I once spent over 2 hours in the ER for the doctor to take 5 minutes to look at my ankle and tell me the same tidbit I've written out for you down below. I later received a bill for over $200 for that 5 minutes of doctor-ly wisdom. (I'm giving it to you free of charge)
The R.I.C.E.R. method and the Vascular Flush are two very important tools when treating an injury or preventing a flare-up in an old (chronic) injury. Now perk up your ears this is a valuable lesson and some people (like myself and other sport and health professionals) have to pay a lot of mullah and spend many hours in school to learn about these two vital recovery tools!
First of all remember that you are never to use a vascular flush during the first 72 hours of an injury or during an acute stage of a chronic injury. Please refer to my other article “Oops I injured myself” if you need a refresher on identifying the different stages of injury.
R.I.C.E.R.
When a soft tissue injury occurs there is a large amount of uncontrolled bleeding around the injury site. This excessive bleeding causes swelling. This swelling puts pressure on nerve endings and results in increased pain. It is exactly this process of bleeding, swelling and pain which the R.I.C.E.R. regime will help to alleviate. This will also limit tissue damage and help the healing process.
Rest
It is important that the injured area be kept as still as possible. If necessary support the injured area with a sling or brace. This will help to prevent any further damage and slow down blood flow to the injured area.
Ice
This one is a biggie! If you remember nothing else, remember the simple application of ice/cold packs can go a long way towards keeping an individual comfortable. Not only will it help to alleviate any symptoms of pain that are already being experienced, but it will help to prevent a significant amount of the tissue fluid accumulation (swelling) from occurring as well as numb pain and control bleeding. This in turn will significantly shorten the duration of any injury-related disabilities (time off from work or athletic duties) and hasten a return back to full function.
Always protect skin from tissue damage by wrapping the ice pack in a thin towel, or my favorite is a t-shirt. Apply ice for 20 minutes every 2 hours for the first 48 to 72 hours. Use your judgment, for some people 20 minutes is way too much. For others, especially well conditioned athletes, they can leave ice on for up to an hour at a time.
You should apply ice for as long as it is comfortable. There will be a slight discomfort from the cold, but as soon as pain or excessive discomfort is experienced, it's time to remove the ice. It's much better to apply ice for 3 to 5 minutes a couple of times an hour, than not at all.
Compress
Compression achieves two things. It helps to reduce both the bleeding and swelling around the injured area, and it provides support for the injured area which helps prevent further damage. Simply use a wide, firm, elastic, compression bandage to cover the injured part. Make sure you bandage both above and below the injured area.
Elevate
Simply raise the injured area above the level of the heart at all possible times. This will further help to reduce the bleeding and swelling.
Referral
It is important that you consult a professional physical therapist or a qualified sports doctor for an accurate diagnosis of the injury. With an accurate diagnosis, you can then move onto a specific rehabilitation program to further reduce your injury time.
Be sure to avoid any form of heat at the injury site for the first 24 to 72 hours after an injury. This includes heat lamps, heat creams, hot tubs, Jacuzzi's, heating pads and sauna's. Applying heat may actually slow healing during the first 72 hours after an injury takes place.
Please, at all costs avoid all movement and massage of the injured area. Also avoid excessive alcohol. All these things will increase the bleeding, swelling and pain of your injury.
Vascular Flush
A vascular flush is a contrast of hot and cold hydrotherapy treatments. The cold water causes the vessels in the area to constrict, the hot causes the vessels to dilate, thus creating a localized temperature pump for the lymphatic system and blood stream without stressing muscle tissue. This is just the action your body needs to speed healing! The pumping motion flushes wastes and acids from the tissues, replenishing the area with freshly oxygenated, nutrient-rich blood.
It is called a “Vascular Flush” because that is exactly what is happening on the molecular level. You are flushing wastes and acids that cause stiffness, pain, adhesions, muscle spasms and other myofascial conditions away by increasing the lymphatic and blood flow. This increase in nutrition brings the benefits of faster regeneration of overworked, strained or sprained muscle tissue, an increase in response rate, metabolism, flexibility and awareness, a decrease for potential and related injuries and a decrease in pain and discomfort.
Flushes are great for periods of stress on your body like before and/or after working out or after a repetitive activity that is a strain on an area of the body. It’s best to implement this method at a time of day that is convenient for you and easy to make into a routine, like first thing in the morning before you get busy with your day and/or at night before you settle in. One of my instructors from my massage school days taught me to always do a vascular flush on my arms and hands after a long day of massage. I simply fill a tub with ice water and another with warmish hot water- I set them side by side and just alternate between the two (this was one of the most valuable lessons I learned in massage school). If I skip this treatment I will definitely feel the effects of being a massage therapist the next day. We’re talking achy hands, irritated elbow joints and a fragile demeanor!
You always want to use a 3:1 ratio for 3 cycles:
(30 seconds cold : 10 seconds hot)
(3 minutes cold : 1 minute hot)
(3x hot/cold, hot/cold, hot/cold)
Your heat source should be around 105 F and please remember to always end on cold and never go longer than (6 minutes cold : 2 minutes hot). Sometimes you will have a difficult area like your low back or shoulders and will need to do this in a shower or with ice packs and a moist heat pack. Any way you are able to do this is fine just as long as you get it done. Remember accomplishing these two techniques can take day and sometimes weeks off of your recovery time!
Related Articles: Oops I Injured Myself, Sport Injury Prevention
