Category: Icing Therapy

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Intense Exercise, Muscle Soreness, Recovery, and Anti-inflammatories

Rehab Deb’s Comments:

One of the most important bits of this report is something I’ve been reading more and more research regarding, and that is that nsaids (non-steroidal anti-inflammatories) subdue, limit, delay the healing process. I have also read several reports regarding the same being true when ice is used.

Nsaids in animal medicine include Previcox, Peroxicam, Deramaxx, Rimadyl, Metacam, among others…and for humans include Advil, Ibuprofen, Motrin, Tylenol, Aspirin, Aleve (sodium naproxen), etc…Does this mean to cut them out altogether? No, but I do think it means to consider the necessity of application and what is hoped to be achieved…is it really necessary?? Pain is often very well controlled or minimized by combining smaller doses of several analgesics, pain relievers, depending on the issue, rather than higher doses of just one medication and/or continuous doses of nsaids that probably aren’t doing much to help the pain problem.

This is only one suggestion.

Ultimately this information should be discussed with the medical practitioner who prescribed the medications in the first place if/when you have questions. There are other reasons to minimize nsaids and use Tramadol and/or Gabapentin and/or other prescription analgesics to alleviate pain for the short run while building muscle to support damaged joints. Many practitioners are aware of using these other drugs, and while they may not know about this more recent news regarding nsaids delaying healing and muscle growth, which came out of human sport science, veterinarians in my area seem to be interested in the information when it is presented to them.

Article from Dr. Gabe Mirkin’s Fitness and Health E-Zine
May 6, 2012

How to Recover from Muscle Soreness Caused by Intense Exercise

Muscle soreness should be part of every exercise program.  If you don’t exercise intensely enough on one day to have sore muscles on the next, you will not gain maximum fitness and you are also losing out on many of the health benefits of exercise. The benefits of exercise are much greater with intense exercise than with casual exercising.

You must damage your muscles to make them grow and become stronger.  When muscles heal, they are stronger than they were before you damaged them. All athletes train by “stressing and recovering”. On one day, they take a hard workout in which they feel their muscles burning.  Eight to 24 hours after they finish this intense exercise, their muscles start to feel sore. This is called Delayed Onset Muscle Soreness (DOMS). Then they take easy workouts until the soreness is gone, which means that their muscles have healed.
DOMS IS CAUSED BY MUSCLE DAMAGE. Muscles are made up of fibers. The fibers are made up of a series of protein blocks called sarcomeres that are lined in a long chain. When you stretch a muscle, you stretch apart the sarcomeres in the chain. When sarcomeres are stretched too far, they tear.  Your body treats these tears in the same way that it treats all injuries, by a process called inflammation.  Eight to 24 hours after an intense workout, you suffer swelling, stiffness and pain.

The most beneficial  intense exercise program  is:
* severe enough to cause muscle pain on the next day, and
* usually allows you to recover almost completely within 48 hours.

ACTIVE, NOT PASSIVE, RECOVERY:  When athletes feel soreness in their muscles, they rarely take days off.  Neither should you. Keeping sore muscles moving makes them more fibrous and tougher when they heal, so you can withstand greater forces and more intense workouts on your hard days.  Plan to go at low intensity for as many days as it takes for the soreness to go away. Most athletes try to work out just hard enough so that they recover and are ready for their next hard workout in 48 hours.

TIMING MEALS TO RECOVER FASTER:  You do not need to load extra food to recover faster. Taking in too much food fills your muscle cells with fat, and extra fat in cells blocks the cell’s ability to take in and use sugar. Sugar is the main source of energy for your muscles during intense exercise. Using sugar to drive your muscles helps them to move faster and with more strength. Timing of meals is more important than how much food you eat. Eating protein- and carbohydrate-containing foods helps you recover faster, and the best time to start eating is as soon as you finish a hard workout. At rest, muscles are inactive. Almost no sugar enters the resting muscle cell from the bloodstream (J. Clin. Invest. 1971;50: 2715-2725). Almost all cells in your body usually require insulin to drive sugar into their cells. However during exercise your muscles (and your brain) can take sugar into their cells without needing insulin.  Exercising muscles are also incredibly sensitive to insulin and take up sugar into their cells at a rapid rate.  This effect lasts maximally for up to an hour after you finish exercising and disappears almost completely in around 17 hours.  The best time to eat for recovery is when your cells are maximally responsive to insulin, and that is within a short  time after you finish exercising. Not only does insulin drive sugar into muscle cells, it also drives in protein building blocks, called amino acids.  The sugar replaces the fuel for muscle cells. The protein hastens repair of damaged muscle.  Waiting to eat for more than an hour after finishing an intense workout delays recovery.

WHAT TO EAT AFTER YOUR INTENSE WORKOUTS: Fatigue is caused by low levels of sugar, protein, water and salt.  You can replace all of these with ordinary foods and drinks. If you are a vegetarian, you can replace your protein with combinations of grains and beans. You can replace carbohydrates by eating virtually any fruits, vegetables, whole grains, beans, seeds and nuts. A recovery meal for a vegetarian could include corn, beans, water, bread, and fruits, nuts and vegetables.  If you prefer animal tissue, you can get your protein from fish, poultry,or meat.   Special sports drinks and sports supplements are made from ordinary foods and therefore offer no advantage whatever over regular foods.

BODY MASSAGE:  Many older studies have shown that massage does not help you recover faster from DOMS. Recently, researchers at McMaster University in Hamilton, Ontario showed that deep massage after an intense workout causes muscles to enlarge and grow new mitochondria (Science Translational Medicine, published online Feb, 2012). This is amazing. Enlarging and adding mitochondria can help you run faster, lift heavier weights, and even prevent heart attacks and certain cancers.

NSAIDS DELAY DOMS RECOVERY:  Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may help relieve pain, but they also can block muscle repair and delay healing.

HOT BATHS:  Most research shows that a hot bath is not much better than doing nothing in helping muscles recover from exercise (European Journal of Applied Physiology, March 2006)

COLD OR ICE BATHS:  A recent review of 17 small trials, involving 366 participants, showed a minor decrease in DOMS with ice water baths.  They found “little quality research” on the subject and “no consistent method of cold water immersion” (Cochrane Library, published online February 15, 2012).  Cold water immersion can reduce swelling associated with injury, but has not been proven to speed the healing of DOMS.

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WHERE DO I PUT THE ICE?

Where Do I Put The Ice?

I have read the homework and this is a dumb question, but I do not know where to put the ice on an ACL tear.

I would like to have an evalution to see what I can do to make my guy better. He has started limping more and I want to start using the ice. He does not seem to be in any pain at all and I do not have him on any meds except a chinese herb which is not helping. I will be setting up my work schedule tomorrow for the upcoming weeks. Is it possible for you to evalute my boy?

Not a dumb question at all…for now, you may just place a pack directly on his knee, on the side, while he is lying down. Leave on the pack for 20 minutes, no towels or other barriers, especially if he has fur…that is enough of a barrier.

Yes, we may set up an appt. I have some openings next week, and I will write you mail this weekend to set up a time and day. Thanks-

Oh, and if he is limping, he is likely in pain.

It is common for most people, even people with medical training, to think for a variety of reasons I won’t take time to discuss here that the animal is not in pain, however the best demonstration that he is in a little pain, at the least, is usually limping.

I suggest you speak to the vet about getting an anti-inflammatory or another pain reliever, like Tramadol (used a lot here in Austin, TX), if you are open to that idea, and if you are not, we will talk about some other options when I see him for evaluation. There are usually not any combinations of even several non-pharmaceutical helps that will do away with the type of pain that is enough to make the patient limp. This means you usually need pharmaceutical drugs to help your pet feel better, feel less pain.

Also, if you do give a pain reliever for a day or two and the limping stops, that is another good clue that the limping has been due to pain. For more information on pain, please see my pain posts by searching the word pain in the search box.

I also highly recommend fish oil capsules…they are anti-inflammatory, for one, and good for many things. Look for a capsule with 1000 mg of oil or less and definite amounts of EPA and DHA, noted separately on the label. A good place to start is about 20 mg of EPA daily for every kg of body weight.

Deb

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Why Ice Delays Recovery

March 16, 2014

by Gabe Mirkin, MD

“When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression, Elevation) for the treatment of athletic injuries (Little Brown and Co., page 94).

Ice has been a standard treatment for injuries and sore muscles because it helps to relieve pain caused by injured tissue. Coaches have used my “RICE” guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.

In a recent study, athletes were told to exercise so intensely that they developed severe muscle damage that caused extensive muscle soreness. Although cooling delayed swelling, it did not hasten recovery from this muscle damage (The American Journal of Sports Medicine, June 2013).

A summary of 22 scientific articles found almost no evidence that ice and compression hastened healing over the use of compression alone, although ice plus exercise may marginally help to heal ankle sprains (The American Journal of Sports Medicine, January, 2004;32(1):251-261).

Healing Requires Inflammation

When you damage tissue through trauma or develop muscle soreness by exercising very intensely, you heal by using your immunity, the same biological mechanisms that you use to kill germs. When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing.

The response to both infection and tissue damage is the same. Inflammatory cells rush to injured tissue to start the healing process (Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999). The inflammatory cells called macrophages release a hormone called Insulin-like growth Factor (IGF-1) into the damaged tissues, which helps muscles and other injured parts to heal.However, applying ice to reduce swelling actually delays healing by preventing the body from releasing IGF-1.

The authors of one study used two groups of mice, with one group genetically altered so they could not form the normally expected inflammatory response to injury. The other group was able to respond normally. The scientists then injected barium chloride into muscles to damage them. The muscles of the mice that could not form the expected immune response to injury did not heal, while mice with normal immunities healed quickly. The mice that healed had very large amounts of IGF-1 in their damaged muscles, while the mice that could not heal had almost no IGF-1. (Federation of American Societies for Experimental Biology, November 2010).

Ice Keeps Healing Cells from Entering Injured Tissue

Applying ice to injured tissue causes blood vessels near the injury to constrict and shut off the blood flow that brings in the healing cells of inflammation (Knee Surg Sports Traumatol Arthrosc, published online Feb 23, 2014). The blood vessels do not open again for many hours after the ice was applied. This decreased blood flow can cause the tissue to die from decreased blood flow and can even cause permanent nerve damage.

Anything That Reduces Inflammation Also Delays Healing

Anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by: * cortisone-type drugs, * almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)), * immune suppressants that are often used to treat arthritis, cancer or psoriasis, * applying cold packs or ice, and * anything else that blocks the immune response to injury.

Ice Also Reduces Strength, Speed, Endurance and Coordination

Ice is often used as short-term treatment to help injured athletes get back into a game. The cooling may help to decrease pain, but it interferes with the athlete’s strength, speed, endurance and coordination (Sports Med, Nov 28, 2011). In this review, a search of the medical literature found 35 studies on the effects of cooling . Most of the studies used cooling for more than 20 minutes, and most reported that immediately after cooling, there was a decrease in strength, speed, power and agility-based running. A short re-warming period returned the strength, speed and coordination. The authors recommend that if cooling is done at all to limit swelling, it should be done for less than five minutes, followed by progressive warming prior to returning to play.

My Recommendations

If you are injured, stop exercising immediately.

If the pain is severe, if you are unable to move, or if you are confused or lose even momentary consciousness, you should be checked to see if you require emergency medical attention. Open wounds should be cleaned and checked. If possible, elevate the injured part to use gravity to help minimize swelling. A person experienced in treating sports injuries should determine that no bones are broken and that movement will not increase damage.

If the injury is limited to muscles or other soft tissue, a doctor, trainer or coach may apply a compression bandage (or not-DC). Since applying ice to an injury has been shown to reduce pain, it is acceptable to cool an injured part for short periods soon after the injury occurs. You could apply the ice for up to 10 minutes, remove it for 20 minutes, and repeat the 10 minute application once or twice.

There is no reason to apply ice more than six hours after you have injured yourself.”

Dr. Mirkin, M.D.

 

 

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MASSAGE, NUTRITION, NSAIDS, ICE, HEAT, AND MUSCLE RECOVERY

Intense Exercise, Muscle Soreness, Recovery, and Anti-inflammatories

Rehab Deb’s Comments: One of the most important bits of this report is something I’ve been reading in more and more research: nsaids (non-steroidal anti-inflammatories) delay or stop the healing process. I have also read several reports regarding the same outcome using ice. Nsaids in animal medicine include Previcox, Peroxicam, Deramaxx, Rimadyl, Metacam, etc…and for humans include Advil, Ibuprofen, Motrin, Tylenol, Aspirin, Aleve (sodium naproxen), etc…Does this mean to cut them out altogether? NO…it means think about the application, and possibly combine smaller doses of several pain relievers, depending on the issue, rather than higher and continuous doses of nsaids or only nsaids.

This is only one suggestion.

Ultimately the pain relief drugs for your pet should be discussed with the medical practitioner who prescribed the meds or will be prescribing them in the first place. There are other reasons to minimize nsaids and instead use Tramadol and/or Gabapentin and/or other analgesics to alleviate pain for the short run. The primary reason would be to better encourage building muscle to support damaged joints.

Many practitioners are aware of the benefits of using these other drugs, and while they may not know about this more recent news regarding nsaids delaying healing and muscle growth, it should be easy for anyone to find research papers in addition to those listed on this website.

Article from Dr. Gabe Mirkin’s Fitness and Health E-Zine
May 6, 2012

HOW TO RECOVER FROM MUSCLE SORENESS CAUSED BY INTENSE EXERCISE:

Muscle soreness should be part of every exercise program.  If you don’t exercise intensely enough on one day to have sore muscles on the next, you will not gain maximum fitness and you are also losing out on many of the health benefits of exercise. The benefits of exercise are much greater with intense exercise than with casual exercising.

You must damage your muscles to make them grow and become stronger.  When muscles heal, they are stronger than they were before you damaged them. All athletes train by “stressing and recovering”. On one day, they take a hard workout in which they feel their muscles burning. Eight to 24 hours after they finish this intense exercise, their muscles start to feel sore. This is called Delayed Onset Muscle Soreness (DOMS). Then they take easy workouts until the soreness is gone, which means that their muscles have healed.

DOMS is caused by muscle damage:

Muscles are made up of fibers. The fibers are made up of a series of protein blocks called sarcomeres that are lined in a long chain. When you stretch a muscle, you stretch apart the sarcomeres in the chain. When sarcomeres are stretched too far, they tear.  Your body
treats these tears in the same way that it treats all injuries, by a process called inflammation.  Eight to 24 hours after an intense workout, you suffer swelling, stiffness and pain.

The most beneficial  intense exercise program  is:
* severe enough to cause muscle pain on the next day, and
* usually allows you to recover almost completely within 48 hours.

Active, not passive recovery:

When athletes feel soreness in their muscles, they rarely take days off.  Neither should you. Keeping sore muscles moving makes them more fibrous and tougher when they heal, so you can withstand greater forces and more intense workouts on your hard days.  Plan to go at low intensity for as many days as it takes for the soreness to go away. Most athletes try to work out just hard enough so that they recover and are ready for their next hard workout in 48 hours.

Timing meals to recover faster:

You do not need to load extra food to recover faster. Taking in too much food fills your muscle cells with fat, and extra fat in cells blocks the cell’s ability to take in and use sugar. Sugar is the main source of energy for your muscles during intense exercise. Using sugar to drive your muscles helps them to move faster and with more strength. Timing of meals is more important than how much food you eat. Eating protein- and carbohydrate-containing foods helps you recover faster, and the best time to start eating is as soon as you finish a hard workout.

At rest, muscles are inactive. Almost no sugar enters the resting muscle cell from the bloodstream (J. Clin. Invest. 1971;50: 2715-2725). Almost all cells in your body usually require insulin to drive sugar into their cells. However during exercise your muscles (and your brain) can take sugar into their cells without needing insulin.  Exercising muscles are also incredibly sensitive to insulin and take up sugar into their cells at a rapid rate.  This effect lasts maximally for up to an hour after you finish exercising and disappears almost completely in around 17 hours.

The best time to eat for recovery is when your cells are maximally responsive to insulin, and that is within a short  time after you finish exercising. Not only does insulin drive sugar into muscle cells, it also drives in protein building blocks, called amino acids.  The sugar replaces the fuel for muscle cells. The protein hastens repair of damaged muscle.  Waiting to eat for more than an hour after finishing an intense workout delays recovery.

What to eat after your intense workouts:

Fatigue is caused by low levels of sugar, protein, water and salt.  You can replace all of these with ordinary foods and drinks. If you are a vegetarian, you can replace your protein with combinations of grains and beans. You can replace carbohydrates by eating
virtually any fruits, vegetables, whole grains, beans, seeds and nuts. A recovery meal for a vegetarian could include corn, beans, water, bread, and fruits, nuts and vegetables.  If you prefer animal tissue, you can get your protein from fish, poultry,or meat. Special sports drinks and sports supplements offer no advantage whatever over regular foods.

Body Massage:

Many older studies have shown that massage does not help you recover faster from DOMS. Recently, researchers at McMaster University in Hamilton, Ontario showed that deep massage after an intense workout causes muscles to enlarge and grow new mitochondria (Science Translational Medicine, published online Feb, 2012). This is amazing. Enlarging and adding mitochondria can help you run faster, lift heavier weights, and even prevent heart attacks and certain cancers.

NSAIDS delay DOMS recovery:

Non-steroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen, may help relieve pain, but they also can block muscle repair and delay healing.

Hot Baths:

Most research shows that a hot bath is not much better than doing nothing in helping muscles recover from exercise (European Journal of Applied Physiology, March 2006)

(RehabDeb’s comment: On the other hand, Epsom Salts Soak/Bath works well for humans and the dogs and cats I’ve encouraged toward that therapy. Of course, this is more than “just” a hot bath…)

Cold or ice baths:

A recent review of 17 small trials, involving 366 participants, showed a minor decrease in DOMS with ice water baths.  They found “little quality research” on the subject and “no consistent method of cold water immersion” (Cochrane Library, published online February 15, 2012). Cold water immersion can reduce swelling associated with injury, but has not been proven to speed the healing of DOMS.

(RehabDeb’s comment: ice baths are proved to be beneficial and instrumental in reversing back spasms!)

Revised 8-1-14

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ICE (CRYO) THERAPY

Here is how you do it for some of the best benefits…

Prior to writing a pretty basic icing protocol for widespread use in veterinary rehab almost 10 yrs ago, I examined research papers regarding how well different types of ice worked, including papers that dealt with muscle biopsies as evidence. That being said, for almost 6 years I have not been using ice very often, if at all, on my own athletic injuries, on animal patients, or on others athletic injuries. This is due to there being great evidence from scientific research regarding the benefits of the inflammatory process in most situations and the detriments of stopping that process. Ice stops that part of the healing process. The exception to this “rule” for me is that if the pet does not have pain medication(s) available, at all (which sometimes happens), and the pet is in obvious pain or discomfort and if I think ice will be helpful for the situation. More about pain on my pain post, here.

I currently usually only recommend ice for a pet that has ongoing joint pain issues and is having a lot of trouble with pain resolution and usually only if the pet has been given prescriptions for (and is using them) pain and they aren’t helping enough to enable better function.

I recommend icing directly on the site, using the “pupsicle” method, for 5-10 mins, depending on the size of the animal, prior to walks or drills in order to enable better limb (or other part of the body) use. Meaning that perhaps the ice will dull the pain some, and the pet will use the leg and build muscle, will increase joint use and encourage healing, and will improve overall. Otherwise, see other information I have posted regarding research about ice and the problems with using ice. (4-27-14)

Ice therapy is used to decrease pain and inflammation and to increase healing in some cases. Ice may be effectively applied 2-4 times per day, with 4 times being optimal within the first week after injury/surgery.  Ice may be used in several forms, some of which are as follows:  

     *Frozen vegetables make a tidy ice pack, although the pack is not as cold as other, better options.  This pack should be left on the treatment area for approximately 20-30 minutes without a towel and on bare skin.  Frozen veggies are not cold enough, nor do they retain cold very well or long enough, so that is why extended application times are recommended.

*Slush ice in two zip lock-type baggies, meaning, double-bagged.  This turns out to be very cold and is made with one part water to two parts rubbing alcohol.  If the mixture is too watery, add more water to make it icier.  If the mixture is too hard, add more alcohol to make it slushier.  This ice pack should only be left in place for ten minutes at a time without a towel or twenty minutes on a medium-to-large dog with full fur.  Divide the times in half for small dogs. Fur is a barrier for icing like a towel on a human would be, especially if “colder” icing options are used (pupsicle, slush packs, etc…).  Smaller animals with less dense hair coats will still only need a 10 min. ice application, so try to use good judgment.  Dish soap in sliding zip-locked baggies, double-bagged and frozen, works like the slush pack mentioned above.     

*Pupsicle ice is a cup of ice, made either paper or Styrofoam cups that have been filled ¾ with water and then frozen.  This ice is especially effective and may also accomplish some surface tissue massage at the same time as the cryotherapy.  The ice melts into puddles, so grab a towel.  You should rub this ice over the affected area for approximately ten minutes at a time using circular or stroking motions, as in massage.

Ice, not heat, should be used for at least the first 72 hours post-surgery or injury, and there is generally no need for heat at all in most injury or surgery situations.  This phase is often referred to as phase one inflammation-breakdown or phase one post-trauma.

During the “phase one” time, pupsicle and slush ice may be left on 10 minutes, taken off 10 minutes, and then reapplied 10 minutes.

I am often asked if ice may be used any time, and the answer is yes.  If back muscle spasm episodes occur, if there seems to be pain or inflammation, or even if a new incident of disc rupture occurs, ice may be used even while on the way to the vet.  In these instances, always use ice and not heat.

Ice increases blood flow by cooling and slowing blood while constricting the blood vessels, after which the body reacts by sending more blood to the cold area to warm it and thus increase the flow of body fluids through the area.  This can actually be beneficial in reducing swelling, but, again, reducing swelling can prolong the healing process.

On the other hand, heat increases blood flow by opening up blood vessels.  The opening of the blood vessels by heat early in post-injury phases could cause unwanted swelling and inflammation, so even though heat may seem to feel good, it is not what should be done to help healing at this time.

Rehabilitation and Conditioning for Animals

Deborah Carroll, CCRP, CSCS

copyright 2007

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