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How Long should you Ice an Injury for?

In light of the current frigid conditions, we thought we would write a little bit about something we have all had just about enough of… Ice.

We’ve all heard it before, if you are injured, ice it. But did you know that icing for too long could actually be counter productive and lead to an INCREASED inflammatory response?

Interestingly, applying ice for a period of time greater than ten minutes puts the injured area at risk for creating an even greater inflammatory response due to a phenomenon known as the Hunting Response. In a cold winter environment while walking outside, our nose and ears will turn red after some time because our body has sensed that the area in question is at risk of freezing. The body’s natural response is to increase blood supply to this area, thereby increasing the inflammatory markers in that area. Leaving an ice pack on for too long to an acute injury will create the same reactive increase in inflammatory response. 

We suggest patients use ice in ten minute intervals, ten minutes on – ten minutes off for an ideal effect.

Strength Training and Knee Pain

With Strength comes stability and with stability always comes less knee pain.

If you have spent any amount of time in our clinic, this is something you have more than likely heard. Dr Karmali shares a little on what makes stability so important to the health of our joints.

“When it comes to maintaining the long-term health of any joint in our body, stability plays a critical role. Take for example, the knee.
The knee joint is the largest and most superficial joint, primarily operating as a ‘hinge’, allowing for bending and straightening of the leg. These hinge movements are combined with gliding, rolling, and rotation, which add to the functional complexity of the knee. Despite being well constructed, the knee joint is relatively vulnerable mechanically because of the in-congruence of its articular surfaces, which can be likened to two balls laying on a warped tabletop.

With that thought in mind, imagine if we didn’t have any ligamentous or muscular control to hold things together… We wouldn’t have a very good knee and understandably, be more prone to injury or accelerated joint degeneration. It is with this notion that ensuring the integrity of joint-specific ligaments as well as adequate and timely neuromuscular control that we can provide our joints with optimal loading and force dissipation to maintain and even improve their longevity.”

Low Back Pain and Disability

Did you know that low back pain causes more disability than any other condition globally? As such, the development, or ‘pathogenesis’, of low back pain has long been investigated by research groups and programs. Most recently, the esteemed Drs. Injeyan, Injeyan, and Triano compared differences in inflammatory markers in the blood between asymptomatic individuals, and patients with non-specific acute or chronic low back pain. While there are limitations to every study, their results highlighted a distinct increase in pro-inflammatory mediators and a marked decrease in anti-inflammatory mediators in both groups of symptomatic patients when compared to asymptomatic individuals. Interestingly, a separate group in 2016 looked at the various effects of spinal manipulation and found that this technique may in fact activate naturally-produced anti-inflammatory mediators.

Inflammation and OA

Osteoarthritis (OA) was previously considered non-inflammatory. It is now well recognized that inflammatory mediators are produced and can be measured in joint fluids of patients with OA. This inflammation is a major risk factor in cartilage loss, pain, swelling, and stiffness. When management and treatment of OA consists of anti-inflammatory components, patients can improve their function and decrease pain levels. Platelet-rich plasma (PRP) is a cell therapy, that uses one’s own blood through joint injections, to reduce inflammation. Platelets are a high source of concentrated growth factors and inflammatory mediators. Platelets in PRP release many types of anti-inflammatory proteins that signal cells that lead to suppression of inflammation in OA.

 

Goldring and Otero. Inflammation in Osteoarthritis. Curr Opin Rheumatol. 2011; 23

Xie et al. Biology of platelet-rich plasma and its clinical application in cartilage repair. Arthritis Res Ther. 2014; 16