Cryotherapy (Ice) – 2 Articles

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) stifle the healing process. I have also read several reports regarding the same and ice. Nsaids in animal medicine include Previcox, 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 analgesics, depending on the issue, rather than higher and continuous doses of nsaids.
This is only one suggestion.
Ultimately this should be discussed with the medical practitioner who prescribed the meds in the first place. There are other reasons to minimize nsaids and use Tramadol and/or Gabapentin and/or other 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, vets 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.

Surgeons Report Two New Approaches to Lessen Postoperative Pain

(Taken from ScienceDaily.com, intended for human medicine audience, however the principles are good and some are interchangeable. I’m also pretty sure this isn’t “new” news…Italics mine)

Oct. 8, 2013 — New combinations of postoperative pain treatment decreased both pain and the use of narcotic pain relievers according to two studies presented this week at the 2013 Clinical Congress of the American College of Surgeons. One pain treatment utilized the simple but nonstandard application of ice packs after major abdominal operations in patients, and the other treatment was a prolonged drug delivery method using nanotechnology in animals.

Past research has shown that postoperative pain is often under-treated  The standard pain treatment after most major (human) operations is narcotics, also called opioids, such as morphine. However, these medicines have many possible side effects, including sleepiness, constipation, and — when used long term — the risk of drug dependence. (we don’t see this issue in veterinary medicine, not in the same way, so  for now don’t worry about your pet becoming an addict!)

“A growing body of scientific evidence shows that narcotics may not be the best way to control pain,” said the principal investigator of the ice pack study, Viraj A. Master, MD, PhD, FACS, associate professor of urology at Emory University School of Medicine, Atlanta. “We now know that it is more effective to use combination treatments that reduce the amount of narcotics needed.

New use for ice following open abdominal procedures

Multiple studies have found that cryotherapy — application of ice to the surgical wound — is safe and effective at reducing pain after some types of operations, such as orthopedic procedures. However, researchers have not studied the use of cryotherapy in patients undergoing major, “open” (large-incision) abdominal operations, Dr. Master explained.

For the Emory study, Dr. Master and his colleagues compared the effect on postoperative pain of applying soft ice packs to the incision area after open abdominal operations (27 patients), versus no ice application (28 patients).

Patients in the cryotherapy group applied ice packs to the wound at desired intervals for at least 24 hours. They also had the option of taking prescribed opioids, whereas the other group received only opioids for pain relief. Twice a day the patients rated their pain intensity on a line indicating a range from no pain (zero) to severe pain (100).

The results showed that patients who used ice packs reported significantly less pain than those who did not ice their surgical wounds. On average, the cryotherapy group had about 50 percent less pain on the first and third days after the operation compared with the no-ice control group, according to the investigators. In addition, on the first postoperative day, the cryotherapy group used 22.5 percent less opioid pain medication than controls, while some patients who iced reportedly used no narcotics.

According to Dr. Master, surgeons should recommend that their patients who have open abdominal operations intermittently apply ice packs to the surgical wound, removing the ice when it becomes too cold. “An ice pack,” he said, “is safe and inexpensive, gives the patient a sense of empowerment because it is self-care, and doesn’t require high-tech devices.”

Prolonged delivery of lidocaine effective in animals

The pain treatment utilized in the second study used a high-tech device — nanoparticles — to create a controlled-release delivery system for the nonopioid numbing medication lidocaine. Although the effects of lidocaine injections usually are short-lived, nanotechnology allowed researchers at Houston Methodist Research Institute to extend the drug’s delivery time so that pain relief lasted all seven days of the study.

Led by Jeffrey L. Van Eps, MD, a research associate at the institute and general surgery resident at Houston Methodist Hospital, the research team developed an injectable hydrogel containing lidocaine. The gel also held microscopic spheres of a biodegradable polymer called polylactic-co-glycolic acid (PLGA), which the U.S. Food and Drug Administration has approved for drug delivery. This polymer acts as an “envelope” for nanoparticles — molecular-sized structures — of the mineral silica, whose spongelike holes take up the lidocaine gel, Dr. Van Eps explained.

“Nanotechnology with PLGA makes an ideal drug delivery system because we can tailor the nanoparticles to allow prolonged delivery,” Dr. Van Eps said. He said that this method re-duces or avoids side effects.
After first testing their lidocaine delivery system in the laboratory, Dr. Van Eps’ team obtained results in an animal model of postoperative pain. In groups of rats under different experimental conditions, the investigators rated the animals’ pain by measuring their withdrawal response to mechanical force applied around the surgical wound.

Rats that received lidocaine gel through the novel delivery system needed twice the amount of force to elicit a pain response compared with control rats that received no pain medication after the incision, the researchers reported. Using this same technique of measuring the pain response, the investigators reported that the lidocaine gel also was superior to daily treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) alone.

The best study results were seen with combination therapy using lidocaine gel and daily NSAIDs. This combination therapy reportedly showed equivalent effect to daily opioid narcotic treatment by mechanical-force withdrawal testing and superior results by daily scoring of pain-related adaptive behaviors. This finding is important because it shows that the experimental drug delivery system is not inferior to standard opioid treatment of pain, according to Dr. Van Eps.

Studies in larger animals will take place before the research team can test this therapy in patients, he said. Yet he called the new technology an “exciting potential treatment of post-surgical pain, the largest barrier to successful postoperative care.”

The research team developed and is testing the drug delivery system in the Houston Methodist Research Institute’s Surgical Advanced Technology Lab, which was created to accelerate transition of new products to the clinic.

The above story is based on materials provided by American College of Surgeons, via EurekAlert!, a service of AAAS.

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