Almost every physical therapy clinic in the country uses cryotherapy (ice packs, ice massage, spray and stretch, etc...) as an intervention for pain management and decreasing inflammation following an acute injury. In theory, these interventions make sense. Cold is a method of vasoconstriction, which will blunt blood flow and reduce swelling to an injured region. However, what other processes are we altering by constricting blood flow? Are there negative effects to icing an acute injury?
A New Paradigm for the Use of Cold
Inflammation is a natural part of the healing process. With inflammation, inflammatory mediators, leukocytes, and macrophages flood the region. These cells function to clean up and repair the injured area. Additionally, the lymphatic system is designed to eliminate excessive fluid accumulation and the musculoskeletal system uses movement to power the lymphatic system. In other words the body has systems and processes established to eliminate swelling. A study by Meeusen and Lievens found that prolonged icing affected the permeability of the lymphatic channel and increased local swelling. Another experimental study performed on rats found that icing following an acute injury decreased the amount of macrophages and reduced the number of regenerating muscle cells.
This post is not intended to convince the reader to avoid using cryotherapy as an intervention, but rather provide a different perspective. There is not strong evidence supporting or refuting the use of ice to decrease inflammation. Understanding both sides of the conversation is important. What do you think?
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MMT: A neuromuscular perspective
A couple weeks ago I was evaluating someone with low back and groin pain. I did my usual systematic examination that included various mobility and strength measurements. I was surprised to find the patient had MMT (Manual Muscle Test) strength of 2+/5 in her gluteus maximus bilaterally. The patient was in her mid-20's, an avid rock climber, and had reported doing clamshells for strengthening regularly. The patient immediately showed a positive response to approximately 20 repetitions of repeated lumbar sideglides. Continue Reading
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