PROTECTION – RELATIVE REST:
Protect or provide relative rest to the area by avoiding activities and movements that cause pain beyond a tolerable level. Do move the area in a range that is not painful or tolerable. Movement allows the injured tissue to heal along the normal stress lines of the joint; therefore allowing greater tissue strength after healing is completed. Movement also helps pump out any fluid that has accumulated in the soft tissue from injury, and it pumps in nutrients necessary for healing. Movement helps keep muscle tissue strong, and it helps reduce scar tissue and adhesion formation. This is why bed rest is no longer routinely recommended for low back pain. Let pain be your guideline for what activities that you should and shouldn’t do and how much you should and shouldn’t do.
Ice relieves pain through the stimulation of endorphins-a natural painkiller released by the body. Also, congestion in the area due to swelling inhibits oxygen flow to the cells of the healing tissue, thus causing impaired healing and cell death. Ice helps to slow down the metabolic rate of the cell. Ice packs may be applied for 10 to 20 minutes every two hours. If reapplying, wait 2 hours in order to allow the skin to rewarm. Ice massage is another way to apply ice. Fill a Dixie cup or a Styrofoam cup with water and freeze it. Tear off ¼ to ½ of the cup bottom, and directly massage the injured area for 5 to 10 minutes. You might experience the following sensations, in order, during the application: coldness, aching, burning, and numbness. Use circular motions and be sure to place a towel under the treated area to catch any dripping water. If reapplying, wait 2 hours in order to allow the skin to rewarm.
When using heat, consider using moist heat than dry heat. Dry heat robs moisture from muscles and skin, which are primarily composed of water. Moist heat may be applied for 20 minutes. If reapplying, wait 2 hours in order for the skin ti return to its normal temperature.Alternating heat and ice is also an option. For example, moist heat 10 minutes followed by ice for 10 minutes. If reapplying, wait 2 hours.
Compression to an injured area has been identified as the single most important and effective way to control swelling. Compression causes increased pressure in the area thus keeping fluid accumulation to a minimum thus allowing for cell oxygenation to occur with decreased cell death on a microscopic level.
Elevate the injured area above the heart in order to promote fluid drainage.
Analgesic balms or crèmes such as SOMBRA and BIOFREEZE help break the pain cycle, thus decreased pain>increased movement>increased healing. SOMBRA also contain Capsaicin, the substance that makes chili peppers so hot; have been found to reduce pain in patients when topically applied repeatedly over several weeks. Researchers have found that Capsaicin appears to work by reducing substance P that is found at nerve endings and is involved in transmitting the pain signal to the brain. Crèmes can be applied three to four times a day.
The return of function and the reduction of pain can be a slow process. Expect good and bad days. Try to identify a task or an activity that may have caused the set back and modify or eliminate it.
Paint a mental picture of improvement for yourself. Set goals. Manage stress well to promote healing after an injury and as a preventative measure in the future.