Over the last half decade the vast majority of problems that I tend to treat in my practice are ones that are chronic and reoccurring.
These are situations where the problem has no clear structural cause, or at the very least the changes that are seen on imaging are ones that the medical system has nothing useful to offer.
In these cases, the treatment is mainly focused on understanding the habits that are contributing to their situation, and working replace them with other ones that distribute the labor in a more comfortable, effective and resilient way.
The process can be a bit involved, and the journey a bit of a winding one.
However, plenty of times a pain, problem or injury is a bit more cut and dry.
Something big, hard and rough absolutely happened… and then the impacted body part is very much put out of commission.
When this occurs, it tends to be called an acute injury.
Specifically, these tend to be sprained joints, torn muscles, bruised body parts and surgeries.
Yes, surgeries are very much an injury… albeit a planned one.
I mention all this, because the management of an acute injury is very different from the management of a chronic one.
You must stop the bleeding, if there is blood, and you need to give the body both room and support to heal.
And while thankfully our bodies are absolutely built to heal, the recovery from an sprain, tear, bruise or surgery can be often times difficult.
However, regardless of where things may have the potential to end up in the long term, whether it is the unplanned sprained ankle or the schedule joint replacement, the immediate hours and days after an injury or surgery can be fairly uncomfortable.
And that is what I want to talk to you about in this article… the ideal management of these uncomfortable and inconvenient instances.
Essentially, the recovery from a sprain, strain, bashing our surgery does not have to be as painful as it sometimes is for folks… provided the swelling that occurs with any of those injuries is managed as well as it can be.
You see, swelling is a normal part of healing, however the pressure from the swelling pressing into “ornery anatomy” is often the main source of pain in the immediate period after any injury or surgery.
What this means is if you relieve the pressure, you tend to also relieve the pain.
Now, often when these sorts of injuries occur, I am asked what the best approach is to manage the situation… and more than half the time I am asked whether it is best to use ice, heat or even anti-inflammatories.
The answer tends to be none of the above.
Instead, the best option tends to be avoid any position or action that is painful, and otherwise manage the regular buildup of swelling through a combination of elevation and non-aggravating movement.
Another way to say this is that it is best to simply allow the body to heal in its own time and help the swelling move along in the process.
Not stop or reduce the swelling… instead both allow it and manage it.
To understand why, it is best to take a look at the big picture of what is going on when a injury occurs and the body is attempting to heal it.
Before we do that, we should probably get the elephant in the room out of the way and just ask…
ARE ANTI-INFLAMMATORY MEDICATIONS HELPFUL?
My best answer to this question is… it depends.
In general, my advice when it comes to the use of anti-inflammatories in the management of any injury… is to avoid them.
The reason I advise this is because has been well documented that anti-inflammatories interfere with the healing of any injury, an absolutely a musculoskeletal one.
If you have any doubts about this, then feel free to view for yourself HERE, HERE and HERE.
That said there are always exceptions to the rule, and in the cases where the swelling response of the body is so severe that it is difficult to manage it solely through relative rest, elevation, and non-aggravating movement… then anti-inflammatories may be helpful on a limited basis.
This is especially true if you are having a difficult time sleeping due to the situation.
However, beyond that… they are not the ideal first choice response.
Now, beyond scrutinizing the links I gave above, in order to best understand why, it would be prudent to ask…
WHAT EXACTLY IS SWELLING?
Our bodies are in a constant state of adaptation, and part of that process involved the regular break down of older tissues so that new tissue can take its place. The process is going on at all times, and it is what allows for us to grow our hair and nails, as well as a callus when hard work is taken on.
For this process to take place, consistent circulation needs to happen at a constant pace helping the nutrition and supplies to come into any area, and the waste to be carried out.
However, when an injury occurs to any tissue of the body, this very same process needs to be accelerated. And, in a healthy body and ideal situation… it is.
Mere moments after any measurable injury occurs, our immune system immediately redirects its resources, and the normal process of constant tissue adaptation is done at a faster rate, and with a great volume of work occurring at the affected area.
Essentially, swelling is simply the result of all the increased amount of fluid that needs to be circulated to allow for this to happen.
If you were to compare it to rush hour traffic on an otherwise quiet street, you would not be far off.
However, just like rush hour traffic, if things get so congested that they become backed up, there can be a great deal of discomfort for all involved. Throw in an ambulance or two that needs to cut through, and the metaphor really takes off.
In fact, in the case of most musculoskeletal injuries most of pain after the injury has occurred is mainly due to the discomfort of swelling building up and pressing into already ornery tissues.
So, while it is best to not interfere with the inflammatory process, leaving it unmanaged can prove to be far more uncomfortable than necessary.
This bears the question of how to best manage it… and if we comes back to the statement that I gave above where I advocate elevation as being ideal, it would absolutely be reasonable for you to ask…
WHY IS ELEVATION THE BEST CHOICE FOR MANAGING SWELLING?
In short, because elevation allows for your body to do the necessary work for healing to occur, while giving relief from the discomfort that is caused by swelling backing up… all while offloading the effected body part.
The reason this is so, is because elevating the involved part simply allows for a gutter effect to occur.
Essentially, when you elevated any part of your body above the level of your heart, then the fluid in that part of the body will tend to return to heart more easily due to the increase gradient that is present.
No different than the way any gutter would work, provided it is not stuffed with last year’s leaves.
Now, when things are running otherwise fine it is normally the basics of active movement that helps to pump the fluid in our veins and lymphatic systems back to our heart.
However, when there is an injury to an area, it can often make it difficult to both move and use the anatomy.
So, Noah, in order to prevent the unnecessary and aggravating accumulated of fluid in the effected, injured and very much ornery part of your body… it is advisable for you to favor elevating that body part above the level of you heart as much as necessary for comfort and relief.
That said, old habits die hard, and of course it is reasonable to ask…
WHAT ABOUT ICING?
In general, icing an area that is swollen tends to be counterproductive when it comes to both your comfort, as well as managing the big picture.
This is because apply that level of cold to the surface of your skin tends to result in constriction of the local blood vessels.
Essentially, applying ice to your skin reduces circulation in the area that it is applied to.
This is obvious when you observe that skin tends to become white upon direct application of ice.
Yes, you may experience a certain level of pain relief as a result of putting that ice on the area… but this is simply due to the location being numb.
However, ideally this does not last for long, and as that numbness subsides… and that circulation returns, you will be greeted with a still very overloaded and poorly drained ornery body part.
So, save the ice for your beverage of choice… water included.
Speaking of water…
WHAT ABOUT COLD WATER IMMERSION?
Unlike the direct application of ice to ones skin, there are actually some excellent benefits to cold water immersion when it comes to managing the swelling that occurs with injury.
This is because with cold water, it is never actually frozen. So, the temperature exposure will not cause the same level of problematic constriction of blood vessels as we see with icing.
Because of this, one major benefit to cold water immersion is that there seems to be a notable increase in blood flow to the area that is being submerged. This is readily observed by the area that has been immersed temporarily turning pink or even red when taken out of the water.
Essentially, cold water immersion aides in circulation of the local area.
When it comes to the management of any swelling, this is fantastic.
The other benefit is seen in the pressure gradient that occurs when one body is submerse in water. A simple way to appreciate this is to picture yourself immersed in cold water up to the level of your chest. When this occurs, the pressure on your feet and ankles is higher than on your knees and thighs, and far higher than your waist.
The effect of this pressure gradient is similar pressure stockings, and absolutely aides in fluid being washed out of those most immersed parts in an efficient manner.
It should be noted that it is only advisable to allow an injury to soak in water for any length of time if there is no damage the skin in the area, as it would be immediately after a surgery or if a puncture wound had otherwise occurred.
DOES HEAT HELP?
In general I would not recommend throwing a hot pack on a patch of freshly injured body part. More often than not, it tends to be a bit akin to stoking a fire.
That said, heat can at times be comforting… especially in the case where some level of muscle spasm is contributing to the whole mess of the situation.
With that, and much like cold water immersion, heat can aide in increasing circulation to the surface area that it is applied to.
So given those opposing factors, I have found that a good way to check whether heat is a viable option in any sprain, strain, or general injury situation is via a hot shower.
What this means, is if it feels better when or after you take a hot shower, then perhaps a hot pack on the area might feel nice.
That said, when applying that hot pack, be sure to still have that aching injured part supported and elevated in an effective and comfortable position… since that is ultimately what will provide the most effective relief.
ARE THERE ANY OTHER APPROACHES THAT TEND TO HELP MANAGE SWELLING?
Absolutely… and like I mention above one of the most notable helpful things is any non-aggravating movement.
Most especially, non-aggravating movement of the body part itself, or any part that is distal to the injured location.
By distal, I further away from the heart.
A good example of this is if you have a sprained ankle, then wiggling your toes is going to be helpful.
If you have a swollen knee, then pump your ankle.
If you have an injured elbow, then open and close your hand or wiggle your fingers.
If you add doing this while you are elevating that aggravated, injured and ornery body part… then you will really have an impact.
The reason this helps because one of the primary ways in which we pump fluid back to the heart is through rhythmic and regular muscular activity. When this is not occurring, and even when there is no actual injury present, fluid tends to pool in the tissues of the body… most significantly the further away from the heart it is.
If you picture the sock lines that folks will get when they must stand upright without a large amount of movement for a prolonged period, then you will get a good idea of what I am speaking to.
Now, if you have read this far, and would like the above summarized in an easily to digest and engaging audio-visual format… then I recommend you view the link below.
There you can view an eight minute video providing you just that…
If you have any questions about the above, please do not hesitate to reach out.
Regardless, I hope you find the above helpful, and I hope you are comfortable, able and well.