Stop Icing and Heal Faster

Stop Icing and Heal Faster

 

The use of ice to treat injuries has become controversial in sports medicine. Gabe Mirkin, MD coined the mnemonic R.I.C.E. (Rest, Ice, Compression, and Elevation), for sports injury first aid in 1978. But he recanted his opinion on ice in 2014. His reversal came after a review of the research which indicated no evidence that ice improves recovery time. Moreover, research suggests that cold therapy can suppress the body’s natural inflammatory stage of healing and reduce blood circulation to the injury.

Inflammation gets a bad rap in the medical community as it is associated with many disease states from cancer to arthritis – this association applies to chronic inflammation, NOT acute inflammation that follows trauma to the tissues. Acute inflammation is a normal healthy response.

The body’s response to ice is as follows: blood vessels constrict to reduce hemorrhage and swelling; nerve endings are numbed to provide pain relief; and, when applied intensely, the painful inflammatory response is suppressed. All three effects reduce pain which is why ice has been a popular home remedy. Giving up the ice does not mean you have to suffer in pain; there are other measures you can take that provide relief and support your natural healing response.

The reduction of hemorrhage, swelling and pain can be accomplished with compression, elevation, and gentle movement. Notice complete “Rest” of injuries (from the R.I.C.E. model) is also in question. Gentle movement helps the body pump dead cells away from the injury and reduce swelling. It also improves circulation of blood to the injured site, bringing healing factors released by your immune system.

Heat also improves circulation to the area but is not recommended the day of injury because increasing circulation to a fresh injury may increase the bleeding in the area. But within hours the bleeding stops, especially when compression is applied, so after that heat is okay and studies indicate it causes no harm.

Over-the-counter pain medicine can reduce the pain, but be wary of the one you choose. Ibuprofen (Advil) is an anti-inflammatory – is that what you want? Acetaminophen (Tylenol) offers pain relief without affecting inflammation. Pain medicines commonly prescribed in emergency rooms are also acetaminophen based.

If your goal is to be back in action as soon as possible, don’t freeze your injury. Instead, take other measures to help yourself heal: start with compression and elevation and after the first day include heat and gentle movement.

(A more thorough article on this topic titled Think twice before applying ice was posted earlier on my blog)

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The Healthy Kind of Happiness

The Healthy Kind of Happiness

You can take anti-inflammatory drugs and consume an anti-inflammatory diet, but how about experiencing a dose of volunteer work to lower your inflammation? Chronic inflammation is a topic of research because it is implicated in a wide range of diseases from cancer to heart disease  A study published in Proceedings of the National Academy of Science showed that people who experienced happiness primarily by working for the greater good had lower levels of inflammatory proteins circulating in their blood; in contrast, people who experienced happiness predominately from self-gratification had higher levels of inflammatory proteins – comparable to levels in people who are depressed or stressed.

TWO TYPES OF HAPPINESS

The authors differentiate between the following two types of well-being:

  • Hedonic: self-gratification experienced from positive transitory events such as purchasing a new car, smelling roses or enjoying ice cream
  • Eudemonic: happiness that results from striving toward meaning, a noble purpose beyond self-gratification, and working for the greater good

The emotional experience of these two kinds of happiness feels the same to you but the research shows your body knows the difference.

Perhaps when your source of happiness is primarily hedonic, there is an underlying stress after one source of gratification ends until the next one is attained. Self-gratification happiness is situational and temporary. Let’s say, for example, you go to the freezer for your private stash of chocolate ice cream — your source of hedonic happiness — but find that your carefully hidden stash has been uncovered and consumed down to the last teaspoon. If you were dependent on that chocolate ice cream for your happiness, then your biomarkers for inflammation just increased.

Eudemonic sources of happiness – volunteer work, spirituality, creative endeavors – are more stable and have deeper meaning than the “stuff” in your life. You can attain this type of happiness in a variety of ways: practicing your spirituality; volunteering your service to organizations that serve the disadvantaged; building trails and picking up litter to care for the environment; being involved in political activism for a cause that is compelling to you.

Hedonic and eudemonic forms of happiness are not mutually exclusive and this post is not about convincing you to give up your hedonic pleasures. The point is that participating in activities that benefit the common good and feeling a part of something greater than yourself create physiological changes in your body that positively impact your health.

 

Breathing Alignment into the Painful Shoulder

Breathing Alignment into the Painful Shoulder

Have you ever had a shoulder pain that seems to have crept up on you for no traumatic reason? Maybe it’s a too-much-sitting-not-enough-moving type of injury or the too-much-moving-in-poor-posture sort of injury. It could be a problem of alignment.

If you have been following this blog, you are already familiar with the link between diaphragm dysfunction and low back pain. Perhaps your shoulder pain could also benefit from the inclusion of respiration activities. The exercises described in this post are meant to provide you with a possible home remedy for non-traumatic shoulder pain; and to alert you to an important, but possibly missing, piece of your prescribed home exercise program following traumatic shoulder injury.

Most gym workouts targeting the upper body focus on the visible outer layer of muscles to develop shoulder strength. Lying deep to those is the rotator cuff, a more delicate group of muscles that stabilize and guide the bones to articulate properly within the primary shoulder joint.  If the shoulder muscles aren’t balanced in strength, or the shoulder is not aligned with good posture, these deeper muscles and their associated tissues cry out with pain.

Dysfunctional breathing patterns and poor position of the diaphragm leads to imbalanced inhalation and twisting in the rib cage. If your shoulder blades are sitting on a misaligned rib cage your shoulder is out of alignment. Exercises for stabilizing the shoulder blades are essential to every home exercise program for shoulder rehabilitation. Unfortunately, these exercise programs often lack respiratory activities to address the ribcage component; this may result in stabilizing yourself in poor position – a situation that leads to abnormal wear and tear on the shoulder complex.

Various postural bodywork disciplines, including the Rolf Method of Structural Integration, address alignment quite effectively. As a living, breathing, moving human being, your muscles also need to be trained to support your alignment.  The exercises described in this post train the muscles that influence the ribcage.

The diaphragm muscle has an elaborate array of connections and influences in the human body as described here. The Postural Restoration Institute and the therapists trained in their method have had excellent results treating chronic pain by incorporating diaphragm training into their home exercise routines; considering the proximity of the shoulder girdle to the rib cage it makes sense to include this training in shoulder rehabilitation.

The first exercise described below was previously included in my blog post  The Diaphragm is a Core Muscle. The second exercise – 90/90 Bridge with Ball and Balloon – was designed by the Postural Restoration Institute; a thorough rationalization for this exercise was published in the North American Journal of Sports Physical Therapy in 2010. Though I recommend it here for shoulder pain, it was originally developed as a remedy for low back pain, another condition often attributed to misalignment.

DIAPHRAGMATIC BREATHING EXERCISE

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  • Lie on the floor with your legs up on a chair or couch so that your hips and knees are at right angles. This passive position allows you to focus your attention on your breathing mechanics while allowing your body to settle into balance.
  • Place your hands on the sides of your ribcage and abdomen.
  • Expand your abdominal region and your chest as you breathe in. This expansion naturally occurs when the diaphragm descends and displaces the abdominal organs outward.
  • Allow the expansion of your ribs out to the sides to create space for the air filling up your lungs.
  • Your shoulders should not move toward your head as this indicates unnecessary contraction of the neck and upper chest muscles – a breathing pattern that can lead to fatigued and tender neck muscles.
  • Practice breathing into your abdomen in this position for 10 minutes a day to regulate your nervous system and to bring awareness to how it feels to breathe correctly.

90/90 BRIDGE WITH BALL AND BALLOON

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  • Lie on your back with your feet flat on a wall and knees and hips bent to a 90-90 degree angle
  • Place a 4-6 inch ball between your knees, squeezing with light pressure on the ball
  • Hold the balloon in one hand and place the other arm above the head in a relaxed position
  • Perform a posterior pelvic tilt (tailbone is slightly raised off floor, the back is flat against the floor). Make sure you are not pushing your feet into the wall, but rather slightly pulling your heels down, contracting your hamstrings. Maintain this position throughout the exercise!
  • Inhale through your nose (~75% of max) and slowly blow out into the balloon (3-4 seconds)
  • Pause for 3 seconds with your tongue on the roof of your mouth to prevent airflow out of the balloon and without pinching the neck of the balloon
  • Inhale through your nose again, and slowly blow back out into the balloon (Do not perform too forcefully, you should not be straining your neck or cheeks)
  • Repeat breathing technique a total of 4x
  • After the 4th breath in, pinch the neck of the balloon, remove it from your mouth, breath normally and let the air out of the balloon
  • Relax and repeat the entire process a total of 5 times!

(Credit for 90/90 Bridge with Ball and Ballon Exercise: “The Value of Blowing up a Balloon” by Kyndall L Boyle, PT, PhD, OCS, PRC; Josh Olinick, DPT, MS; and Cynthia Lewis, PT, PhD

 

 

 

 

Welcome to Being Human

Balancing my life as a physical therapist, business owner, trail runner, meditator, world traveler, and Mom of three kids has been my practice in the art of being human.  My happiness and health are interdependent, and so I seek ways to experience peace of mind as much as I do physical health.

For nearly 30 years, my career has been to help people restore function and balance in their bodies in order to return to the activities they love whether it be hiking up a mountain, running a marathon, or as basic as maintaining an independent living situation.

As the cost of healthcare escalates each year, it is more important than ever to take responsibility for the health of our bodies and minds. This requires self-motivation to educate ourselves and to follow through with proper nutrition, exercise, and as much balance as we can achieve between family, work and play. Our mental health is intricately woven into our physical health; positive social interactions, time in nature, spiritual practice, appreciation of the arts, and any activity that reduces stress are all supportive to our mental health.

Being Human is about taking care of ourselves so that we can minimize our reliance on the overburdened healthcare system.  If you share this philosophy and want non-preachy guidance from a physio in the field, then you have come to the right place.

Photos posted on this blog are all mine taken on my trail runs and travels. Enjoy!