it appears that both Ice and complete Rest may delay healing, instead of helping.
(Dr. G. Mirkin)
The RICE guidelines are mainly used in the english speaking countries and wide parts of Europe. But in China with over 1.2 bill. people and most other countries in Asia, icing and rest is not a common treatment for injuries. During my time at one of the elite sports universities in China, I saw many sport injuries: sprains contusions etc. Some with severe swellings. I have never seen any of the physicians using ice or recommending to use it. The swelling was usually treated with chinese herbal poultice and a tight compression bandage over it. Also complete rest, was out of the question. There was always some movement involved in the therapy.
But if I tell a western physiotherapist ice is a bad choice for treating swelling he most likely will look at me like I’m out of my mind and
Babbling utter nonsense.
On the other side, if I tell a Chinese doctor to use ice on a swollen knee, he will also look at me like I’m out of my mind to even think about doing something so ridiculous. Because in Traditional Chinese Medicine cold is a constricting, closing force. Coldness blocks the flow of Qi “Life-force” and blood in the body. By applying ice you cause more stagnation in a anyway stagnated area. Instead Chinese Medicine uses herbs with blood moving function to clear the stagnation and allow the qi and blood to flow freely again and heal the damaged structures. One of the most often used herbal formulas for treating grade 1 injuries of sinews and bones is San Huang San also called “herbal ice”. Ingredients: Da Huang “rhizome rhei”, Huang Qin “radix scutellaria”, Huang Bai “cortex phellodendri”, Pu Gong Ying “herba taraxaci mongolici”, Zhi Zi “fructus gardenia jasmonoidis”, Hong Hua “flos carthami tinctorii”).
But why is using ice so popular and was never really questioned?It is probably because ice showed to be effective for short time pain relieve, by numbing the nerve receptors in the muscles. This and because it’s cheap and easily available, makes it an ideal pain relief remedy. So if the purpose is to relief pain, ice could be used. But I wouldn’t apply it longer than 10 min. because ice is to cold and aggressive. In most hospitals in Switzerland they don’t use ice anymore to treat pain and swelling. Instead they use quark “curd cheese” a milk product made of soured milk fermented with mesophile bacteria. The advantage of this method is it sooth the pain by cooling down slowly. In the beginning quite cold (not as cold as ice), but than you can feel how it sucks and absorbs the heat of the injured part and gets warmer with time. Usual application time is about 20 – 30 min.
How to use quark “curd cheese
Take a household paper cover it with a layer of quark put another paper on top and put it on top of the injured part. Because its soft you can form it around any joints. Just make sure to have some towels underneath – it can get wet and a little messy.
So what could be a better approach than RICE?
If ice and rest are out of the equation, it leaves just movement, compression and elevation. Also the benefit of elevation is only of passive nature, by helping the back flow of the liquid in the lymphatic vessels.
What really shows to help are compression and movement. Compression helps draining the lymphatic vessels and transport the liquids out of the body. Muscle contraction helps pumping the lymphatic vessels.
So a useful formula for injury treatment could be MCE
- Moderate movement
By moving the injured part in a light and painless range of motion, we get a better circulation in the injured area and the soft muscle contractions helps to drain the lymph in the lymphatic vessel. In Traditional Chinese Medicine TCM, movement promotes the flow of Qi “live force” in the body.
Important is not to move forcefully or looking for the pain, this could injure the ligaments and muscles more. Instead do it softly or use assistance from a therapist or a friend to move it passive if you can’t do it yourself.
There are several methods I think worth trying and to look at it closer:
- Lymphatic compression
- Floss band
- Manual lymphatic drainage
- Kinesiotaping (lymphatic taping techniques)
- Electro Muscle Stimmulation
1. Lymphatic compression bandages and socks
If there is a strong swelling the traditionally used compression bandages still works great. Start banding distal from the injury with moderate to strong compression and band it over the swelling towards the trunk. Use less stretch as closer you get to the body.
Compression socks or stockings are a good solution for ankle and leg swelling if not to severe. The material is not so stiff and uncomfortable as it used to be. Compression stockings improve venous and lymphatic blood flow and help reduce the swelling.
A quick relieve technique which finds its way more and more onto the sports field to treat minor sports injuries. By applying a strong thick rubber band (basically a strong tube like a bicycle tube or extra thick thera band) we start band up the injured area and move the injured part under compression in full range of motion. It works on many levels, it creates shear force within the deep fascia layer and compresses swelling out of the tissues and joints.
As soon as there is any feeling of numbness, or weird feeling in the extremity you should stop and take off the bandage. The usual time you can leave it on is about 2 min.
There are several methods of how you can apply manual lymphatic drainage. But all styles have in common, that the the techniques are soft pumping movements to support the flow in the lymphatic vessels.
When kinesiology tape is applied to the skin over an inflamed area, the stretch in the tape gently lifts the skin, creating a space between the skin and the tissues below. This creates an area of negative pressure, allowing both blood vessels and lymphatic vessels to dilate (open), increasing the circulation of both fluids.
Improved blood flow enhances delivery of oxygen and nutrients to the injured tissues, accelerating the healing process. When lymphatic vessels dilate, the fluid that has collected in the injured area can drain away. This reduces swelling, which relieves pressure on the pain receptors providing immediate pain relief! (physioworks)
I would be interested to know what are your experience with either methods?