First off, you should have a first aider around and listen to medical advice etc etc and don't sue me if anyone looses a leg. This guide is for the bruise/sprain level of injury (ie. you land badly and then your ankle hurts like you've got a knitting needle through it). Can't guarantee perfection but this is working to the best of my ability. BEGIN If you work on an injury, it gets worse. Don't finish your set or any of that manly jazz - stop and check yourself out. --- Investigate the injury, if it is near a joint then try flexing it -sharp shooting pains would be bad, poss. broken bones bad. Note that not all broken bones can be 'felt' by moving bone fragments independently, partial fractures and greensticks being the worst. Also, you don't want to poke your bones about if they're broken. - Instant swelling of a joint after trauma is normally hospital/physio treatment (partial/full ligament tears through to breaks) --- First job is to reduce the swelling. Swelling is an all out bad reaction that delays healing and can increase the injury. -Ibuprofen/diclofenac or other anti-inflammatory drugs are good for medium injuries. If you're likely to call Paramedics then ffs take note of exactly what you took (dosage) and when, I'd advise no self-admin if you are going via ambulance. - Ice is an excellent choice. I AM NOW GOING TO EXPLAIN HOW TO ICE VERY CAREFULLY BECAUSE NEARLY EVERYONE DOES THIS INCORRECTLY. Ice works by vasoconstriction (reducing blood flow) which is your body's reaction to getting a slightly cold. This is good because less blood flow means less chemicals being provided to the injury site to feed the inflammation[swelling] cascade. HOWEVER, if you leave ice on too long (injury site gets too cold) then your body goes "Whoa, s***! I'm gonna get frostbite. Quick! Warm that up with some blood!" and then vasodilation (more blood flow) occurs and you've made the swelling worse... You prize pillock. Good rule of thumb is 5min on/2min off when applying ice. With your initial injury management done you need to think about yourself for the next few days. I'm not a fan of painkillers (they mask injury) but taking anti inflammatories for a day or two can help to reduce recovery time. For a ligament/meniscus injury you should think about a medical check (GPs are generally not great at sports injuries, given that they see more pensioners than sportstars. I prefer a physio, but I'm lucky to have a world-class physio down the road) rest them and use the joint a minimal amount. Bruises need no special care - just don't poke 'em! Lemme know if you have questions All the best, Atre PS. Yes, this was mostly about ice but people getting ice horribly wrong 'tis a major issue. I'm also not giving detailed diagnostics on more severe injury [breaks/ruptures] because I worry about misdiagnosis... But feel free to ask stuff if you want!
Interesting post but there was research done on this by Dr Kenneth Knight in the 1980's showing that this 'warming up' only happened in the hands and occasionally in other highly vascularised tissues. Not typical for most of the body. He encourages long periods of cooking the area throughout rehab to make things less painful and to allow better rehab. Think those that used the ice methods in his studies improved faster and were able to return to active competition 2-4 weeks faster than athletes using the idea of short cooling periods. Been a sports/ortho physio for > 20 years myself and have seen this to be a better way more often than not. powchoy
Kl thanks, is there a pubmed reference for Knight? Can't find any work pre-1990. Think you might have had a win though - all the literature that talks about "reactive vasodilation" says it is a disputed area. Ankle sprain, short-term better pain reduction from intermittent ice. Long term (week) little difference. http://www.ncbi.nlm.nih.gov/pubmed/...nel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum Doesn't observe reactive vasodilation in 20min of cold pack. Sadly can't see the article so don't know their methodology. http://www.ncbi.nlm.nih.gov/pubmed/1584860?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedarticles&logdbfrom=pubmed
Product Description Cryotherapy is the most prevalent modality used to treat sport injuries. But when and how should you apply cryotherapy for the best results? In this book, Kenneth L. Knight—a veteran athletic trainer, sports medicine researcher, and athletic training educator—presents the most extensive and up-to-date resource available on understanding and using cryotherapy to treat and rehabilitate injuries. Cryotherapy in Sport Injury Management gives you clear "how-to" instructions for both immediate and long-term care of a wide variety of injuries. Athletic trainers, physical therapists, sport physicians, and other sports medicine specialists will find the numerous clinical applications and accompanying illustrations especially useful. The book also presents the theoretical basis for cryotherapy, along with subject and author indexes and more than 800 references, making it a valuable reference for researchers and practitioners alike. Part I introduces readers to the concept of cold injury treatment and examines the cold versus hot treatment controversy. Knight traces the development of cryotherapy from the ancient Greeks and Romans to the present day. Part II, The Scientific Basis of Cryotherapy, reviews in depth the physiological response of bodily tissues to cold treatment and provides a theoretical basis for the cryotherapy techniques used in dealing with acute musculoskeletal conditions. Throughout this section, Knight includes specific, direct applications of the principles being discussed. He also introduces precautions and caveats on when not to use the technique. Part III, Clinical Techniques Involving Cryotherapy, discusses the most common (and some not-so-common) cryotherapeutic techniques, and is abundantly illustrated for direct application. This section provides clear instructions for administering both immediate and long-term care of a variety of injuries. Pre- and postsurgical applications of cold treatment are evaluated, including cold packs, ice immersion, cold whirlpool, and sprays. Knight also describes the role of cryotherapy in rehabilitation. Whether you're looking for clear, illustrated instructions on how to use cryotherapy to treat injuries or want a resource that explains the scientific basis underpinning the technique, you'll find everything you need to know in the only book dedicated to the history, science, and applications of cold treatment: Cryotherapy in Sport Injury Management. Contents Part I. Introduction to Cryotherapy Chapter 1. The What and Why of Cryotherapy Why the Confusion? What Is Cryotherapy? Cryotherapeutic Techniques What Happens When Cold Is Applied? Heat vs. Cold: When and Why Summary Chapter 2. Historical Perspective Heat vs. Cold Early Medical Uses of Cold Cold and Immediate Care Use of Ice for Rehabilitation: The History of Cryokinetics Summary Part II. The Scientific Basis of Cryotherapy Theory vs. Technique Central and Local Responses Pathophysiology Chapter 3. Inflammation and Wound Repair The Inflammatory Response The Sport Injury Model Secondary Injury Swelling: Hemorrhaging and Edema The Healing Process Summary Chapter 4. Sport Injury Rehabilitation Rehabilitation vs. Reconditioning What Rehabilitation Is Not Principles of Rehabilitation A Systems Approach to Total Rehabilitation: The 10 Phases What Modality Is Used When? The Psychology of Rehabilitation Summary Chapter 5. Temperature Changes Resulting From Cold Applications Heat and How It Is Measured Heat Conduction Heat Capacity Surface Temperature Deep-Tissue Temperature Intraarticular Temperature Rewarming Following Cold Applications Controversy Over Contralateral Limb Temperatures Adaptation to a Cold Environment Summary Chapter 6. Metabolism and Inflammation Decreased Metabolism at Lower Temperatures Cryotherapy in Cardiac Surgery and Transplant Surgery Studies of Induced Injuries Cryotherapy and Inflammation Effects of Cold on Wound Healing Summary Chapter 7. Rest, Ice, Compression, Elevation, and Stabilization for the Immediate Care of Acute Traumatic Injuries Clinical Studies Effects of Ice During Immediate Care Effects of Ice on Swelling Effects of Compression on Swelling Effects of Elevation on Swelling Rest Stabilization What Types of Injuries Are Treated With RICES? Ice Application Protocols Summary Chapter 8. Orthopedic Surgery and Cryotherapy Postsurgical Cryotherapy Presurgical Cryotherapy Cryoanalgesia Summary Chapter 9. Circulatory Effects of Therapeutic Cold Applications What Is Cold-Induced Vasodilation? What Is Dilation? Cold Dilemma Evidence for CIVD CIVD: A Red Herring Benefits of the CIVD Theory Contrast Baths Summary Chapter 10. Neurological and Neuromuscular Effects of Cold Applications Effects of Cold on Sensory Nerve Functions Effects of Cold on Neuromuscular Parameters Tetanic Tension Effects of Cold on Reflexes Summary Chapter 11. Pain and Cold Applications What Is Pain? Measuring Pain Cold-Induced Pain Coping With and Adapting to Cold-Induced Pain How Does Cold Relieve Pain? Pain Reduction With Cryotherapy: Clinical Uses Summary Chapter 12. Reduction of Muscle Spasm With Cold Therapy Clinical Studies Mechanism of Spasm Relief Summary Chapter 13. Tissue and Joint Stiffness Connective Tissue Muscle Stiffness Joint Stiffness Manual Dexterity Manual Performance Cryotherapy During Sports Activities Muscle and Joint Stiffness as a Symptom Summary Chapter 14. Problems, Precautions, and Contraindications in Cold Therapy Frostbite and Related Conditions Pressure-Related Nerve Palsy Cold Hypersensitivity Vasospastic Disorders Contraindications Precautions Summary Part III: Clinical Techniques Involving Cryotherapy Chapter 15. Methods of Cold Application Ice Packs Cold-Gel Packs Artificial Ice Cube Packs Chemical Cold Packs Ice Immersion Cold Whirlpools Ice Massage Cold Machines Vapo-Coolant Spray Vapo-Coolant Cuffs Chapter 16. Initial Care of Acute Injuries: The RICES Technique Summary of Rationale for RICES Equipment Needed Preapplication Procedures Application Procedures Postapplication Procedures Key Points for Applying RICES Chapter 17. Cryokinetics in Rehabilitation of Joint Sprains Summary of Rationale for Cryokinetics Equipment Needed Preapplication Procedures Application Procedures Alternatives Key Points for Using Cryokinetics Chapter 18. Relieving Acute Muscle Spasm: Cryostretch Cryostretch Summary of Rationale for Cryostretching Equipment Needed Preapplication Procedures Application Procedures Combined Cryostretch and Cryokinetics Key Points for Using Cryostretch Chapter 19. Postsurgical Cryotherapy Aircast Cryo Cuff Dura-Kold Packs Circulating Cold-Water Machines Chapter 20. Cryotherapeutic Techniques for Relieving Pain Relieving Menstrual Cramps Application Procedures Treating Headaches Painless Injection and Venipuncture Myofascial Trigger Point Therapy Application Procedures Chapter 21. Miscellaneous Cryotherapeutic Techniques Medicated Ice for Abrasions Equipment Needed Preapplication Procedures Application Procedures Stretching Connective Tissue Equipment Needed Application Procedures Cooling Athletes During Exercise in a Hot Environment Minimizing Cold Sores Application Procedures Minimizing Blisters Prevention of Hair Loss During Doxorubicin Chemotherapy 1. Knight KL, Brucker JB, Stoneman PD, Rubley MD. Muscle Injury Management with Cryotherapy. Athletic Therapy Today. 2000;5(4):26-30 3. Knight KL, Rubley MD, Ingersoll CD, Brucker JB. Pain Perception is Greater During Ankle Ice Immersion Than During Ice Pack Application. Journal of Athletic Training, Supplemental. 2000;35(2):S-35 6. Knight KL, Rubley MD, Brucker JB, Huff JM, Bernards SA. Knee surface temperature changes on uninjured subjects during and following application of three post-operative cryotherapy devices. Journal of Athletic Training, Supplemental. 2001;36(2):S-90. http://www.pickeringhockey.com/assets/docs/Injury Ice.pdf not a bad summary article :''The length of application of ice according to Mr. Knight is considerably longer than you might think or possibly have heard in the past. The ice packs should be applied intermittently, so no continuous application because it is both unnecessary and potentially dangerous. Because most of the body’s parts rewarm slowly after ice application you could keep an area cool by applying ice for 30 minutes up to 40 minutes for large muscle groups, every 2 hours.'' hope this gets you started .... powchoy
Cheers, I'm very annoyed to have posted what looks to be "not 100% accurate" information on ice packs... Especially seeing as having said my piece about ice I didn't cover the other simple advice any first aider knows . Can't edit the first post and can't kill the thread. Balls.
