The acronym PRICE (Protection, Rest, Ice, Compression and Elevation) has been at the corner stone of acute soft tissue damage (ligaments; muscles and tendons). This form of management has served us well over the years. By implementing this vast array of treatment modalities it has shown through subjective findings to have a significant effect on the healing process, however there is no high quality empirical research showing this conclusion. Furthermore the typical use of anti-inflammatory (NSAID’s) medication straight after an injury, causes the area to bleed more and will lead to further inflammation and swelling. The reason for this is that NSAID’s has COX 2 inhibitors within it and this causes a reduction of platelet aggregation and decreased vasoconstriction and thus causes further swelling and thus decreasing the healing rate.
Protection and rest following an injury is still crucially important during the initial healing process. Immobility can never be over-looked, due to the fact all injuries are an over-extension of a joint which damages either your ligament or tendon. So limiting that joint movement and securing it, in its optimal anatomical position will allow the ligaments to knit in its correct shortened state. But, rest should be of limited duration and restricted to immediately after trauma. Longer periods of unloading are harmful and produce adverse changes to tissue biomechanics and morphology. So it is crucial that you seek medical advice as it is a fine balancing act between immobility and activity. Progressive mechanical loading is more likely to restore the strength and morphological characteristics of collagenous tissue.
Ice; compression and elevation (ICE) are the other basic principles of early treatment. Most research has focused on the analgesic effect of icing or the associated skin or intramuscular temperature changes; a recent randomized controlled trial by ‘Prins and colleagues’, which examined the effectiveness of ice on recovery from acute muscle tear, is the first of its kind, showing that the use of ice is not beneficial for people who receive cryotherapy. Clinical studies into compression are also lacking, and much of its rationale is extrapolated from research relating to deep venous thrombosis prophylaxis and lymphoedema management; there is little clinical research on elevation.
The difficult clinical challenge is finding the balance between loading and unloading during tissue healing. If tissues are stressed too aggressively after injury, the mechanical insult may cause re-bleeding or further damage. Protection of vulnerable tissues therefore remains an important principle. But, too much emphasis creates a default mindset that loading has no place in acute management. Rest may be harmful and inhibits recovery. The secret is to find the ‘optimal loading’.
Optimal loading means replacing rest with a balanced and incremental rehabilitation program where early activity encourages early recovery. Injuries vary so there is no single one size fits all strategy or dosage. A loading strategy should reflect the unique mechanical stresses placed upon the injured tissue during functional activities, which varies across tissue type and anatomical region. For example, a muscle injury to the lower limb has cyclic loading through normal ambulation. The upper limb may require additional cyclic load to be factored into the rehabilitation program in order to maximise mechanical stimulus.
POLICE, a new acronym, which represents protection, optimal loading, ice compression and elevation, is not simply a formula but a reminder to clinicians and patients to think differently and seek out new and innovative strategies for safe and effective loading in acute soft tissue injury management. Optimal loading is an umbrella term for any mechano-therapy intervention and includes a wide range of manual techniques currently available at CostaSpine; indeed the term may include manual techniques such as massage refined to maximise the mechano-effect. Paradoxically, strapping, crutches, braces and supports, traditionally associated with rest, may have a greater role in adjusting and regulating optimal loading in the early stages of rehabilitation.
POLICE should make us think more about research into designing rehabilitation strategies that are appropriate to the nature and severity of injury in different sports and activities. If the primary principle of treatment is to restore the histological and mechanical properties of injured soft tissue, optimal loading may indeed be sport specific. The challenge is in determining what is ‘optimal’ in terms of the dosage, nature and timing.
Yours in Healthcare
Arthritis has always been considered to be part of the aging process, along with indicating to the patient that he cannot be as active as he/she would want to be. This however has changed. As new research and science has found ways to slow this degenerative disease down. The usual remedy for arthritis was bed rest but it is now shown increased bed rest can hasten the progression of the disease.
What Is Arthritis (other clinical names: Osteoarthritis; Degenerative Joint Disease; Spondylosis and Scelorsis)
“Arthritis” basically means “joint inflammation”. Although arthritis often begins in middle age and is more frequent in the older generation, it can also start at a young age where serious trauma has occurred at that particular joint. A simple and non- technical description of arthritis is basically when bone starts rubbing against bone. Either through joint dysfunction and irregular movement or due to the fact that every joint is lined with cartilage and when this cartilage starts to wear thin, inevitably bone will then articulate on bone. This is when intra-articular loose bodies will occur and the following signs and symptoms will begin to show:
- Tender, warm, and swollen joints usually early morning or late at night
- Pain and stiffness lasts for more than 30 minutes after a long rest.
- It will usually occur around joints where there has been previous injury and/ or trauma to the area.
- The condition is asymmetrical.
- The wrist and finger joints closest to the hand are most frequently affected. However, the neck, hip, elbow, knee, shoulder, ankle, and feet joints can also be affected.
- Loss of flexibility
- Grating sensation, you may hear or feel this sensation when that particular joint is moving
- Cosmetic deformities
Reason for the pain is the body detects damage within the joint and pumps large amount of synovial fluid into the joint space. So the pain is most noticeable after long periods of immobility. So when the joint starts to articulate, the fluid is very distended and pushes on the joint capsule. As the fluid starts to disperse itself the pain starts to alleviate as there is now less pressure within in the joint, reason being why your pain gets better after 20-30 minutes of activity
Should Arthritic Patients Exercise?
Exercise is crucial in successful arthritis management and treatment. It ensures healthy and strong muscles, joint mobility, flexibility, endurance, and helps control weight. Rest, on the other hand, helps to decrease active joint inflammation, pain, and fatigue. For best results, arthritis patients need a good balance between the two: more rest during the active phase of arthritis, and more exercise during remission. For patients suffering with severe arthritis, none loading bearing exercises would be the best such as aqua aerobics; swimming; elliptical trainer; ect. The following exercises are most frequently recommended for patients with mild to moderate arthritis:
- Range-of-motion exercises, e.g. dynamic stretching and easy- flowing movements (yoga or pilates) help maintain normal joint movement and increase joint flexibility. Can be done daily and should be done at least every other day.
- Strengthening exercises, e.g. weight lifting (this include your body weighted exercises) help improve muscle strength, which is important to support and protect joints affected by arthritis. Should be done every other day, unless pain and swelling are severe.
- Aerobic or endurance exercises, e.g. walking, bicycle riding, and swimming help improve the cardiovascular system and muscle tone and control weight. Swimming is especially valuable because of its minimal risk of stress injuries and low impact on the body. Should be done for 20 to 30 minutes three times a week unless pain and swelling are severe.
Nutrition for the Arthritic Patient:
Some foods and nutritional supplements can be helpful in managing arthritis:
- Research shows that the best nutrition to aid cartilage production and slow would be a combination of the these 4 essential components: Glucosamine; Chondroitin; MSM and Hyaluronic acid (GOOD NEWS CostaSpine NOW STOCKS THE LATEST OF THESE PRODUCTS)
- Fatty-acid supplements: eicosapentaenoic acid (EPA), docosahexaenoic acid (DHA), and gamma linolenic acid (GLA). Several studies point to the effectiveness of these fatty acid supplements in reducing joint pain and swelling, and lessening reliance on corticosteroids.
- Deep-sea fish, such as salmon, tuna, herring, and halibut, are sources of EPA and DHA. GLA is found in very few food sources, such as black currants.
- Turmeric, a spice that’s used to make curry dishes, may also be helpful. A 95 percent curcuminoid extract has been shown to significantly inhibit the inflammatory cascade and provide relief of joint inflammation and pain.
- Ginger extract has been shown to be beneficial in terms of inflammation.
- A vegetarian or low-allergen diet can help with the management of arthritis as well.
The benefits and risks of most of these agents are being researched. Before taking any dietary supplement, especially if you are using medication to control your condition, consult with your health care provider.
What Can Your Doctor of Chiropractic Do?
If you suffer from arthritis, your doctor of Chiropractic can help you plan an individualized exercise program that will:
- Help you restore the lost range of motion to your joints.
- Improve your flexibility and endurance.
- Increase your muscle tone and strength.
Chiropractors can also give you nutrition and supplementation advice that can be helpful in controlling and reducing joint inflammation.
Through the specialized exercise program and nutrition supplements your body will be performing at its’ optimum so therefore have the ability to strengthen the joints and muscles effected by the arthritis.
Yours in healthcare
Appearing your best might not always be the best thing for you. Today’s society is all about extreme fashion along with being style conscious. Unfortunately, clothing designers and stylists aim to be visually appealing but they are not always practical or even comfortable in their approach.
The desire of people to mimic models and their runway ‘walk’ along with all their accessories could lead to leg, back, and spine or neck problems. Women tend to wear high heels to complement an outfit, not for comfort. However do not realize that these shoes can cause serious discomfort in their feet and can also exacerbate back pain. High heels disrupt the balanced position of a person’s body. When a person wears high heels, a new dynamic equilibrium occurs.
Essentially, wearing high heels for a prolonged period of time increases the normal forward curve of the back and causes the pelvis to tip forward. This alters the normal configuration of the pelvis and spine necessary for the body to maintain a center of gravity.
The legs are the foundation of the musculoskeletal system, and a person standing flat-footed or bare-footed would be completely balanced. During standing, the hamstrings are taut and both parts of the pelvis are stabilized so that the support is normal. When wearing high heels, you encourage the hamstring muscles to shorten along with the whole posterior chain. It is imperative to take the necessary time to choose the correct footwear, ask your Chiropractor to determine if you have a neutral foot, pronated foot or a supinated foot as this information will help you choose the correct comfortable footwear. To avoid atrophy of the hamstring, please ensure you do regular stretching of your hamstring and calf to counter-act the poor biomechanics along with strength training exercises of the leg, if you persist with wearing high heels..
Women and men alike need to avoid tight fitting clothing. Reason being clothes that are too tight throw a person off-balance, and simple daily tasks such as bending, sitting and walking become extremely difficult. Furthermore incredibly tight clothing can also cut off circulation to certain parts of your body and blood flow is crucial for a human body to function efficiently.
Another popular fashion item is handbags, briefcases and unilateral (on one side) sling bags. Women and men tend to carry too many items in these bags, and are often not aware of the potential health risks associated with carrying an excessive amount of “stuff.” Carrying any bag unilaterally with a weight-more than 10 percent of your own body weight-can cause improper balance, thus leading to dysfunction. The person carrying the bag will raise the one shoulder to subconsciously guard against the weight, holding the other shoulder immobile. This results in the unnatural counterbalance movement of one shoulder and little control over the movements of the arms and legs. Even worse, the spine curves toward the shoulder. So when choosing bags, try and decrease the weight of each bag, along with trying to find a bag that allows you to carry it on both shoulders, might not be very fashionable but much more effective and ergonomically friendlier. If you insist on using a unilateral bag, please ensure you keep switching it from one side of your body to the other.
Many people also tend to carry their wallets, personal identification and car keys in their back pocket. When this individuals sit down for an extended period the weight distribution of their pelvis will be thrown out of sync, thus again leading to further dysfunction. This dysfunction won’t cause pain initially, however after months of compensation the body will start to develop aches and pains due to the poor biomechanics which you have installed.
Stylists; designers and fashion guru’s tend to be more interested about the way something appears rather than the way it feels. Listen to your body. One of the most important aspects of being in style and looking your best is to ensure first and foremost your health and wellness is not affected through whatever outfit or accessory you want to be wearing, “There is no such wealth as health”.
Stay classy, yours in healthcare
Dr. Kahn provided striking new findings related to the power of exercise for health domains, such as brain function, cancer prevention, and depression. Kahn showed data supporting the view that inactivity/low fitness causes more deaths than smokadiabesity! “At epidemic proportions, smoking, diabetes and obesity are major public health concern. Yet low physical fitness kills more people than all these in combination”
Weight resistance training and the benefits thereof have been extensively researched on osteoporotic patients in increasing their bone density. Furthermore a day without activity is equivalent to smoking three cigarettes.
Dr. Sallis, a model of fitness, writes with passion and verve, “The importance of physical activity to health and wellness has been established incontrovertibly. There is a linear relationship between physical activity and health. Those who maintain an active and fit way of life live longer, healthier lives.”
He further discusses how sedentary, unfit behaviours “predictably” develop chronic diseases prematurely and die at a younger age.
So, how much physical activity should I be doing per day?
- 30 minutes 5x week (decreases relative risk factors of serious disease by 30%)
- 60 minutes 5x week (decreases relative risk factors of serious disease by 50%)
So what are you doing still sitting there 🙂
Yours in Health Care