Injuries and Ice

[Guest guest]

In a dance injuries context I learned that ice is applied to acute injuries

to reduce inflammation and swelling, thereby reducing further damage from the

swelling itself.

 

In TCM class I have heard that applying ice causes stasis. I'm not convinced

about this however. I think it depends on the amount of time the ice is

applied. With the initial application of ice, blood vessels may contract, but

if

the ice is left on a longer time, there will be a rebound effect and the

vessels will dilate, suffusing the area with blood.

 

Anyone who has ever jumped into an ice cold pool at the Russian baths knows

that in a matter of seconds the body reacts, heats up and turns cherry red and

there is an overwhelming sense of invigoration.

 

-roseanne

[Guest guest]

In a message dated 8/28/2004 7:52:54 AM Eastern Daylight Time,

attiliodalberto writes:

Hi all,

 

I was wondering if the time old idea on putting ice in injuries to

reduce the inflammation actually works. Wouldn't this cause blood

stasis and make the problem worse? Wouldn't heat be better as this

would increase the rate of recovery?

 

Any answers?

 

Attilio

 

 

I've always used alternating heat and cold. I believe this is typical in

the sports world these days.

 

Chris

 

 

 

[Guest guest]

Hi Attilio

 

Although there are differeing protocols....once such is alternating ice and

heat at a certain point which would address what you bring up.

 

Richard

 

In a message dated 8/28/2004 7:52:40 AM Eastern Daylight Time,

attiliodalberto writes:

Hi all,

 

I was wondering if the time old idea on putting ice in injuries to

reduce the inflammation actually works. Wouldn't this cause blood

stasis and make the problem worse? Wouldn't heat be better as this

would increase the rate of recovery?

 

Any answers?

 

Attilio

 

 

 

[Guest guest]

The first 48 hours is when the traumatic reaction causes the influx of

liquids to the injury. The balance of 20 minutes on and 20 minutes for the ice

should not cause any stasis. It keeps the swelling to a minimum.

 

richard

 

In a message dated 8/28/2004 9:12:06 AM Eastern Daylight Time, ra6151

writes:

In a dance injuries context I learned that ice is applied to acute injuries

to reduce inflammation and swelling, thereby reducing further damage from

the

swelling itself.

 

In TCM class I have heard that applying ice causes stasis. I'm not convinced

about this however. I think it depends on the amount of time the ice is

applied. With the initial application of ice, blood vessels may contract,

but if

the ice is left on a longer time, there will be a rebound effect and the

vessels will dilate, suffusing the area with blood.

 

Anyone who has ever jumped into an ice cold pool at the Russian baths knows

that in a matter of seconds the body reacts, heats up and turns cherry red

and

there is an overwhelming sense of invigoration.

 

-roseanne

 

 

 

[Guest guest]

Experientially I have found much benefit to sports injuries and others by

applying immediate and continuous movement after injury with aspects falling

under the umbrella of tuina...namely guasha and cupping. the quicker one moves

the

extravasated blood out of the area and restores normal flow...the better.

Healing time actually shortens.

 

richard

 

In a message dated 8/28/2004 9:14:17 AM Eastern Daylight Time,

passivebackseatdemonengines writes:

Light massage close to 2 days afterwards to initiate better blood flow.

 

 

 

[Guest guest]

Hi all,

 

I was wondering if the time old idea on putting ice in injuries to

reduce the inflammation actually works. Wouldn't this cause blood

stasis and make the problem worse? Wouldn't heat be better as this

would increase the rate of recovery?

 

Any answers?

 

Attilio

[Guest guest]

Chinese Medicine , " "

<attiliodalberto> wrote:

> Hi all,

>

> I was wondering if the time old idea on putting ice in injuries to

> reduce the inflammation actually works. Wouldn't this cause blood

> stasis and make the problem worse? Wouldn't heat be better as this

> would increase the rate of recovery?

>

> Any answers?

>

> Attilio

 

Attilio,

I worked with 3 Australian " Rules " amatuer Footbal teams over two years. Had an

ongoing

debate with players who wanted recommendations as to what to do with a fresh

injury,

and the information from the governing body Sportsmed is to ice, and ice and ice

and

ice... Although some research has proven otherwise, it seems to be the norm

amongst

sports injuries to be in & out of ice for over two days. This seems to be to

reduce the pain

more so than anything else. Professional players even hop in and out of full

body baths. In

my humble opinion far too much: we are not creatures designed to be in ice. From

a

practical perspective: ice immediately after injury twice for no longer than 20

minutes each

application, with 20 - 30 minutes in between. This reduces initial inflammation

and ceases

too much bleeding. After that leave the ice off. Yes, from a TCM perspective it

does cause

blood stasis and blood is the main carrier of all the goddies that will allow

the site to heal.

Light massage close to 2 days afterwards to initiate better blood flow.

This becomes one of those conundrums: where does one think WSM or TCM? From a

diplomatic perspective as a therapist, allow someone to ice but not for long.

This is what

they are used to. Then gradually bring in your preferred way of working. The

last club I

was involved with came around to TCM, loved the results even if the treatments

were a

little unorthodox (imagine a coach entering the club rooms to smell moxa and

wondering

what the hell is EXACTLY going on...) and quite painful. Player recovery time

was down and

they were trusting of a new approach. But it did take time, and diplomacy.

Any other thoughts?

Regards,

Martin.

[Guest guest]

Hi Martin,

 

Being an Aussie boy myself I am very interested in the experiences you

have had with AFL. Being a TCM practitioner I have had to tackle the

prevalent " sports medicine " approach of immediate ice, verse the TCM

" prevent and remove blood stasis " ideals.

 

My lecturer in traumatology was influenced by the modern protocol of

RICE but also recommended the use of plasters and acupuncture for acute

injuries.

 

Finding the best protocol for acute injuries still fascinates me as I

can see the logic in both sides. I do lean towards ice when the injury

is " Bleeding " to prevent the blood stasis caused by blood from ruptured

vessels entering the connective tissues. After-all; blood in tissue is

blood stasis, and the more we can prevent blood entering tissue the

better it is for the recovery.

 

The issue is, in my opinion; deciding when we should apply heat, herbs

or physical therapy to invigorate the blood and remove the blood stasis

and encourage qi and blood flow through the injured area.

 

The obvious answer to me is too allow, nay " encourage " , the clotting of

the vessel/ channel walls to prevent bleeding into surrounding tissues

before we encourage the static blood that has already entered the

tissues to be re-absorbed and removed from the injury site,

establishing free-flow and thus allowing healing to begin.

 

This, I confess is my " theory " of how acute injury should be approached

based on my studies of both sports medicine and TCM................

 

I would love to hear your experience and results from what you have had

to deal with in this sport.

 

Best Wishes,

 

Steve

 

 

On 28/08/2004, at 11:07 PM, mckenzy72 wrote:

 

> Chinese Medicine , " "

> <attiliodalberto> wrote:

> > Hi all,

> >

> > I was wondering if the time old idea on putting ice in injuries to

> > reduce the inflammation actually works. Wouldn't this cause blood

> > stasis and make the problem worse? Wouldn't heat be better as this

> > would increase the rate of recovery?

> >

> > Any answers?

> >

> > Attilio

>

> Attilio,

> I worked with 3 Australian " Rules " amatuer Footbal teams over two

> years. Had an ongoing

> debate with players who wanted recommendations as to what to do with

> a fresh injury,

> and the information from the governing body Sportsmed is to ice, and

> ice and ice and

> ice... Although some research has proven otherwise, it seems to be

> the norm amongst

> sports injuries to be in & out of ice for over two days. This seems

> to be to reduce the pain

> more so than anything else. Professional players even hop in and out

> of full body baths. In

> my humble opinion far too much: we are not creatures designed to be

> in ice. From a

> practical perspective: ice immediately after injury twice for no

> longer than 20 minutes each

> application, with 20 - 30 minutes in between. This reduces initial

> inflammation and ceases

> too much bleeding. After that leave the ice off. Yes, from a TCM

> perspective it does cause

> blood stasis and blood is the main carrier of all the goddies that

> will allow the site to heal.

> Light massage close to 2 days afterwards to initiate better blood

> flow.

> This becomes one of those conundrums: where does one think WSM or

> TCM? From a

> diplomatic perspective as a therapist, allow someone to ice but not

> for long. This is what

> they are used to. Then gradually bring in your preferred way of

> working. The last club I

> was involved with came around to TCM, loved the results even if the

> treatments were a

> little unorthodox (imagine a coach entering the club rooms to smell

> moxa and wondering

> what the hell is EXACTLY going on...) and quite painful. Player

> recovery time was down and

> they were trusting of a new approach. But it did take time, and

> diplomacy.

> Any other thoughts?

> Regards,

> Martin.

 

Dr. Steven J Slater

Practitioner and Acupuncturist

Mobile: 0418 343 545

chinese_medicine

 

 

 

[Guest guest]

Attilio,

 

Good basic question. I know at least for sports injuries there is a formula:

 

RICE.

 

Rest (actually it should be 'active rest' to help maintain mobility)

Ice (to reduce the size of blood vessels and limit inflammatory processes)

Compression (to prevent build up of fluid in the affected area )

Elevation (to drain fluid in the affected area )

 

The idea being to reduce inflammation caused by swelling of the affected area.

As you guys know, inflammation is a response of the immune system to injury to

prevent ingress of pathogens. Ingress of pathogens from an open injury is a

presumed state we have evolved for its survival value. The response is not

always appropriate, as for example with a muscle strain, although the swelling

may limit movement and help the injured part repair, the important thing for

many injuries is to retain as much mobility as possible without causing further

damage.

 

RICE can be alternated with moderate exercise and stretching to warm the area

and encourage circulation and healing and to flush out fluid containing

pro-inflammatory cytokines*. [ Speaking from experience getting over a bout of

sciatica caused by an old injury / muscles tightness in the right leg. Actually

I am just off for a workout / stretch now. I find this reduces pain and sets me

up for another 24 hours. Unfortunately I am too optimistic sometimes, as walk up

Snowden on Wednesday proved. I didn't make it to the top, although my kid and

missus did. Grr .. ]

 

It would be great for someone to give a 'TCM mirror' of the mechanistic process

I described in RICE.

 

Cheers,

 

Sammy.

 

 

* See http://microvet.arizona.edu/Courses/MIC419/Tutorials/cytokines.html

-

Chinese Medicine

Saturday, August 28, 2004 12:15 PM

Injuries and Ice

 

 

Hi all,

 

I was wondering if the time old idea on putting ice in injuries to

reduce the inflammation actually works. Wouldn't this cause blood

stasis and make the problem worse? Wouldn't heat be better as this

would increase the rate of recovery?

 

Any answers?

 

Attilio

[Guest guest]

Hi Attilio,

 

Besides being an acupuncturist, I have a bachelor's degree in sports

medicine and a master's in exercise physiology. I am also a certified

athletic trainer with about 15 years of experience working with

interscholastic/intercollegiate athletics in the treatment, prevention

and rehab of athletic injuries. Therefore, I feel fairly qualified to

answer this question.

 

I was aghast in acupuncture school when in was suggested that ice caused

stasis and would slow an injury's healing. This made sense, however,

with the concepts of cold being yin and heat being yang. Since, I've

learned that that could be true from a CM perspective, but it depends on

timing, just as it does in western medicine's approach. I believe,

though, that the Chinese say to never use ice. I disagree.

 

It has been my experience that ice is a tremendous time-saver in the

process of healing from acute injury. I've seen literally thousands of

injuries that have not been treated with ice, just as many that have,

and an unfortunate large number of injuries mistakenly (from

misinformation but good intention) treated with heat. The ones treated

with heat swell larger, take probably 30% longer to heal and cause the

greatest long term. (The biggest offense here has been the dreaded hot

tub!! " I pulled a muscle in my back and thought it would be a good idea

to loosen in up in the hot tub. " ARGH!!!)

 

So, to answer your question, both heat and ice are good, but timing is

most important.

 

The first 24-48 hours are crucial for the treatment of an acute injury.

In my experience, the sooner ice is applied, the faster rehab and

healing will take place. Ice isn't the only component, however.

Compression, elevation and rest are also involved (but these are other

topics). When an injury first occurs there is major bleeding and

swelling (the body's way of producing a cast to immobilize the area).

The more swelling that occurs, the more the ligaments and tendons will

be stretched. Ice causes vaso-constriction which limits the swelling.

Heat causes MORE bleeding, more swelling (vaso-dilation) and many more

problems down the road.

 

IF swelling has stopped and the patient has been also resting and

elevating the injury, and 48-72 hours has passed, heat can be introduced

by way of a contrast bath. Ice and heat are applied in a rotation

cycle for 25-30 minutes, 3 or 4 times per day. (If you need specifics

about contrast baths, there are many references).

 

After a couple of days of contrast baths and the swelling has reduced

significantly, heat alone can be applied. However, if any swelling

occurs from the heat, or from patient use, ice is to be applied.

 

This is all further confused by the discovery that some types of chronic

injuries, specifically chronic injuries like that in the plantar fascia

or Achilles tendon of a distance runner vary in what they respond to.

Some people and some chronic injuries respond horribly with ice, and

some are bad with heat. The patient needs to see what works best for

them in these circumstances.

 

In my acupuncture practice (I'm no longer working directly with

collegiate sports) I've treated perhaps 100 ankle sprains using both ice

and acupuncture. My patients know to come to me with an acute injury

just as soon as they can (even if it's a Sunday, because I've lectured

them about timing being crucial). Theoretically, CM says that ice would

cause stasis. Well, the combo of acupuncture with simultaneous ice

works fabulously, much better than ice or acupuncture separately. So, I

look at it as yes, ice causes stasis, but stasis basically is what you

need in the bleeding and swelling phase of an acute injury.

 

So, in summary, it goes like this:

 

Ice for 20-25 minutes, 3 or 4 times daily (along with rest, compression,

elevation). (More time than 25 minutes can actually cause the opposite

effect of vasodilation, so don't go longer than 25 minutes). Also,

ideally, use REAL ice, crushed if possible, in a plastic bag with as

much air removed as possible. No towel is necessary between real ice

and skin. Contrary to popular belief, one cannot get frost-bite from

real ice as it is just 32 degrees. Chemical ice packs, however, can

cause frost-bite, so some sort of material needs to be between the skin

and the pack.

 

After 48-72 hours, do contrast baths, 3 or 4 per day, 25-30 minutes

each.

 

After about 5 or 6 days (depending on symptoms), the general rule of

thumb is heat before an activity, and ice afterwards.

 

If you decide you don't want to use ice because of the CM theory, just

PLEASE don't use heat on an acute injury.

 

I hope that helps.

 

Barbara

 

 

[attiliodalberto]

Saturday, August 28, 2004 4:16 AM

Chinese Medicine

Injuries and Ice

 

Hi all,

 

I was wondering if the time old idea on putting ice in injuries to

reduce the inflammation actually works. Wouldn't this cause blood

stasis and make the problem worse? Wouldn't heat be better as this

would increase the rate of recovery?

 

Any answers?

 

Attilio

[Guest guest]

There have been very few times in my practice spanning over three continents

and over decades that I have had to recommend ice on a closed trauma or

a lesion.

 

In the same time I have, after regular questioning if hot or cold packs

helped,

at history taking, very rarely obtained the answer favoring ice or cold

packs.

 

This does not mean they are not efficacious, but that is simply that is what

I

found.

 

Cold on heated lesion may reduce Heat, by a thermal osmosis, if one allows

such a term; or more accurately, by a temperature gradient differential.

 

However, it would also cause stasis, because Cold settles deeper, Heat

raises.

 

In which case there would be a circulatory slowdown of intercellular,

and capillaric fluids, as well as the all important lymphatic circulation.

 

Cold may reduce Heat of a pathogenic nature on a sporadic basis, but

it may also slow down the inflammatory process which leads to pyosis

and mopping up as a result, by dedicated WBCs.

 

Dr. Holmes Keikobad

MB BS DPH Ret. DIP AC NCCAOM LIC AC CO & AZ

www.acu-free.com - 15 CEUS by video.

NCCAOM reviewed. Approved in CA & most states.

[Guest guest]

I have been involved in the study of Dieh Dah (TCM Injury Medicine) and

Traditional Chinese Martial Arts for over half a century, have been a

StreetMedic for almost 40 yrs, and a WFR for a while too. Our (Dieh Dah)

tradition has always been to ice an acute injury if it is not possible to apply

immediate Dieh Dah Acupuncture and other protocols (including herbs topicly and

internally). Temorary stasis is what is needed. The cold condition that results

is easily treated with Moxa and Acupuncture and does not become a problem.

 

my.02

 

R S Doc Rosen

 

BTW i teach a Dieh Dah base d 3 day disaster medicine class if anyone is

interested

 

" The world is a dangerous place to live; not because of the people who are evil,

but because of the people who don't do anything about it. "

-- Albert Einstein

[Guest guest]

Hi Barbara,

 

Great info thanks!

 

What about the use of acupuncture? When would you start to use acupuncture

and what acupuncture technique would you employ, i.e. reduced treatment time

or reinforce/reduce method?

 

Kind regards

 

Attilio

 

www.attiliodalberto.com <http://www.attiliodalberto.com/>

 

 

Barbara Beale [bbeale]

28 August 2004 16:59

Chinese Medicine

RE: Injuries and Ice

 

 

Hi Attilio,

 

Besides being an acupuncturist, I have a bachelor's degree in sports

medicine and a master's in exercise physiology. I am also a certified

athletic trainer with about 15 years of experience working with

interscholastic/intercollegiate athletics in the treatment, prevention

and rehab of athletic injuries. Therefore, I feel fairly qualified to

answer this question.

 

I was aghast in acupuncture school when in was suggested that ice caused

stasis and would slow an injury's healing. This made sense, however,

with the concepts of cold being yin and heat being yang. Since, I've

learned that that could be true from a CM perspective, but it depends on

timing, just as it does in western medicine's approach. I believe,

though, that the Chinese say to never use ice. I disagree.

 

It has been my experience that ice is a tremendous time-saver in the

process of healing from acute injury. I've seen literally thousands of

injuries that have not been treated with ice, just as many that have,

and an unfortunate large number of injuries mistakenly (from

misinformation but good intention) treated with heat. The ones treated

with heat swell larger, take probably 30% longer to heal and cause the

greatest long term. (The biggest offense here has been the dreaded hot

tub!! " I pulled a muscle in my back and thought it would be a good idea

to loosen in up in the hot tub. " ARGH!!!)

 

So, to answer your question, both heat and ice are good, but timing is

most important.

 

The first 24-48 hours are crucial for the treatment of an acute injury.

In my experience, the sooner ice is applied, the faster rehab and

healing will take place. Ice isn't the only component, however.

Compression, elevation and rest are also involved (but these are other

topics). When an injury first occurs there is major bleeding and

swelling (the body's way of producing a cast to immobilize the area).

The more swelling that occurs, the more the ligaments and tendons will

be stretched. Ice causes vaso-constriction which limits the swelling.

Heat causes MORE bleeding, more swelling (vaso-dilation) and many more

problems down the road.

 

IF swelling has stopped and the patient has been also resting and

elevating the injury, and 48-72 hours has passed, heat can be introduced

by way of a contrast bath. Ice and heat are applied in a rotation

cycle for 25-30 minutes, 3 or 4 times per day. (If you need specifics

about contrast baths, there are many references).

 

After a couple of days of contrast baths and the swelling has reduced

significantly, heat alone can be applied. However, if any swelling

occurs from the heat, or from patient use, ice is to be applied.

 

This is all further confused by the discovery that some types of chronic

injuries, specifically chronic injuries like that in the plantar fascia

or Achilles tendon of a distance runner vary in what they respond to.

Some people and some chronic injuries respond horribly with ice, and

some are bad with heat. The patient needs to see what works best for

them in these circumstances.

 

In my acupuncture practice (I'm no longer working directly with

collegiate sports) I've treated perhaps 100 ankle sprains using both ice

and acupuncture. My patients know to come to me with an acute injury

just as soon as they can (even if it's a Sunday, because I've lectured

them about timing being crucial). Theoretically, CM says that ice would

cause stasis. Well, the combo of acupuncture with simultaneous ice

works fabulously, much better than ice or acupuncture separately. So, I

look at it as yes, ice causes stasis, but stasis basically is what you

need in the bleeding and swelling phase of an acute injury.

 

So, in summary, it goes like this:

 

Ice for 20-25 minutes, 3 or 4 times daily (along with rest, compression,

elevation). (More time than 25 minutes can actually cause the opposite

effect of vasodilation, so don't go longer than 25 minutes). Also,

ideally, use REAL ice, crushed if possible, in a plastic bag with as

much air removed as possible. No towel is necessary between real ice

and skin. Contrary to popular belief, one cannot get frost-bite from

real ice as it is just 32 degrees. Chemical ice packs, however, can

cause frost-bite, so some sort of material needs to be between the skin

and the pack.

 

After 48-72 hours, do contrast baths, 3 or 4 per day, 25-30 minutes

each.

 

After about 5 or 6 days (depending on symptoms), the general rule of

thumb is heat before an activity, and ice afterwards.

 

If you decide you don't want to use ice because of the CM theory, just

PLEASE don't use heat on an acute injury.

 

I hope that helps.

 

Barbara

 

 

[attiliodalberto]

Saturday, August 28, 2004 4:16 AM

Chinese Medicine

Injuries and Ice

 

Hi all,

 

I was wondering if the time old idea on putting ice in injuries to

reduce the inflammation actually works. Wouldn't this cause blood

stasis and make the problem worse? Wouldn't heat be better as this

would increase the rate of recovery?

 

Any answers?

 

Attilio

 

 

 

 

[Guest guest]

>

>

> [attiliodalberto]

> Saturday, August 28, 2004 4:16 AM

> Chinese Medicine

> Injuries and Ice

>

> Hi all,

>

> I was wondering if the time old idea on putting ice in injuries to

> reduce the inflammation actually works. Wouldn't this cause blood

> stasis and make the problem worse? Wouldn't heat be better as this

> would increase the rate of recovery?

>

> Any answers?

>

> Attilio

 

 

1st stage sinew damage usually requires heat-clearing. see:

http://www.gfcherbs.com/Treating_Trauma_Inside_Out.asp?page=5

 

thanks Barbara, for the very informative post.

 

rh

[Guest guest]

Doc,

 

> Our (Dieh Dah) tradition has always been to ice an acute injury

 

How old is this tradition ( & where does it originate) I wonder - what connection

does it have with mainstream TCM ?

 

[ I ask because cooling the affected part - the obvious empirical solution to

trauma management - to have been missed by TCM is something of a challenge. Why

did TCM miss it out and what do we make of all the rationalisations against

using Cold to treat trauma ? China is a big place and some areas where TCM

developed may not have had access to ice at any time of the year. The

alternatives to ice for creating a temporary stasis are just not practically

viable. For example a 'cold compress' made with water and allowed to evaporate

over a wound would not reduce temperature sufficiently to induce stasis in the

required short period of time. If pure alcohol were added to the water then the

problem of storage arises - how many TCM practitioners of old would be able to

store pure alcohol in readiness for this kind of application ? I haven't got any

answers really, but it seems to me Cold as an injury treatment option never

found its way into the mainstream TCM textbook despite being a strong candidate

empirically, because Ice Cold is a rarity and technically difficult to produce.

]

 

Cheers,

 

Sammy.

 

 

-

Doc

Chinese Medicine

Saturday, August 28, 2004 7:09 PM

Re: Injuries and Ice

 

 

I have been involved in the study of Dieh Dah (TCM Injury Medicine) and

Traditional Chinese Martial Arts for over half a century, have been a

StreetMedic for almost 40 yrs, and a WFR for a while too. Our (Dieh Dah)

tradition has always been to ice an acute injury if it is not possible to apply

immediate Dieh Dah Acupuncture and other protocols (including herbs topicly and

internally). Temorary stasis is what is needed. The cold condition that results

is easily treated with Moxa and Acupuncture and does not become a problem.

 

my.02

 

R S Doc Rosen

 

BTW i teach a Dieh Dah base d 3 day disaster medicine class if anyone is

interested

 

" The world is a dangerous place to live; not because of the people who are

evil, but because of the people who don't do anything about it. "

-- Albert Einstein

 

 

 

 

http://babel.altavista.com/

 

and adjust

accordingly.

 

If you , it takes a few days for the messages to stop being

delivered.

 

[Guest guest]

>

> Generally, I do 4 gates and bleeding method at the ting points of the

channels involved for the first 2 days. I don't put needles " in " the

joint until swelling has stopped (generally 4 or 5 days). I do a

reducing method in the acute phase and reinforcing method in the chronic

phase (or after 2 or 3 weeks). I also employ some rehab exercises as

soon as possible, but sometimes that depends on how " in a hurry " the

patient is. I often work with athletes who tend to be in a hurry.

 

 

>

>

> Hi Barbara,

>

> Great info thanks!

>

> What about the use of acupuncture? When would you start to use acupuncture

> and what acupuncture technique would you employ, i.e. reduced treatment

> time

> or reinforce/reduce method?

>

> Kind regards

>

> Attilio

>

> www.attiliodalberto.com >http://www.attiliodalberto.com/<

>

>

> Barbara Beale [bbeale]

> 28 August 2004 16:59

> Chinese Medicine

> RE: Injuries and Ice

>

>

> Hi Attilio,

>

> Besides being an acupuncturist, I have a bachelor's degree in sports

> medicine and a master's in exercise physiology. I am also a certified

> athletic trainer with about 15 years of experience working with

> interscholastic/intercollegiate athletics in the treatment, prevention

> and rehab of athletic injuries. Therefore, I feel fairly qualified to

> answer this question.

>

> I was aghast in acupuncture school when in was suggested that ice caused

> stasis and would slow an injury's healing. This made sense, however,

> with the concepts of cold being yin and heat being yang. Since, I've

> learned that that could be true from a CM perspective, but it depends on

> timing, just as it does in western medicine's approach. I believe,

> though, that the Chinese say to never use ice. I disagree.

>

> It has been my experience that ice is a tremendous time-saver in the

> process of healing from acute injury. I've seen literally thousands of

> injuries that have not been treated with ice, just as many that have,

> and an unfortunate large number of injuries mistakenly (from

> misinformation but good intention) treated with heat. The ones treated

> with heat swell larger, take probably 30% longer to heal and cause the

> greatest long term. (The biggest offense here has been the dreaded hot

> tub!! " I pulled a muscle in my back and thought it would be a good

> idea

> to loosen in up in the hot tub. " ARGH!!!)

>

> So, to answer your question, both heat and ice are good, but timing is

> most important.

>

> The first 24-48 hours are crucial for the treatment of an acute injury.

> In my experience, the sooner ice is applied, the faster rehab and

> healing will take place. Ice isn't the only component, however.

> Compression, elevation and rest are also involved (but these are other

> topics). When an injury first occurs there is major bleeding and

> swelling (the body's way of producing a cast to immobilize the area).

> The more swelling that occurs, the more the ligaments and tendons will

> be stretched. Ice causes vaso-constriction which limits the swelling.

> Heat causes MORE bleeding, more swelling (vaso-dilation) and many more

> problems down the road.

>

> IF swelling has stopped and the patient has been also resting and

> elevating the injury, and 48-72 hours has passed, heat can be introduced

> by way of a contrast bath. Ice and heat are applied in a rotation

> cycle for 25-30 minutes, 3 or 4 times per day. (If you need specifics

> about contrast baths, there are many references).

>

> After a couple of days of contrast baths and the swelling has reduced

> significantly, heat alone can be applied. However, if any swelling

> occurs from the heat, or from patient use, ice is to be applied.

>

> This is all further confused by the discovery that some types of chronic

> injuries, specifically chronic injuries like that in the plantar fascia

> or Achilles tendon of a distance runner vary in what they respond to.

> Some people and some chronic injuries respond horribly with ice, and

> some are bad with heat. The patient needs to see what works best for

> them in these circumstances.

>

> In my acupuncture practice (I'm no longer working directly with

> collegiate sports) I've treated perhaps 100 ankle sprains using both ice

> and acupuncture. My patients know to come to me with an acute injury

> just as soon as they can (even if it's a Sunday, because I've lectured

> them about timing being crucial). Theoretically, CM says that ice would

> cause stasis. Well, the combo of acupuncture with simultaneous ice

> works fabulously, much better than ice or acupuncture separately. So, I

> look at it as yes, ice causes stasis, but stasis basically is what you

> need in the bleeding and swelling phase of an acute injury.

>

> So, in summary, it goes like this:

>

> Ice for 20-25 minutes, 3 or 4 times daily (along with rest, compression,

> elevation). (More time than 25 minutes can actually cause the opposite

> effect of vasodilation, so don't go longer than 25 minutes). Also,

> ideally, use REAL ice, crushed if possible, in a plastic bag with as

> much air removed as possible. No towel is necessary between real ice

> and skin. Contrary to popular belief, one cannot get frost-bite from

> real ice as it is just 32 degrees. Chemical ice packs, however, can

> cause frost-bite, so some sort of material needs to be between the skin

> and the pack.

>

> After 48-72 hours, do contrast baths, 3 or 4 per day, 25-30 minutes

> each.

>

> After about 5 or 6 days (depending on symptoms), the general rule of

> thumb is heat before an activity, and ice afterwards.

>

> If you decide you don't want to use ice because of the CM theory, just

> PLEASE don't use heat on an acute injury.

>

> I hope that helps.

>

> Barbara

>

>

> [attiliodalberto]

> Saturday, August 28, 2004 4:16 AM

> Chinese Medicine

> Injuries and Ice

>

> Hi all,

>

> I was wondering if the time old idea on putting ice in injuries to

> reduce the inflammation actually works. Wouldn't this cause blood

> stasis and make the problem worse? Wouldn't heat be better as this

> would increase the rate of recovery?

>

> Any answers?

>

> Attilio

[Guest guest]

Ancient China did not have ice available except in the winter. Acute

injuries in the first stage are considered an excess hot condition.

It's interesting to me to note that the plasters used for early stage

injuries contain primarily cold stasis resolving herbs. Ice can be

useful in the initial stage to stop swelling. I agree that any stasis

caused by the ice or cold herbs is easy to correct in later stages. As

a side note, I use bleeding often in acute stage sprains which really

seems to reduce pain and healing time.

 

 

 

On Aug 29, 2004, at 7:23 AM,

Chinese Medicine wrote:

 

>> Hi all,

>>

>> I was wondering if the time old idea on putting ice in injuries to

>> reduce the inflammation actually works. Wouldn't this cause blood

>> stasis and make the problem worse? Wouldn't heat be better as this

>> would increase the rate of recovery?

>>

>> Any answers?

>>

>> Attilio

Sharon Weizenbaum

86 Henry Street

Amherst, MA 01002

413-549-4021

sweiz

www.whitepinehealingarts.com

[Guest guest]

In a message dated 8/28/2004 6:26:21 PM Eastern Daylight Time,

kampo36 writes:

1st stage sinew damage usually requires heat-clearing. see:

http://www.gfcherbs.com/Treating_Trauma_Inside_Out.asp?page=5

Although areas of China may not have had ice.....via herbs especially

topicall they accomplished the same as seen in the excerpt from GFC herbs.

 

" The First Stage of Trauma is the most distinct and is marked by the signs of

pain, heat, and swelling. Heat usually manifests as redness, but in the

absence of redness, heat might also be experienced by the patient as the

sensation

of heat, or may be palpated by the practitioner. This stage can last anywhere

from a few hours up to two weeks, depending on the type and severity of

injury. The treatment strategy is to clear heat and resolve toxin, dispel stasis

and

relieve pain. The formulas used to treat stage one trauma are the coldest

formulas of the three stages; they emphasize eliminating heat toxin while

helping

the body move out damaged tissue. "

 

In modern times we do have ice.....therefore an intelligent application of

ice is appropriate for the appropriate diagnosed stage/conditions.

 

 

 

[Guest guest]

Do you tone, or reduce or both, to the 4 Gates?

 

Dr. Holmes Keikobad

MB BS DPH Ret. DIP AC NCCAOM LIC AC CO & AZ

www.acu-free.com - 15 CEUS by video.

NCCAOM reviewed. Approved in CA & most states.

-

<bbeale

<Chinese Medicine >

Saturday, August 28, 2004 6:18 PM

RE: Injuries and Ice

 

 

> >

> > Generally, I do 4 gates and bleeding method at the ting points of the

> channels involved for the first 2 days. I don't put needles " in " the

> joint until swelling has stopped (generally 4 or 5 days). I do a

> reducing method in the acute phase and reinforcing method in the chronic

> phase (or after 2 or 3 weeks). I also employ some rehab exercises as

> soon as possible, but sometimes that depends on how " in a hurry " the

> patient is. I often work with athletes who tend to be in a hurry.

>

[Guest guest]

sammy_bates <sammy_bates wrote:

 

>How old is this tradition ( & where does it originate) I wonder - what

connection does it have with mainstream TCM ?<

 

 

 

Tieh Tah /Dieh Dah is simply the Martial Arts based injury medicine that was

part of the original base of . It claims a tradition of

thousands of years.

As for the rest of your question/theorizing i will firstly point out that Dieh

Dah was considered to low class and pragmatic to make it into TCM texts and

secondly i will follow the concept of Dieh Dah and do what works without any

recourse to theories.

 

Doc

 

[ I ask because cooling the affected part - the obvious empirical solution to

trauma management - to have been missed by TCM is something of a challenge. Why

did TCM miss it out and what do we make of all the rationalisations against

using Cold to treat trauma ? China is a big place and some areas where TCM

developed may not have had access to ice at any time of the year. The

alternatives to ice for creating a temporary stasis are just not practically

viable. For example a 'cold compress' made with water and allowed to evaporate

over a wound would not reduce temperature sufficiently to induce stasis in the

required short period of time. If pure alcohol were added to the water then the

problem of storage arises - how many TCM practitioners of old would be able to

store pure alcohol in readiness for this kind of application ? I haven't got any

answers really, but it seems to me Cold as an injury treatment option never

found its way into the mainstream TCM textbook despite being a

strong candidate empirically, because Ice Cold is a rarity and technically

difficult to produce. ]

 

Cheers,

 

Sammy.

 

 

-

Doc

Chinese Medicine

Saturday, August 28, 2004 7:09 PM

Re: Injuries and Ice

 

 

I have been involved in the study of Dieh Dah (TCM Injury Medicine) and

Traditional Chinese Martial Arts for over half a century, have been a

StreetMedic for almost 40 yrs, and a WFR for a while too. Our (Dieh Dah)

tradition has always been to ice an acute injury if it is not possible to apply

immediate Dieh Dah Acupuncture and other protocols (including herbs topicly and

internally). Temorary stasis is what is needed. The cold condition that results

is easily treated with Moxa and Acupuncture and does not become a problem.

 

my.02

 

R S Doc Rosen

 

BTW i teach a Dieh Dah base d 3 day disaster medicine class if anyone is

interested

 

" The world is a dangerous place to live; not because of the people who are

evil, but because of the people who don't do anything about it. "

-- Albert Einstein

 

 

 

 

http://babel.altavista.com/

 

and adjust

accordingly.

 

If you , it takes a few days for the messages to stop being

delivered.

 

[Guest guest]

This seems to be talking about an injury that is already days old.

Ice (in the Dieh Dah tradition i come from) is used in the first minutes to

hours. I also treat by using MeiHua Tsom (Tapping Hammer) and by cupping,

Bleeding, and by very agressive Acupuncture as well as external, internal herbs

and Manipulation(bone Setting)

 

I have treated litteraly thousands of acute injuries this way with great

success. (ranging from blunt trauma -sprains-fractures etc.)

Doc

 

bbeale wrote:

>

> Generally, I do 4 gates and bleeding method at the ting points of the

channels involved for the first 2 days. I don't put needles " in " the

joint until swelling has stopped (generally 4 or 5 days). I do a

reducing method in the acute phase and reinforcing method in the chronic

phase (or after 2 or 3 weeks). I also employ some rehab exercises as

soon as possible, but sometimes that depends on how " in a hurry " the

patient is. I often work with athletes who tend to be in a hurry.