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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.

Pro Tips for Staying Safe from Shred to Bed

The fresh powder here and ski and snowboard season is well under way! Dr. Karmali has some #protips for you to heed from shred to bed:

1] A dynamic warm up is key – before strapping on your boots, hold on to a bar or rail and perform 30 forward-to-backward leg swings, followed by 30 side-to-side leg swings. Next, find a stable piece of ground and perform 30 on-the-spot high-knees, followed by 30 butt-kicks, both with some haste. The goal here is to power up the muscles you intend to use for the day, including your heart.

2] In addition to having appropriate safety gear on your person and being equipped with protection from the elements, including the sun, ensure that you take a number of breaks through the day. Listen to your body. Don’t try to be a hero. Take the opportunity to “re-fuel” with some water or electrolytes before you hop onto the gondola again. Pure coconut water (no sugar added) is an exceptional natural source of electrolytes. Taking breaks will also help you ward off the fatigue that will inevitably set in after a few long runs… Unless you have magical Scandinavian genes and can go all day. In all seriousness, there’s a reason why injuries on the hill typically occur near the end of the day. Stay fresh, stay safe.

3] At the end of the day, don’t just hit the showers and jump into bed. Get the fireplace crackling and take 15 minutes to engage in active recovery, or what I like to call “floor work”. Grab a mat or rug and work on your low back, hip, and knee mobility. If you want to carve on day 2 without falling apart, active recovery should be part of your apres-ski routine.

 

Pro tips for ski season

The Core Principles of Evidence Based Medicine

EVIDENCE-BASED MEDICINE

The core principles of evidence-based medicine dictate that relevant research, the practitioner’s clinical experience, and the patient’s values all need to be considered when determining the best course of action in any given clinical scenario. Because clinical experience and a patient’s values are considered subjective variables, clear communication and understanding between the practitioner and patient is crucial. Appraising and interpreting relevant research, however, offers a key objective component to consider in the clinical decision-making process.

When it comes to joint pain, we often think of injections or surgery as our only options, however, it is important to understand that the bio mechanics of a joint, or the way a joint functions, is heavily dependent on structures that are adjacent to it. Think of the nerves in the muscles, tendons, and ligaments that relay messages to and from the brain about that joint. Knowing this, it is not surprising that the relevant research around managing many musculoskeletal conditions is to employ what is known as a ‘multi-modal’ approach to treatment. This means that the best outcomes are achieved by utilizing a variety of treatment options, including addressing changes to fascia, muscles, and tendons surrounding a joint, in addition to working through an individualized strengthening program to re calibrate or rehabilitate the function of that joint, and perhaps even protecting it from further damage with a brace.

In applying these concepts, the key to successful outcomes at Elite Sport Performance and the Knee Clinic is our three-pronged approach to treatment: treat the problem, strengthen the area, and avoid or modify offending activities.

Dr. Arif Karmali

BSc(Kin), DC

 

 

Why Manual Therapy could be just what the Doctor Ordered

At Elite Sport Performance and the Knee Clinic, the key to successful outcomes is our three-pronged approach to treatment: treat the problem, strengthen the area, and avoid or modify offending activities. These three components are broad and can encompass a wide variety of decisions and actions. If we zoom in on the first component, ‘treat the problem’, we may encounter a number of treatment options for the problem we are endeavoring to manage, but how do we know what’s best for each patient? The principles of evidence-based medicine would dictate that that the related research, the practitioner’s clinical experience, and the patient’s values all need to be considered when determining the best course of action.

When it comes to joint pain, we often think of injections or surgery as our only options, however, it is important to understand that the bio-mechanics of a joint, or the way a joint functions is heavily dependent on structures that are adjacent to it. Think of the muscles, tendons, ligaments, and nerves that relay messages to and from the brain about that joint. Knowing this, it is not surprising that the related research around managing many musculoskeletal conditions is to employ what is known as a ‘multi-modal’ approach to treatment. This means that the best outcomes are achieved by utilizing a variety of treatment options, including addressing changes to fascia, muscles, and tendons surrounding a joint, in addition to working through an individualized strengthening program to re-calibrate or rehabilitate the function of that joint, and perhaps even protecting it from further damage with a brace.

Whether due to trauma or degenerative changes over time, cellular scar tissue, or fibrosis can accumulate and disrupt optimal function of a joint or tissue, and can even be a cause of pain. Using a variety of clinically-derived manual, or hands-on treatment protocols such as Active Release Techniques, Graston Technique, and other similar approaches, practitioners can improve the rate and quality of healing as well as aid in restoring optimal function to a joint or tissue.  This ‘hands-on work’ will often be prescribed as part of a patient’s individualized plan of management, and would fall under the ‘treat the problem’ component.