Injury – The nemesis of training (Part 1)
Let’s face it, anyone who lives an active lifestyle has suffered some cuts, abrasions, bumps and bruises. These generally heal pretty fast and are usually nothing more than nuisances. The real troublesome injuries are those that involve collagen based connective tissue such as tendonitis, strains, and sprains.
For decades “modern” medicine has preached the R.I.C.E approach to dealing with these sorts of injuries. R.I.C.E is an acronym for:
R = rest
I = ice
E = elevation
C = compression
Often the addition of Anti-inflammatory medication is also recommended such as Ibuprofen or naproxen and in severe cases corticosteroids such as prednisone in oral form or even injected into the site of the injury.
There is a small but growing group of medical practitioners and athletes who view that paradigm as outdated. Just as Integrative Defense Strategies seeks to redefine the self defense paradigm, we seek truth is all facets of life. I have no formal medical training and do not claim to be a medical professional but one doesn’t need to have a degree to employ critical thinking. I have been proving doctors wrong my whole life and I will continue to challenge them when their decisions are based on poor data or directives from a money driven system that puts profits before health.
I’ve been an avid gym rat for over 30 years and spent a lot of that time training various forms of martial arts and self-defense. I’ve battled chronic disease since I was 6 months old and by the time I was 10 years old had a paper chart at the University of MN hospital that dwarfed modern paper phone books in thickness. Needless to say, I have suffered my share of injuries. My goal here is to share with you my experience in dealing with injuries, specifically those involving collagen based connective tissue.
In all aspects of life, I first and foremost seek to understand the principles or foundation of a given subject. Far too many people simply mimic responses to accomplish tasks without ever truly understanding how something works. This approach is often good enough to get the job done, however when they run into a situation they don’t have a programmed response for they flounder and often fail. I have pages of reference material I could include here but am going to refrain from sharing it. The reason for that is I want each and every one of you to question what I say here. I want you to do your own research and employ your own critical thinking. I think you will find the journey rewarding as well as educational and I hope you come to the same conclusion I have. If not, I would love to have a discussion on your findings.
With the above in mind I think its important to understand some basic principles involved in this discussion so let’s start off with healing and anatomy. Jump in your “way back” machine to high school biology. How many people remember discussions of the “Healing Cascade”?
The Healing Cascade is the general principle of healing and the various phases involved in would repair. Depending on who is presenting the information and the tissue being discussed there are generally 3 or 4 distinct phases, for this article I will use a 4-phase model.
Phase 1: Homeostasis
This phase starts immediately after injury and only lasts about 10 minutes. The goal here is to stop any bleeding or leaks of internal fluids. Vasoconstriction occurs and platelets are released. Fibrin is released from damaged blood vessels if involved to stop bleeding tissue. Platelets release critical growth factors and cytokines which will be employed in later phases.
Phase 2: Inflammation
This phase generally lasts about a week and is accompanied by reddening of the area, swelling and pain. Neutrophils congregate in the damaged area to kill bacteria and Macrophages to clean up any bacterial or other debris. These Macrophages also produce chemoattractants and growth factors essential in the healing process. The growth factors released by the Macrophages also increase the level of fibroblasts at the site of injury, all of which are key elements in the next phase.
Phase 3: Proliferation
The third phase in the process generally runs for 1-3 weeks and is heavily dependent on fibroblasts which are responsible for and lay the foundation for new extracellular matrix for collagen and granulation tissue.
Phase 4: Remodeling
This process can last upwards of 2 years and involves collagen synthesis and remodeling of the initial wound repair to further strengthen the damaged area.
As we can tell from the brief synopsis above there are many critical elements that take place during the healing cascade the promote healing.
With a basic understanding of the healing cascade let’s take a critical look at the oh so often recommended R.I.C.E method of treatment.
R = rest:
On the surface this one makes sense, but specifically what does rest mean? Personally, I abhor language because the ultimate meaning of nearly every word used by humans is open to variations in interpretation and this is no different. Some people will assume rest means simply don’t use the injured area while others will interpret it as “use with caution”. The real answer is usually somewhere in between depending on the injury itself.
My experience has led me to the conclusion that one should be as active as possible without inhibiting healing. This usually means activity that elicits only minor discomfort is usually beneficial. However, there is a very fine line that once crossed beneficial becomes detrimental, so I usually try and err on the side of caution.
Over the years, for various injuries, I have had medical professionals tell me “rest” meant just that, rest, don’t workout or perform activities that involve the injured area at all. As we can tell from the healing cascade the process of wound healing involves a lot of moving parts and the key word is “moving”. Moving essential components to AND from the site of injury. Most people assume this is all handled by the circulatory system but the lymphatic system plays a key role in this as well. Unlike the circulatory system that has the heart working around the clock to move blood, the lymph is moved by muscular contractions. If one is laying bed 24 hours a day, muscle contractions are at a minimum and by association so is lymph movement.
With the above in mind, light activity will increase heart rate speeding up the rate at which materials can be moved to and from the site of injury. Likewise, the movement will get the lymph moving as well. Since healing is completely reliant on the transport of “materials” why is “rest” so often recommended if it actually reduces the movement of required materials for healing?
I = ice:
The purpose of ice seems to be nothing more than a vasoconstrictor. We are always warned to be cautious and to not overuse and cause skin damage. As discussed above, the movement of materials to facilitate healing is critical to healing so as with rest above I have to ask why do we want to curtail the movement of materials to the site of injury?
C = compression:
Similar to ice, compression will compress the tissues in the area of injury and reduce blood and lymph flow thereby reducing the movement of materials to the site of injury.
E = elevation:
Here is yet another means to reduce both blood and lymph flow to an area. If movement of materials is critical to healing, as above, why would this be recommended?
Anti-inflammatories work within the body to block various processes and reduce or eliminate inflammation. Corticosteroids are very powerful anti-inflammatory and the injectable form can inhibit localized inflammation for months.
If you take a moment to look back over the healing cascade many aspects of the inflammatory phase are CRITICAL to healing! So why on earth is the most commonly recommended solution reduce or eliminate inflammation and an even more important question is what are the long-term side effects?
I’ve asked many medical professionals’ why they recommend R.I.C.E for tendonitis, strains and sprains and the answer is usually boils down to relieving pain and/or reducing inflammation which helps healing. The answers are generally curt and boiled down to nothing more than regurgitated information that’s been told to them. Much like modern firearms training it seems a lot of medical advice doesn’t take context into account and doesn’t involve much in the way of critical thought.
I will admit that at the very onset of injury, specifically those around the ankle or knee that invoke heavy swelling, immediately treating with ice for a short period of time can be beneficial. Excess swelling can cause excessive localized pressure and reduce the movement of required materials but beyond that the idea of R.I.C.E quickly becomes detrimental, especially when related to collagen based connective tissue.
So how did we get to where we are today in terms of treating connective tissue injuries? Its hard to say for certain but it just seems to be a natural side effect of our “instant gratification” lifestyles. News and information is at our fingertips 24 hours a day, fast food on every corner and “minute clinics” every few blocks. Our own impatience as a species has spread so we expect immediate results, immediate relief from the pain and in response the medical system has responded by treating symptoms instead of the actual problem……but at what cost?
Keep checking back as we continue the discussion in Part 2.