developed (they weren’t developed based on randomized controlled trials), and whether RICE really is the best course of action. The goal of RICE is to reduce inflammation, but our bodies need inflammation to heal properly. This is particularly true for ligaments and tendons, which have a poor blood supply. RICE stops blood flow, along with the healing cells the body needs to regenerate damaged tissue. Plus pain is supposed to keep us from over-using the area. You need to be careful with icing or using analgesics such as Tylenol or Ibuprofen, because you won’t be in touch with what you should or should not be doing with the injured area.

One proposed alternative is “MEAT” – Movement, Exercise, Analgesics, and Treatments. Gentle movement and gentle range-of-motion exercises improve blood flow to the injured area (your movements should be pain-free). Natural analgesics (such as herbs and homeopathics) move Qi and Blood to remove the damaged cells and bring in the healing cells (such as thrombocytes, leukocytes, macrophages, fibroblasts, myofibroblasts, and fibroclasts). Treatments such a massage therapy, acupuncture, physical therapy, and ultrasound increase blood flow and cell migration to the injured area. Another proposed alterative is “METH” – Movement, Elevation, Traction, and Heat. It will be interesting to see what emerges as this debate evolves.

My recommendations for acute injuries:

Traditionally in my clinic, I have recommended icing the first 48 hours (The Western Medical recommendation), and then for post-48 hours I have gone with the Chinese Medical recommendations: heat, or alternating heat and cold, or experiment to see what feels best to you. If you have an aversion to the heat or cold, avoid what doesn’t feel good. (I’m starting to re-think the cold in the 1^st 48 hours, based on the reasoning above that is now emerging.)

Gentle massage strokes (toward your heart) will improve circulation.

Get some T-Relief™ ointment and oral Arnica Montana homeopathic. Have these available in your medicine cabinet since it may be hard for you to go to the store after you are injured, and because these work best when you start using them immediately after your injury.

Get Chinese herbs for traumatic injury from your local acupuncturist.

See an acupuncturist, massage therapist, or physical therapist who is experienced in working with recent injuries. You may also need to see a chiropractor or osteopathic physician.

It is important to treat trigger points as soon as possible so that they are less likely to cause chronic pain problems. So often I hear patients say, “I kept thinking it would go away.” Sometimes symptoms will go away in a few days and never return. But more often, the longer you wait to see if pain will go away, the more muscles become involved in the chain reaction of chronic pain and dysfunction. A muscle hurts and forms trigger points, then the area of referral (where you feel the pain or other symptoms) starts to hurt and tighten up and forms its own satellite trigger points, then those trigger points refer pain somewhere else, and so on. Or the pain may improve for a while, but the trigger points are really just in an inactive phase and can become active and cause pain or other symptoms once again. See this website for treatment techniques and helpful hints to help you recover from injuries (acute or chronic) and prevent the pain and problems spreading to additional muscles.

My recommendations for Chronic injuries and Surgeries:

Start using arnica and T-Relief ointment as soon as possible after a surgery. They will also work on chronic injuries.

Heat, or alternating heat and cold, will likely feel better than just cold. At this stage, use whatever feels best and relieves pain.

Both injuries and surgeries will likely leave some amount of scar tissue, which can perpetuate trigger points. Scar tissue can be broken up to some extent by vigorous cross‑friction massage, but most people will not work on their own scars vigorously enough due to the pain it causes. You will probably need to see a practitioner for help. Acupuncture can treat scar tissue and help eliminate the pain from trigger points around the area. I recommend using both cross‑friction massage and acupuncture as part of the treatment protocol, rather than just one or the other.

75% of pain is caused by trigger points, and injuries are one of the most common causes and perpetuating factors of trigger points. See this website for treatment techniques and helpful hints to help you recover from injuries (acute or chronic) and prevent the pain and problems spreading to additional muscles.

See the page on Pain Relief.

Physical therapy will be helpful in gaining both range-of-motion and strength.

Chiropractic or mobilizations may be needed to re-align skeletal structures that were put out of alignment from the injury itself of from the recovery (such as using crutches or limping).

Disclaimer: The Food and Drug Administration has not evaluated these statements. Information on this web site is provided for informational and educational purposes only and is not intended as a substitute for the advice provided by your physician or other healthcare professional. The products and information are not intended to diagnose, treat, cure, or prevent any diseases or, medical problems. Nutritional benefits may vary from one person to another.