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Author Topic: Should we be icing or heating.... or both?  (Read 18875 times)

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Offline zengirl

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Should we be icing or heating.... or both?
« on: July 25, 2006, 05:48:06 PM »
I ice my knee once a day. And I don't see the blindest bit of difference in my knee over the weeks. The swelling isn't going anywhere fast. What does icing do?

I've heard that heating the area brings blood to the knee and promotes healing by increasing oxygen etc to the spot. This makes more sense. Should I try heating the area? (Normally I would welcome the idea of heat, but in this weather icing is just lovely!)
Feb '03 Ladies badminton, bad fall, detached ACL
May '06 - ACL reconstruction & meniscus repair
Complications - swelling, pain, lack of flexion/extension, 50% graft failure
Jan '07 Arthoscopy, debride, removal of adhesions & 50% of graft
Attempting to rebuild muscles so can continue sport & life

Offline Kai

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Re: Should we be icing or heating.... or both?
« Reply #1 on: July 25, 2006, 06:28:43 PM »
Icing reduces swelling and inflammation..  heating relaxes muscle....    Do not heat an acl reconstruction...    I am 8 weeks post op tommorrow, and I ice a minimum of twice a day for at least 30 minutes each time...    if you feel your operated knee..  and it is warmer than the unoperated knee..  that tells you that inflammation is still present (and probably will be for a long time)  uncontrolled inflammation leads to all kinds of problems with scar tissue, reduced ROM and if the swelling is not controlled, that darn quad shuts down again resulting in atrophy...

For better, faster recovery, ice ice ice ice ice...

good luck
Kai
ACLR - (patellar BTB autograft) left knee - May 31, 2006
Partial Lateral Meniscectomy right knee Feb 20, 2008
Partial Lateral Meniscectomy right knee Aug 11, 2008

Offline zengirl

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Re: Should we be icing or heating.... or both?
« Reply #2 on: July 25, 2006, 06:47:39 PM »
How does ice reduce swelling and inflammation? What is wrong with heating the ACL Reconstruction?
Feb '03 Ladies badminton, bad fall, detached ACL
May '06 - ACL reconstruction & meniscus repair
Complications - swelling, pain, lack of flexion/extension, 50% graft failure
Jan '07 Arthoscopy, debride, removal of adhesions & 50% of graft
Attempting to rebuild muscles so can continue sport & life

Offline kevc

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Re: Should we be icing or heating.... or both?
« Reply #3 on: July 25, 2006, 07:47:34 PM »
I've started heating for patella tendonitis and I have seen a big improvement.  I dont think I would heat an ACLR leg though.

I read heat encourages blood flow to affected area and can speed up healing process.  Ice restricts blood flow and makes blood vessels smaller thus reducing swelling.  So depending on symptoms both can be good.
07/01 ACL rupture, left knee
08/02 ACL reconstruction (patellar tendon graft)
10/05 Re-tore ACL graft
01/06 Scheduled for ACL revision using hamstring graft

Offline zengirl

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Re: Should we be icing or heating.... or both?
« Reply #4 on: July 25, 2006, 07:59:50 PM »
So reducing the blood flow reduces swelling? So swelling is do do with blood then?
Feb '03 Ladies badminton, bad fall, detached ACL
May '06 - ACL reconstruction & meniscus repair
Complications - swelling, pain, lack of flexion/extension, 50% graft failure
Jan '07 Arthoscopy, debride, removal of adhesions & 50% of graft
Attempting to rebuild muscles so can continue sport & life

Offline Kai

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Re: Should we be icing or heating.... or both?
« Reply #5 on: July 25, 2006, 08:27:05 PM »
The main purpose of inflammation, this immensely complex response seems to be to bring fluid, proteins, and cells from the blood into the damaged tissues. It should be remembered that the tissues are normally bathed in a watery fluid (extracellular lymph) that lacks most of the proteins and cells that are present in blood, since the majority of proteins are too large to cross the blood vessel endothelium. Thus there have to be mechanisms that allow cells and proteins to gain access to extravascular sites where and when they are needed if damage and infection has occured.

The main features of the inflammatory response are, therefore: vasodilation, i.e. widening of the blood vessels to increase the blood flow to the infected area; increased vascular permeability, which allows diffusible components to enter the site; cellular infiltration by chemotaxis, or the directed movement of inflammatory cells through the walls of blood vessels into the site of injury; changes in biosynthetic, metabolic, and catabolic profiles of many organs; and activation of cells of the immune system as well as of complex enzymatic systems of blood plasma. Of course, the degree to which these occur is normally proportional to the severity of the injury and the extent of infection.

Inflammation can be divided into several phases. The earliest, gross event of an inflammatory response is temporary vasoconstriction, i.e. narrowing of blood vessels caused by contraction of smooth muscle in the vessel walls, which can be seen as blanching (whitening) of the skin. This is followed by several phases that occur over minutes, hours and days later, outlined below.

The acute vascular response follows within seconds of the tissue injury and last for some minutes. This results from vasodilation and increased capillary permeability due to alterations in the vascular endothelium, which leads to increased blood flow ( hyperaemia) that causes redness ( erythema) and the entry of fluid into the tissues ( oedema). This phase of the inflammatory response can be demonstrated by scratching the skin with a finger-nail. The ''wheal and flare reaction'' that occurs is composed of (a) initial blanching of the skin due to vasoconstriction, (b) the subsequent rapid appearance of a thin red line when the capillaries dilate; (c) a flush in the immediate area, generally within a minute, as the arterioles dilate; and (d) a wheal, or swollen area that appears within a few minutes as fluid leaks from the capillaries. It is usually terminates after several tens minutes.

If there has been sufficient damage to the tissues, or if infection has occured, the acute cellular response takes place over the next few hours. The hallmark of this phase is the appearance of granulocytes, particularly neutrophils, in the tissues. These cells first attach themselves to the endothelial cells within the blood vessels ( margination) and then cross into the surrounding tissue ( diapedesis). During this phase erythrocytes may also leak into the tissues and a haemorrhage can occur (e.g. a blood blister). If the vessel is damage, fibrinogen and fibronectin are deposited at the site of injury, platelets aggregate and become activated, and the red cells stack together in what are called ''rouleau'' to help stop bleeding and aid clot formation. The dead and dying cells contribute to pus formation.

If the damage is sufficiently severe, a chronic cellular response may follow over the next few days. A characteristic of this phase of inflammation is the appearance of a mononuclear cell infiltrate composed of macrophages and lymphocytes. The macrophages are involved in microbial killing, in clearing up cellular and tissue debris, and they also seem to be very important in remodelling the tissues.

Over the next few weeks, resolution may occur, meaning that the normal tissue architecture is restored. Blood clots are removed by fibrinolysis, and if it is not possible to return the tissue to its original form, scarring results from in-filling with fibroblasts, collagen, and new endothelial cells. Generally, by this time, any infection will have been overcome. However, if it has not been possible to destroy the infectious agents or to remove all of the products that have accumulated at the site completely, they are walled off from the surrounding tissue in granulomatous tissue. A granuloma is formed when macrophages and lymphocytes accumulate around material that has not been eliminated, together with epitheloid cells and gigant cells (perhaps derived from macrophages) that appear later, to form a ball of cell.
Inflammation is often considered in terms of acute inflammation that includes all the events of the acute vascular and acute cellular response (1 and 2 above), and chronic inflammation that includes the events during the chronic cellular response and resolution or scarring (3 and 4).

It is the chronic inflammation that results in loss of ROM, arthrofibrosis, etc..  also, a moving knee is a healing knee..  and if you are in great pain due to inflammation and swelling......

cheers
Kai
ACLR - (patellar BTB autograft) left knee - May 31, 2006
Partial Lateral Meniscectomy right knee Feb 20, 2008
Partial Lateral Meniscectomy right knee Aug 11, 2008

Offline henri

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Re: Should we be icing or heating.... or both?
« Reply #6 on: July 25, 2006, 08:47:24 PM »
Whats up with this need to get the swelling off so fast?
Give your knee a break,if its swelled,then its swelled,i doubt it disturbs you that much that you cant do anything else in your daily life.I stopped icing like 2 weeks post op or even before and the swelling have subsided by its own,this icing like takes away the swelling,but i suppose it comes back later.
I still have some swelling in the fat pad place 6 months post op,but i dont ice it, i,personally feel its not that important.I really think that too much ice on that place isnt also the best choice.
Anyway,if you want to do something to the swelling,then i would suggest icing, no warming for sure. ;)
unhappy triad

Offline zengirl

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Re: Should we be icing or heating.... or both?
« Reply #7 on: July 25, 2006, 08:50:20 PM »
"The main purpose of inflammation, this immensely complex response seems to be to bring fluid, proteins, and cells from the blood into the damaged tissues. It should be remembered that the tissues are normally bathed in a watery fluid (extracellular lymph) that lacks most of the proteins and cells that are present in blood, since the majority of proteins are too large to cross the blood vessel endothelium. Thus there have to be mechanisms that allow cells and proteins to gain access to extravascular sites where and when they are needed if damage and infection has occured.

The main features of the inflammatory response are, therefore: vasodilation, i.e. widening of the blood vessels to increase the blood flow to the infected area; increased vascular permeability, which allows diffusible components to enter the site; cellular infiltration by chemotaxis, or the directed movement of inflammatory cells through the walls of blood vessels into the site of injury; changes in biosynthetic, metabolic, and catabolic profiles of many organs; and activation of cells of the immune system as well as of complex enzymatic systems of blood plasma. Of course, the degree to which these occur is normally proportional to the severity of the injury and the extent of infection
."


So basically swelling is a great and helpful thing!! I don't see why we're in a rush to get rid of it... I am active and go to the gym and work out. My knee is fine during exercise and sometimes sore during non-exercise (whether or not I've exercised a few hours ago or a few days ago - the soreness is not to do with exercising). There's no redness or infection at all. It's just swollen! If the swelling is a way to help heal then I don't mind it being there. Only thing is it restricts the range of movement: I don't have full flexion, nowhere near, and I don't have full extension. I can put my leg straight and for the first two or three minutes it's fine. Then it just aches and aches until I HAVE to move it to relieve the pain. As soon as I move it the pain vanishes.
Feb '03 Ladies badminton, bad fall, detached ACL
May '06 - ACL reconstruction & meniscus repair
Complications - swelling, pain, lack of flexion/extension, 50% graft failure
Jan '07 Arthoscopy, debride, removal of adhesions & 50% of graft
Attempting to rebuild muscles so can continue sport & life

Offline Kai

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Re: Should we be icing or heating.... or both?
« Reply #8 on: July 25, 2006, 08:57:40 PM »
If you don't get full flexion and extension equal to the uninjured leg, you will have a lifetime of pain ..  not just in the knee but in the back, shoulders, calves, feet, etc..   If your legs are not working the same, it throws your gait off balance and you will never be fully functioning... 
If you have swelling, you will not get full ROM.  The longer you have limited ROM, the harder it will get to get it.  The pain you have when you straighten the leg out will get harder and harder to eliminate.  The other thing that swelling does is inhibit the firing of your muscles..  mainly the quad but the calf muscles as well.  You will consciously and subconsciously compensate for the leg that is lacking and will continually lose ground.  The healing response is a good thing, but not when it becomes chronic.

You need full range of motion and strength in the muscles of the operated leg at least 85% of the unoperated leg to be considered recovered from knee surgery.  Swelling will prevent and/or make this hard to obtain.

sincerely
Kai
ACLR - (patellar BTB autograft) left knee - May 31, 2006
Partial Lateral Meniscectomy right knee Feb 20, 2008
Partial Lateral Meniscectomy right knee Aug 11, 2008

Offline The-Rock

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Re: Should we be icing or heating.... or both?
« Reply #9 on: July 25, 2006, 09:55:31 PM »
Hi ZenGirl,
here is a article I found on the web about using ice to treat injuries.

The Power of Ice
by: Louise Roach

Using ice to treat injuries is one of the oldest methods of pain control. Proven to be safe and effective at reducing swelling, relieving pain and decreasing muscle spasms, ice therapy is an easy self-care technique that anyone can administer. Every mother knows to put ice on a bruised knee after a soccer game or on a teething toddler’s tender gums. But do you really know how ice works?

Cold therapy, also known as cryotherapy, works on the principle of heat exchange. This occurs when you place a cooler object in direct contact with an object of warmer temperature, such as ice against skin. The cooler object will absorb the heat of the warmer object. Why is this important when it comes to cold therapy?

After an injury, blood vessels that deliver oxygen and nutrients to cells are damaged. The cells around the injury increase their metabolism in an effort to consume more oxygen. When all of the oxygen is used up, the cells die. Also, the damaged blood vessels cannot remove waste. Blood cells and fluid seep into spaces around the muscle, resulting in swelling and bruising. When ice is applied, it lowers the temperature of the damaged tissue through heat exchange and constricts local blood vessels. This slows metabolism and the consumption of oxygen, therefore reducing the rate of cell damage and decreasing fluid build-up. Ice can also numb nerve endings. This stops the transfer of impulses to the brain that register as pain.

Most therapists and doctors advise not to use heat right after an injury, as this will have the opposite effect of ice. Heat increases blood flow and relaxes muscles. It’s good for easing tight muscles, but will only increase the pain and swelling of an injury by accelerating metabolism.

When it comes to cooling devices, different effects will result due to the device’s ability to exchange heat. Crushed ice packs do a better job at cooling the body than chemical or gel packs, because they last longer and are able to draw four times the amount of heat out of tissue. The important difference is that ice packs undergo phase change, allowing them to last longer at an even temperature, creating a more effective treatment. Most chemical or one-time-use packs and gel packs do not undergo phase change. They quickly loose their ability to transfer heat, limiting their effectiveness to reduce swelling. Their short duration of cold is not long enough to produce numbness, also reducing their ability to relieve pain.

Cold therapy should always be used as soon as possible after an injury occurs and continued for the following 48 hours at 15 to 20 minute intervals. Remember – if you hurt yourself, you need to ice!

This information is not intended as a substitute for professional medical treatment or consultation. Always consult with your physician in the event of a serious injury.



Louise Roach is the editor of an on-line health and fitness newsletter. She has been instrumental in the research, testing and development of SnowPack, a patented cold therapy that exhibits the same qualities as ice. Her injury prevention and treatment articles have been published on running, walking and fitness websites. For more information visit: http://www.snowpackusa.com or NewsFlash*SnowPack at: http://home.netcom.com/~newsflash. Louise Roach can be reached at: [email protected]

2006 two times partial meniscectomy, left knee.
2006 Subacromial Decompression surgery in left shoulder.
2006 Diagnosed with spondylitis ankylopoetica.

Offline patpalloon

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Re: Should we be icing or heating.... or both?
« Reply #10 on: July 25, 2006, 10:28:09 PM »
basically, the inflammatory response is useful in the short term. Even the ancient Romans knew the 5 cardinal signs of inflammation - pain, swelling, heat, loss of function and .. the other one. It stops you using your leg when you've just damaged it thus protecting it from further damage. The inflammatory response and the healing response are very closley linked. If you had no inflammatory response then your skin wounds would pop open when they took the stitches out, and your graft wouldn't heal to the bone. But Kai is right in that the long term effects of swelling are harmful to the recovery from ACLR as they inhibit ROM and muscle firing etc.
LEFT KNEE: ACL and medial meniscal tear Sept 05.
Arthroscopy Jan 06.
Hamstring ACLR Apr 06.

RIGHT KNEE: meniscal tear 2008. Partial meniscectomy 2008 and again 2009.

Offline henri

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Re: Should we be icing or heating.... or both?
« Reply #11 on: July 26, 2006, 06:21:08 PM »
yes,but you also shouldnt go crazy with your icing, leave some ice cubes for cold drinks on these hot summer days ;)
unhappy triad

Offline zengirl

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Re: Should we be icing or heating.... or both?
« Reply #12 on: July 26, 2006, 06:23:03 PM »
I iced this afternoon because my knee was aching and afterwards it felt much better. Only twenty minutes, but... good results.
Feb '03 Ladies badminton, bad fall, detached ACL
May '06 - ACL reconstruction & meniscus repair
Complications - swelling, pain, lack of flexion/extension, 50% graft failure
Jan '07 Arthoscopy, debride, removal of adhesions & 50% of graft
Attempting to rebuild muscles so can continue sport & life

Offline ibis003

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Re: Should we be icing or heating.... or both?
« Reply #13 on: July 29, 2006, 03:03:36 AM »
I think everybody is looking at it differently, yet we all have the same routine on it
This is the way I see it or has worked for me.  I work my knee out 3 time a day, evertime you work it out you are warming it/ get the blood flowing, then I ice it after the workout, helps the swelling.  Then I take a hot shower, get the blood flowing again, then ice.  i do this 3 time a day and I noticed a huge reduction in swelling from week 2 to week 3, in all areas except my my repaired MCL, I didn't see a big cahge in swelling in that area until about week 8 or 9.
Dislocated Knee/ Blown ACL/ruptured MCL 2-18-06 (Donahue  Triad)
Started pre-op PT 3-14-06
ACLR & MCL repair on 4-26-06