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-   -   heat and dit da (http://www.catalystathletics.com/forum/showthread.php?t=108)

Yael Grauer 10-20-2006 05:38 PM

heat and dit da
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


Originally Posted by Robb Wolf (Post 385)
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:
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.

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.

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