You're walking to your front door, up your front walk: you turn towards the peculiar sound of a bird to your right and... CRUNCH!!! You roll your ankle off the side of the walk, cursing profusely. You hobble inside and all you want is to get your shoe off as your ankle begins to swell. The pain and swelling are tremendous; what should you do once that confounding shoe comes off? Pop an Advil? Grab a bag of frozen peas and an ACE bandage, post up on the couch with an ottoman, a stack of pillows, and the first season of your favorite show?
Throughout most of our lives, we were taught that the best thing to do was to stop the inflammation process and reduce the swelling with anti-inflammatory medication, rest, ice, compression, and elevation (RICE). Both non-steroidal anti-inflammatory (NSAID) medications, such as ibuprofen, and ice ultimately result in a local decrease of inflammatory biochemicals at the site of injury. (Hertel 1997, Takagi R et. al. 2011). This would be great if decreasing inflammatory biochemicals led to quicker and more robust healing of injuries, but it doesn't, and in fact it may weaken the injured tissue and make it more susceptible to injury in the future (Hertel 1997, Tortland 2007, Reynolds 2009, Jam 2014).
The inrush of pain-producing inflammatory biochemicals to the site of an injury is a necessary process in response to physical trauma that transforms into a healing process roughly 24 hours after the initial injury. If that process is inhibited by anti-inflammatory medications, ice, or prolonged immobilization, the result will most likely be muscles, tendons, or ligaments that are much structurally weaker had those treatments not been applied (Hertel 1997, Tortland 2007, Jam 2014).
Part 2 of this blog post will cover some of the methods used in Chinese Medicine to treat acute soft tissue injuries.
For further reading on NSAID use in the treatment of acute soft tissue injury see:
"The Role of Nonsteroidal Anti-Inflammatory Drugs in the Treatment of Acute Soft Tissue Inuries" by Jay Hertel, MEd, ATC, Journal of Athletic Training, 1997, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1320354/
"Sports Injuries and Nonsteroidal Anti-Inflammatory Drug (NSAID) Use" by Paul D. Tortland, DO, SPORTS Med (CSMS Committee on the Medical Aspects of Sports), Winter 2007
"Phys Ed: Does Ibuprofen Help or Hurt During Exercise?" by Gretchen Reynolds, The New York Times, September 1, 2009, http://well.blogs.nytimes.com/2009/09/01/phys-ed-does-ibuprofen-help-or-hurt-during-exercise/?_r=0
For further reading on the use of ice in the treatment of acute soft tissue injury see:
"Paradigm Shifts: Use of Ice & NSAIDs Post Acute Soft Tissue Injuries (Part 1 of 2)" by Dr. Bahram Jam, DScPT, MPhty, BScPT, CredMDT, Advanced Physical Therapy Institute, 2014, http://physicaltherapyweb.com/paradigm-shifts-use-ice-nsaids-post-acute-soft-tissue-injuries-part-1-2/
"Influence of icing on muscle regeneration after crush injury to skeletal muscles in rats." by Tagaki R, et. al., Journal of Applied Physiology, 1985, http://www.ncbi.nlm.nih.gov/pubmed/21164157
Written by David Derdiger, EAMP, LAc, February 11th, 2015
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