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Yael Grauer
10-20-2006, 05:38 PM
An acupuncturist told me that in Chinese medicine, they never use ice for injuries because it supposedly pushes the injury deeper and can cause arthritis in the area years later. I don't always listen to everything TCM folks say because 1) they say some really weird things and 2) there's no way to definitively prove it was the ice and not the original injury that caused the arthritis. However, I tried her recommendation (dit da jow topically with a hot-as-you-can-stand towel over it) and it felt SO good and brought immediate relief. Anyone else tried anything like this? I thought it was more fun than trying to figure out how something can still hurt when it's iced to numbness.

Ken Urakawa
10-22-2006, 08:07 AM
Wouldn't it depend on the type/severity of the injury to some degree?

Yael Grauer
10-22-2006, 10:47 AM
I suppose so! I'm talking about strains, sprains, bruising, things like that. I've been asking acupuncturists I know and the most they will admit to is using ice once right after an injury for no more than ten minutes. They also told me that ice is very good for dead people, because it helps them keep.

Research-wise, I've read about the efficacy of hot/cold and cold/cold (and there's a lot of science to back both up), but I haven't found anything about heat alone.

Clinically, it does seem that almost all of these types of injuries can be characterized as "cold" injuries (i.e. cold makes it feel worse, heat makes it feel better) and most acupuncturists I know seem to have a very high success rate in dealing with injuries (mostly long-term recurring pain) as well as other "cold/damp" conditions like arthritis. (This, of course, doesn't mean they are right about ice, only that there seem to be ways to treat cold/damp conditions successfully without the use of ice.) I also know a top-notch Hispanic herbalist and curandero whose school has the motto "blood follows heat" and I'll have to ask him if he ever uses ice. In my own experience, I've used warming herbs topically for a small handful of people (about two dozen) following an injury (usually 2-7 days later) and it works very well and often immediately. This would include liniments with rosemary, mustard powder, ginger power, sometimes cayenne, foot baths with rosemary essential oil and sometimes camphor essential oil, poultices with a combination of mostly warming herbs, and even just topical application of plain ol' ginger root when it was all I had on hand. I've used ice a LOT on myself and others and I've never seen it get things moving the way that warming herbs do. I have seen some pretty amazing things from hot/cold applications (and I know a naturopathic doc who has a lot of positive clinical experience re: this) but the million dollar question is, what are the long-term effects?

I'm actually planning on asking on a couple e-mail lists I'm on and see if there's research I wasn't able to dig up or any other clinical experience that might be useful. People have recommended Tom Bisio's book to me as well.

Robb Wolf
10-22-2006, 02:17 PM
Not too sure on this. The physical therapy community had its collective ass handed to it a few years ago when they were going after Chiropractic. PT had claimed for years that DC's had no research to hang their hat on...but most of western physical medicine has been used for ages and had no "proof" that it worked. Well...the DC's started publishing research and took the PT's to task and they fell back on "this is what we have always used..." not scientific and the same things that mainstream medicine uses to dismiss "alternative" therapies. You cannot have it both ways!

All that said I think there are now some good studies on ice vs. heat at various points post acute (injury) but this is tough stuff to study thoroughly. How do you cause identitical soft tissue injuries in 2 groups of people to compare this stuff? Clinical communications become important. From my own experience I throw my hat in with post acute cold and then contrast methods after 48-ish hrs. Make inflamed tissue more inflamed and you are fudged. Just because you make something feel more comfortable for a moment does not mean you are making it heal faster.

Yael Grauer
10-22-2006, 02:32 PM
Just because you make something feel more comfortable for a moment does not mean you are making it heal faster.

True that, but wouldn't that go for ice as well as heat? Also, if you are making something heal faster but will have issues with it later on, then maybe it's not the most efficacious treatment... so the question is whether or not ice is what causes problems (arthritis, etc.) in the area later on or not... and I think that would be next to impossible to determine.

Greg Everett
10-22-2006, 02:48 PM
"Just because you make something feel more comfortable for a moment does not mean you are making it heal faster."

"True that, but wouldn't that go for ice as well as heat?"

The primary use of ice post-acute is not to make the injury feel better, it's to minimize inflammation.

Yael Grauer
10-22-2006, 03:06 PM
I thought you said in another thread that local inflammation is a necessary step in the healing process.

Anyway, I found this article: http://www.jfponline.com/Pages.asp?AID=1971 which seems to support ice and/or anti-inflammatory use right after injury but doesn't show anything for long-term effects (and I don't know anyone who would use heat immediately after an injury)...

I found another study which is pro short-term intermittent ice applications and I have a bunch more to sort through. http://bjsm.bmjjournals.com/cgi/content/full/40/8/700

Also, I think something feeling better can be indicative of quicker recovery, if it continues to feel better (as opposed to just feeling better for a few minutes) AND it can be useful for specific injury treatment, for example if you are using heat so that you can work on your rehabilitation routine without pain. Just some thoughts.

Yael Grauer
10-22-2006, 06:12 PM
After sifting through about fifty zillion articles online and in my filing cabinet, I found an old article a naturopath gave me on the efficacy of hot and cold hydrotherapy, and it seemed to indicate that lukewarm/cold is better than hot/cold if the injury is particularly inflamed. The amount of heat versus cold varies, but there is almost always more heat used than cold. So I was thinking if the injury is particularly cold (as in, cold to the touch, as my joints often get when I have an injury) then hot/lukewarm might be indicated (the "cooling" part would be the air, or removing heat). I guess this would vary based on the individual. Like, maybe if someone is cold all the time even though they live in the desert, you could use hot followed by lukewarm or something.

The theory behind alternating hot and cold is to use heat (or moist heat) to increase the vascular size and transport cellular waste and remove damaged cells, but then use the cold to stop the swelling. I would think that too much inflammation caused by heat would either hurt or be obviously swollen (visually) afterwards and that would be an indication, so I'm guessing that me using heat that doesn't increase swelling even without icing is unlikely to be harmful (someone correct me if you think I'm wrong.)

This gets even more complicated if you talk to homeopaths, who would use fairly mild heat to treat inflammation (and even burns, for that matter.)

Since ice (or heat) is a temporary measure there are absolutely no follow-up studies on this, so even though it's not definitive proof I think people's clinical experience over a long period of time is the only thing to go on for now. Of course if people are just trying to make something hurt less or heal faster then it's not important anyway--I may be one of the few people who wants to see the result of long-term studies of ice.

On the pro-heat front, I found a study that showed that continuous low-level heat wrap therapy is effective for treating wrist pain and one for heat during back pain. These studies didn't compare heat and ice. The ones that do seem to be pretty pro-ice, as much as I want them not to be.

For back pain:
http://www.thespinejournalonline.com/article/PIIS1529943005001166/abstract
It just says heat and exercise is better than heat or exercise alone, and that just one of the two is better than nothing.

I also found this little disclaimer, which seems to indicate there may be a conflict of interest here as it was funded by Procter & Gamble, who make more money off of their ThermaCare Heat Wrap than they would off of ice packs. :rolleyes: I love science.


FDA device/drug status: approved for this indication (ThermaCare Heat Wrap, The Procter & Gamble Co).

Support in whole or in part was received from The Procter & Gamble Company. Author GNE acknowledges a financial relationship (employee of The Procter & Gamble Co.), which may indirectly relate to the subject of this manuscript."

The wrist pain article covered carpal tunnel, tendinosis, osteoarthritis, strains and sprains. Heat helps with pain relief and grip strength. It scores the same as placebo for joint stiffness and "patient rated wrist evaluation", whatever that is.
http://www.archives-pmr.org/article/PIIS0003999304000139/abstract

So there you have it!

Robb Wolf
10-23-2006, 06:01 PM
You need ENOUGH localized inflammation. Frequently one will cause a heightened state of inflammation via exercise or manual therapy and then squealch the overflow via ice. This induces a macrophage influx and a tendancy to lay down connective and scar tissue in a BENEFICIAL manner. I like acupuncture, love Andrew Weils comment on Naturopaths ("Why would I send someoen to a poorly trained physician...") and love the smart use of cryotherapy to enhance recovery.

Robb Wolf
10-23-2006, 06:06 PM
Regarding the "make it feel better" thing. It is very common for people to put a heating pad an a "bad back" for example. This introduces a chronic level of inflammation. Not good. If you understand the mechanisms of tissue turnover the the associated immune response this starts making more sense.

A legit post accute cryotherapy treatment is excrutiating. It hurts worse than the injury. This is not throwing a bag of frozen peas on the bo-bo and having a martini. I can tell that a few patients wanted to punch the crap out of me while icing. Its NOT fun.

Yael Grauer
10-24-2006, 12:28 AM
Hmmm, I thought Andrew Weil was a naturopath. He lives in my town and I see supplements with his photo on them everywhere I go. Anyways...

I agree that something feeling better doesn't necessarily make it better, and of course this is true in TCM as well--needles certainly don't feel very good, and TCM is opposed to certain arthritis meds that they say cause "dampness" and exacerbate the problem while treating the symptoms. I suppose whether or not you use the TCM model depends on whether or not you believe in "dampness," or "blood stasis" or chi even... or the idea that people could present the same symptoms and have totally different "conditions" (or patterns of disharmony to use TCM terminology). I've had pretty amazing experiences with TCM for serious issues that I can't explain scientifically, so I'm a believer, but I drew the line when they tried to get me to take a "patent formula" with stir-fried squirrel poop.

Robb, I'm assuming you don't want your clients to punch you and you obviously have good science-based reasons for doing cryo... are there any reasons for doing it other than quicker recovery? Do you think it'd be harmful NOT to use it-- do you think NOT using ice will potentially cause problems later on?

As far as heat for back pain, wouldn't you know if you were causing chronic inflammation, or is this one of those things like yoga or static stretching before workouts that feels really good but will mess you up without you realizing the cause? The two studies I linked to seemed to indicate that heat could be useful, but again they are short-term and like the ice research don't have follow-ups.

My own personal experience this time around is that ice seemed to make things worse (but I'm sure me trying to twirl sticks and do db swings didn't help matters any) and heat with dit da (by heat I mean 1-3 applications with hot towels--they cool down pretty fast) has helped a *lot* (but this may be due to the acupuncture and added rest days as well--too many frickin' variables).

I realize that I've contradicted myself about a zillion times already in this thread alone so I will stop trying to argue my pro-heat case. :) Just curious whether you think not using ice could cause long-term issues (scar tissue laid down in a non-beneficial way or whatnot) and whether damage (inflammation) caused by heat would be noticeable in the short-term. Thanks!!

Robb Wolf
10-24-2006, 03:01 PM
Andrew Weil is an MD...harvard trained I think. I sold him a bar of soap when I worked at Wholefoods in Seattle. he got Pissed when I asked him why he is fat and does nto recomend a diet based on evolutionary biology...go figure.

Whenever one has inflammation for an extended period of time the amount of scar tissue increases and the quality with regards to fiber direction and strength/integrity decrease, so yes, no ice=worse recovery IMO.

Yael Grauer
10-25-2006, 10:53 AM
Oh yeah? Well, the cavemen never used ice! :p Just kidding. Thanks for the info. What else can you do to get scar tissue to be laid down beneficially other than ice? ROM/stretching...anything else?

And that's hilarious about Andrew Weil. I should tell you about the dentist he recommends sometime.

Allen Yeh
10-25-2006, 01:03 PM
I haven't read up on dit dat jow before but I did use to use it liberally when I was younger, ages 13-18 when I used to take Kung fu. I probably used it 1-3 times a week depending on how hard we went and what we were doing that week. It was mostly used after a body conditioning session and usually applied to the forearms, shins sometimes upper leg and upper arms. It was great stuff at the time when I took everything my Sifu said as gospel.

Robb Wolf
10-25-2006, 02:54 PM
Cross-fiber friction (massage, deep tissue) with light loading breaks up scar tissue and then the loading stimulates collagen to be laid down in the direction of the force acting on it=stronger connective tissue.

For example chronic bicep tendonitis from ring work. Crossfiber friction/deep tissue work. 4-5 sets of 15-30 bosy rows, followed by ice massage to numbness. No frostbite!

Jeremy Jones
10-26-2006, 03:51 PM
My wife got frostbyte on her back from icing too much.

Be careful with ice.

Ken Urakawa
10-27-2006, 07:05 AM
"Dr. Weil, you are going to love the colloids in this Oatmeal & Honey soap--you skin will be fantastically smooth. Speaking of skin, why are you such a fat*%^ , again? How about recommending a diet that has some sort of validity there, Chubbsy?"

That is classic, Robb.

Robb Wolf
10-27-2006, 02:43 PM
Ken-
That is scary close to the facts!

Yael Grauer
11-08-2006, 11:37 AM
From the "Robb was right again" files, I went to see to this chiropractor because my elbow was clicking all of a sudden, and he told me I had (que surprise) quite a bit of inflammation and tissue damage in my brachial radialus and bicep muscle. He recommended a stretch he showed me and (drumroll, please) 20+ minutes of ice daily for at least a week. Damn doctors! ;)

Sam Cannons
03-20-2007, 05:41 PM
I use dit da jow on bumps and bruises fairly regualrly and I always have good results in terms of quicker healing but I ice as well.

Sam In Aus

Yael Grauer
03-20-2007, 05:45 PM
I use dit da jow on bumps and bruises farely regualrly and I always have good results in terms of quicker healing but ice as well.

I've been using homeopathic arnica, rhus and ruta. I am a total believer. I dropped a 35# weight on my finger on Friday, thought I broke it, and it is barely even bruised right now. No ice, no jow, nothing but these sugar pills that supposedly don't work. I'm okay with it being placebo, because it's such an inexpensive and effective placebo, if that's what it is.

Sam Cannons
03-20-2007, 05:52 PM
There is also a cheaper version of dit da called Zheng Gu Shui. Pretty much the same thing only less potent but much cheaper.

Yael Grauer
03-20-2007, 06:02 PM
There is also a cheaper version of dit da called Zheng Gu Shui. Pretty much the same thing only less potent but much cheaper.

I've used it but I don't think it works as well. The best jow I ever found is only sold through the Chicago College of Healing Arts. It is called Dr. Wu's liniment oil. The jow I use locally is Five Photo Brand First Aid Antiseptic. It's not bad. I was also prescribed some pills by an acupuncturist that are considered internal jow. They made me very sick and did not help much.