Wednesday, November 21, 2007

Ice Therapy for Acute Trauma

Ice is an extremely useful tool, and it is, in my mind, essential after acute trauma. Ice can slow bleeding in an area, decrease inflammation, reduce muscle guarding, and provide an analgesic effect (decrease pain).

If you injure an area, by events such as tearing a muscle due to overuse, or direct injury like spraining your ankle, you break little blood vessels in and around the area. Blood then flows into the area, transporting products and chemicals needed to help repair the injury. This extra blood and other products cause the characteristic redness, tenderness and inflammation associated with acute injury.

This inflammatory process is vital to proper tissue repair, but if too much blood enters the area, you can have severe pain and loss of use due to the pressure built up by inflammation, and excess scar tissue formation.

This is where ice comes into play! Ice helps in three major ways:

1. Vasoconstriction (narrowing of blood vessels) – this slows bleeding into the area.
2. Decreased Metabolism – slows inflammation and scar tissue formation
3. Analgesia – blocks pain receptors from firing, so you don’t feel as much pain.

It is crucial to apply ice within the first 36 hours following injury, otherwise the process I just described above will be well underway and you will be too late! You can continue to ice the area for up to 72 hours, depending whether swelling and pain persist.

A great way to apply ice is to freeze some water in a Dixie cup, and then massage the “ice pop” over the injured area. Applying ice for 10 to 15 minutes every 2 hours, combined with compression and elevation (if possible) will give great results. If this isn’t possible, even a quick application is better than nothing.

If your injury is severe, you can apply ice more often. If your injury is relatively minor, or is an acute flare-up of a chronic condition, then you might be fine with just a couple of applications. You are the best judge of what your condition needs.

A few words of caution:
- do not fall asleep with any type of ice on you, as it could damage your skin or other tissues.
- use caution with gel ice packs, as they cool to below freezing. It is best to have a layer between your skin and a get pack – a thin damp tea towel is fine.
- be careful when icing over areas where nerves are close to the surface, such as the unlar nerve in the elbow (funny bone), and the peronial nerve on the outside of the knee.
- you should also be careful if you have a sensitivity to cold, poor circulation, or hypertension.

Tuesday, November 6, 2007

Low Back Pain - Not Always a Disc to Blame!

There are many causes of low back pain, so I will start by reminding you to see your doctor if you are experiencing sudden, severe or unusual pain the low back area (or anywhere for that matter). This article is focusing on one possible cause – muscular.

There are many reasons for the muscle around the low back to become unwell, leading to pain in and around them. Just a few examples are overuse, repetitive strain, guarding other injured tissues, sports injuries, and muscle imbalances. The most common problematic muscles producing low back pain are the gluteus medius, multifidi and iliopsoas muscles. These names might mean nothing to you right now, but you will have a better understanding of them soon!

Gluteus Medius

The gluteus medius muscle is located in your hip, running from the iliac crest down to the top of your femur (the upper leg bone). If you put your hands in your rear pockets you are pretty much over the gluteus medius muscle.

Gluteus medius helps to abduct your thigh (lift your leg laterally out to the side), and it also helps stabilize your pelvis when you are standing on one leg.

If you have trigger points in this muscle, pain is often felt in the low back area, along the iliac crest and sacrum, and in your gluteals. Pain is often felt with walking, lying on the problematic side, or on your back, and when slouching in a chair.

Here are a couple of tips to help alleviate gluteus medius trigger point pain:
* don’t cross your legs
* avoid sitting for long periods without moving
* sleep on the unaffected side with a pillow between your legs
* do not sit on a wallet.
* self massage the area by leaning into a tennis ball (either against the wall, or while lying on back or side) and gently roll over tight muscle fibres.


The iliopsoas, or hip flexor muscle, is a tricky one, as it is mostly hidden in the front of your pelvis. It runs from the sides of the lumbar vertebrae, along the inside of the iliac crest, and attaches in the inner thigh. It is actually two muscles, but for the purposes of this article we will discuss them as a single muscle.

The hip flexor muscle, for obvious reasons, helps to flex your hip (bring your knee up toward your nose), it is also used during a sit up, and it helps you stand upright!

Trigger points from iliopsoas can cause pain in the mid to low back (the pain kind of runs down your back – or up, depending on your perspective!), upper gluteal area, and front of the thigh and groin. Pain is often worse when standing, and lessened with lying down with support under your knees (slightly flexes the hips to take a bit of tension off the iliopsoas).

If you suffer from this type of pain, It is a good idea to avoid sitting for long periods, especially if your hips are flexed more than 90ยบ, be cautious when embarking on a new abdominal workout, and try to reposition yourself if you tend to sleep in fetal position with your hips flexed tightly.


The multifidi muscles are part of the group know as the paraspinal muscles. These muscles run along your spine, as the name implies, and they refer pain along the spine as well.

The multifidi muscles help the other paraspinals to rotate and extend your spine, and are used when lifting objects, bending, stooping, and twisting. (They can therefore be injured doing these movements!)

Pain from trigger points in the multifidi is often described as a deep constant ache in the spine, no matter what position you are in.

Movements to avoid if you suspect multifidi problems include side bending, rotating and extending the spine. You should also avoid sitting for prolonged periods, and use care when lifting objects: hold the object as close to you as possible, and lift with your legs, keeping a straight back.

Did you notice the common theme with all three of the muscles just discussed? They are all exacerbated by prolonged sitting! A great reason to go for a lunchtime walk!

Massage therapy is very effective in releasing trigger points in these muscles, and I can also show you ways to treat them yourselves! Speaking of home care, warm buddies hot packs are perfect for warming up your muscles at home any time you need to ease those nasty trigger points! Check them out at

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