RICE (Rest, Ice, Compression and Elevation) is the well known first line intervention for acute injuries. This has been the prevailing advice for many years, but this is now being questioned in the scientific literature.
RICE has been the standard for a long time, though the person who coined the phrase, Gabe Mirkin, has since stated it is not the best approach. Dr. Gabe Mirkin on Health, Fitness and Nutrition.
Evidence is beginning to emerge that the use of ice on acute injuries may actually delay the healing process, a case where the Western scientific evidence is beginning to catch up with the wisdom of Chinese Medicine.
METH (movement, elevation, traction, heat) has been demonstrated to assist a faster recovery process. Why You Shouldn’t Do RICE for Sprains
PEACE and LOVE has also recently been touted as an alternative.
Cold therapy in acute conditions is utilised to reduce swelling and inflammation to reduce pain, and to prevent secondary injury of local cells as a result of the enzymes which are released from damaged cells.
It is worth remembering however that the swelling and inflammation are a natural response to injury, they serve the purpose to protect the injured area and remind us to take care of it.
Chinese Medical understanding
In Chinese Medicine the muscles, sinews and tendons can be organised into what are known as the sinew channels (Jing Jin).
These channels have a similar correlation with our internal organs as the primary channels, and are the region in which our Wei (defensive) Qi circulates. This Wei Qi has the function of protecting the body through keeping the perimeter warm.
When there is an injury to these Jing Jin, the Wei Qi accumulates at the site of injury to protect the body, this results in the localised swelling and inflammation. This is an important step in the body working to heal itself and helps to prevent the injury spreading to other channels and areas of the body.
The use of ice is harmful to this process as it sends both the Wei Qi and the swelling inward, freezing the healing action of Wei Qi. This prevents the smooth flow of Wei Qi once its task of bringing protection is completed, and compounds the chance of an injury being transmitted.
The use of heat
On the other hand heat increases cellular and metabolic activity which increases oxygen uptake and thus benefits healing. Heat applied superficially can also increase vascular flow and thus remove heat from the site of inflammation due to increased circulation.
In Chinese Medicine heat therapy is generally applied in the form of moxibustion, where mugwort leaf is burnt to invigorate circulation, restore warmth and strengthen our Yang Qi. This Yang Qi is our vital active energy in life, essential for healing and recovery from injuries. The use of liniments such as Zheng Gu Shui are also useful for similar purpose.
How to treat an injury
Cold therapy may only be beneficial in the first 24-36 hours following an acute injury. Following this initial period, the negative effects of cold therapy outweigh the benefits. In this period the use of heat therapy may also be detrimental as it may exacerbate inflammation and bruising.
After the initial period of injury heat therapy is more appropriate, helping to restore circulation and promote healing after an acute injury.
This is also an essential consideration in the management of chronic injuries, with persistent and ongoing symptoms. As these injuries flare up, the application of ice will impair the healing process with heart better suited to aid in recovery.
Following the initial period of injury treatments with massage, acupuncture or Chinese herbs can benefit the recovery process, accelerating the reduction of pain and helping to restore movement and function of the injured area to normal. With chronic injuries the underlying contributing factors can be identified to help untangle the debilitating effects on your life.
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