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Soft tissue injuries: why “just put some ice on it” might be the worst advice

By December 18, 2017Soft Tissue Injury

Have you taken a fall lately? We can’t always prevent falling on our asses, but what we do after a fall can make a dramatic difference. And when I say “what we do after a fall” I don’t mean looking around frantically hoping no one saw you hit the deck. Many of us (myself included) are very familiar with the acronym RICE (Rest, Ice, Compression, Elevation). This a very common prescription for anyone who has a soft tissue injury, but in many cases it can do more harm than good.

It might seem counterintuitive that ice, rest, compression and elevation would be detrimental to healing a soft tissue injury, but there are a few reasons that ice and rest specifically can hinder the healing process and potentially cause long term issues. Now for people who are experiencing a soft tissue injury in a joint, that’s different situation in which what I’m about to say wouldn’t necessarily apply. However, if your bruise or injury is in the soft tissue (and not in a joint) you might want to consider skipping the ice.

In the video Elisha recounts a nasty fall she took that ended up leaving a pretty substantial bruise on her left ass cheek… ouch. Being a little on the clumsy side myself, I’ve eaten shit more than a few times and suffered similar injuries. And, because I didn’t know any better, I iced the wound took some time off my favorite activities and eventually returned to my normal routine. The glutes are just one example of an area that you could suffer a soft tissue injury, where ice and rest wouldn’t be the best advice. So, if ice and rest isn’t the right course of action, what exactly should we be doing?

When the RICE acronym was invented they didn’t get it all wrong. In fact, there’s nothing at all wrong with compression and elevation of a soft tissue injury. However…

Numerous doctors and physical therapists (from Nick DiNubile to Kelly Starrett) are now advocating against ice and rest for certain soft tissue injuries.

One extremely important aspect of recovery from soft tissue injury is engaging in gentle movement that actually activates the area you injured. The importance of contacting that injured tissue cannot be understated, and in Elisha’s case, this gentle movement technique relieved 50% of her pain in an hour.

Initially this didn’t make sense to me, as it seemed like you would increase your likelihood of re-injury or making the injury worse. What Elisha explains in the video is that inflammation is bringing extra blood flow to the injured area for the purpose of healing it. Ice actually hinders this process. Yes, our inflammatory response actually exists for a reason.

This flow of blood to the injured area is enhanced by gentle activation and movement of the injured area.

This gentle movement ushers in fresh blood and ultimately gives the injured area a chance to generate new cells and heal faster. I’m not a doctor, but I would guess that when a part of the body isn’t getting proper blood flow, mild necrosis of tissue is far more likely to occur. I wish I had know or thought about this the last time I took a nasty fall.

Another aspect of injuries that isn’t often discussed is that fact that fascia can get “stuck” and form a certain pattern after a traumatic event. If we ice our injury and don’t move the injured area gently and gradually, our fascia is more likely to become fixed in that pattern which has negative implications on the nervous system. And of course, if we have fascial restrictions in a particular area of the body we may have circulation issues in that area over the long haul.

One of Elisha’s friends told us she once had a boyfriend who was very intentional about movement of an injured area post-injury. He would stub his toe on a table leg for example, and after the injury, he would go back to that table repeatedly to mimic the movement of stubbing his toe without actually making contact with the table. This kind of practice not only provides movement that will help with the physical aspect of the injury, but also engages the nervous system. Basically he was reminding his nervous system, “It’s ok to walk right by a table, and not seize up or panic.”

Often we encounter circumstances that might trigger a visceral memory from an old injury, and we don’t even realize that our body gets tense, or we do but aren’t sure why.

I’ve experienced this phenomenon very viscerally through a car wreck I was in. I don’t even remember most of the wreck (head trauma), but I have been notably more anxious while driving ever since it happened. Of course I wasn’t aware of the need to reorient to driving slowly and positively so that I could heal that trauma, and ultimately not be anxious while driving. But even becoming aware of this phenomenon long after the fact has helped me to feel less anxious when, for example, I get cut off at a busy intersection. While stubbing a toe seems like a mild example compared to a bad car wreck, I believe the same principles apply regarding processing injuries/traumas and getting back on the horse.

This is why it’s extremely important to develop a post-injury practice that reminds you, “The trauma (injury) is over, I’m ok, and I’d like to use the injured area again.”

This practice is best implemented relatively quickly after the injury, so the trauma doesn’t reinforce itself (like in my car wreck), but rather gets acknowledged and processed in a healthy way. Of course this healing process typically happens over time, but the faster we start getting both the physical and the mental back on board, the sooner we can function optimally again.

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