The Spinal Column

Piedmont Chiropractic

Cool New Research - To ice or stretch?


New studies are showing that icing banged up muscles may delay the natural healing process.  Ice is the most overused and misunderstood therapy modality available (except ibuprofen and aspirin).  When is ice indicated?  How long should you apply it?  How cold does it have to be?  If it is not cold enough is it even effective?  These are all legitimate questions that many never ask.  There are some studies that have compared different temperatures and it is a fact that temperature matters.  If it is too cold or applied for too long you can damage your skin giving yourself frostbite.  To understand when to use ice you must understand the physiology of ice.  Ice causes your arteries to constrict.  This DEPRIVES  the injured area of blood flow which is why you will see a decrease in Redness and Swelling.  If your goal is to DEPRIVE the injured area of blood then ice may be indicated.  If your goal is to INCREASE blood flow to the area then you would apply heat or stretch and contract the area to warm it up and increase blood flow.   Let's consider the injury Plantar Fasciitis.  Many runners say that their foot hurts worse when getting our of bed in the morning but that it warms up. 

Cold's pain-killing effect is caused by its "deadening" of nerve activity; patients who use cold therapy on injuries tend to require much less pain medication. It also creates a "window of pain relief" during rehabilitation so that patients can reestablish normal motion. This effect, though, can sometimes be counterproductive; an athlete who has iced down an injured body part may get so much pain relief that he/she returns to activity too soon. Cold decreases muscle spasms by making muscles less sensitive to being stretched, and, like heat, cold can be used to treat low-back pain.  Some studies have shown icing is best for individuals who have had back pain for more than 14 days. 

Some injuries respond to stretching while others do not.  Different types of injuries should be stretched while others should not.  The first would be a sprained ankle.  A sprain is a torn or overstretched ligament.  You should NEVER stretch a sprained ankle or any other sprained joint for that matter.  If the ligament is overstretched or torn already muscles around the joint will "splint" or spasm in an effort to stop you from further damaging it.  DO NOT STRETCH A SPRAIN...EVER!  Now let's consider plantar fasciitis.  Plantar fasciitis quickly turns into plantar fasciosis.  Fasciosis is essentially a "scab" at the injured site on the tendon.  Many refer to this as scar tissue.  Stretching the injured plantar fascia prevents the scab from shortening and can help the new fascia fibers that are being formed align correctly. 

Almost everyone can benefit from stretching the soft tissues - the muscles, ligaments and tendons - in the back, legs, buttock, and around the spine.

The spinal column and its contiguous muscles, ligaments, and tendons are all designed to move, and limitations in this motion can make back pain worse.

Patients with ongoing back pain may find it takes weeks or months of stretching and other back exercises to mobilize the spine and soft tissues, but will find that meaningful and sustained relief of back pain will usually follow the increase in motion.  
Now the question is, how much do you stretch?  Once a day?  10 times a day?  How long do you hold the stretch?  1 second?  10 seconds? All injuries are different and your healthcare professional can help you make these decisions.  Generally gentle stretching 2-3 times a day is a good idea.  But stretches should never hurt.  If you overstretch you can damage ligaments, muscles and joint capsules.  If you are stretching and there is pain back off the stretch until the pain goes away.  Now you found your safe stretching zone.