Naturally Healing a Sports Injury

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What is the best way to rehabilitate that sport injury you just suffered? If you’ve ever suffered a knee injury or an ankle sprain, you are probably familiar with the RICE treatment – rest, ice, compression, and elevation.

For decades, RICE was the gold standard for treating athletic injuries. It’s ability to quickly reduce pain and swelling made it especially popular in the various athletic communities. Breaking down the RICE treatment into its separate elements:

  • Rest: The first step to treating a sports injury is to rest from further activity. This is in order to protect the area from additional damage and further swelling.
  • Ice: Cold packs or ice is applied to slow inflammation and reduce pain. Blood to the area is slowed and swelling is minimized.
  • Compression: The injured area is compressed to further reduce swelling and stabilize the area.
  • Elevation: The injured area is elevated above the heart level in order to minimize blood flow and swelling.

As popular as it was and continues to be, it’s very important to note that RICE was never designed to provide complete rehabilitation for athletic injuries. It was designed to quickly and effectively minimize pain, restore mobility, and return professional athletes to the field.

Though RICE has been altered over the years, with new treatments like heat being added into the mix, it is still not an ideal treatment for long-term healing of your athletic injury. Let’s examine why that is.


History of RICE treatment

First coined in 1978 by sports medicine doctor Gabe Mirkin in his best-selling book, The Sportsmedicine Book, RICE quickly became the treatment of choice for athletic injuries. Popular athletic injuries treated by RICE included:

  • Ankle sprains
  • Shoulder injuries
  • Knee injuries
  • Tennis and golf elbows
  • Hamstring injuries
  • Groin pulls
  • Shin splints

The reason RICE is not ideal for complete healing has to do with the fact that it comes from the field of sports medicine. The treatment was created for sporting events and not necessarily for facilitating complete healing. In fact, RICE was created to get athletes back into play as quickly as possible, for as long as possible. It’s important to note that if you are seeking long-term healing and rehabilitation, RICE may actually do more harm than good.

In 2014, Dr. Mirkin updated his original findings and concluded that RICE may actually delay the body’s natural healing process. Cooling of damaged tissue and complete rest inhibit blood flow and inflammation of an injured area. When you inhibit inflammation, you actually slow the healing process and prolong your recovery time. Inflammation is a natural and healthy response to injuries. In fact, allowing inflammation to occur can help you get back on the field as quickly as applying the RICE treatment, and probably stay there longer. Let’s examine what this means.


The role of inflammation in healing athletic injuries

Without inflammation, healing will not occur. In cases of athletic injury, inflammation is a necessary part of the healing process. In fact, any inflammation, whether from injury or infection, is an indication that your body is in the process of healing itself. Telling signs of inflammation include redness, pain, swelling, warmth, and decrease in functionality of the affected area.

Anything that delays or suppresses the inflammatory process, such as the RICE treatment, also delays the body’s healing process. Cooling the surrounding area, a lack of movement, and anti-inflammatory medication all slow or inhibit your inflammatory process.

When you suffer a sports injury, the first 48-72 hours following an injury are especially important. Although uncomfortable, allowing the inflammation to occur without interruption can ultimately speed up your recovery, avoid nerve damage, and give you a better chance at a complete healing of the area.


Three stages of healing a sports injury

To better understand the role inflammation plays in the healing process, let’s review the healing process as it occurs for musculoskeletal injuries. Inflammation is the first of three stages of healing. These three stages are:

  • The Inflammatory Stage – Typically lasting 48-72 hours after injury, this stage of the healing process protects the injured area from further damage and marks the start of the body’s natural healing process. This is when pain is highest.
  • The Repair Stage – Typically lasting several months once inflammation subsides, the repair process involves a rebuilding of damaged tissue. Movement and rehabilitation should be incorporated into treatment to stimulate the injured area and ensure all necessary tissue is repaired.
  • The Maturation Stage – Typically lasting weeks to months after the injury has been repaired, maturation of new tissue means the body undergoes a process of normalizing new tissue with your normal physical demands. At this stage, any new tissue is still weak and must be slowly incorporated with progressive strength training as advised by a physician or physical therapist.

Acupuncture during inflammatory pain

During the healing process, pain is most severe during the inflammation stage and, depending on the site of injury, can become quite uncomfortable. If the discomfort becomes too great, you can reduce pain without anti-inflammatory medication. For that, I recommend medical acupuncture treatments.

Not only does acupuncture alter the chemicals of the brain to help with pain modulation, it also plays several roles in assisting the inflammatory process. Acupuncture for a sports injury increases blood flow to the injured area, and alters the tissue planes to help drain the inflammatory materials from any damaged tissue. Why is draining the inflammatory materials important?


Excessive inflammation 

Although inflammation is a natural and healthy response, prolonged and excessive inflammation can begin to do more harm than good. If not drained properly, the inflammation can cause tissue surrounding the injured area to atrophy and become permanently weaker than its counterpart.

Excessive inflammation can be caused by a lack of blood flow to the area, poor overall health, and signal a more severe injury, which should be examined by your doctor as quickly as possible to determine if you’ve suffered a bone fracture.

Inflammatory materials must be able to drain and leave the area. For most athletic injuries, when inflammation continues beyond 72-96 hours following an injury, you are enduring pain without much healing to show for it.


Osteopathic manipulation for sports injury

One way to help drain the inflammatory materials is with soft-tissue manipulation and gentle movement to restore function in the injured area. Gentle osteopathic manipulation helps the inflammatory materials drain from the damaged area by creating motion in the tissues. It’s important to note that any manipulation or adjustments this early in the healing process should not be aggressive.

Another way to create motion in the body is with deep breathing exercises. Deep breathing performs a pump-like action, which creates motion of the tissue and helps to drain inflammatory materials.


Prolotherapy treatments for sports injury

Athletic injuries to tendons and ligaments heal slowly because they occur in areas without a direct blood supply. Since the cells and proteins needed for healing and inflammation are supplied in the blood, when blood supply is limited, such as in the rotator cuff, inflammation may actually subside before complete healing occurs.

Prolotherapy treatments can temporarily increase the amount of blood flow to tendons and ligaments by temporarily creating an inflammatory response. Prolotherapy injections cause minor irritation to the injured area. This minor irritation causes your body’s inflammatory response to rush to the area and augment healing.

Depending on the type and severity of athletic injury, there are two prolotherapy treatments available: dextrose prolotherapy and platelet rich plasma therapy, known as PRP.


Making the most of prolotherapy and PRP treatments

For prolotherapy and PRP treatments to work as intended, there must first be adequate preparation of the area so the body can properly deal with the inflammatory response created by the injection.

When using prolotherapy for a sports injury, I recommend combining acupuncture, manipulation, and prolotherapy treatments together. Attempting to fix a damaged tendon or ligament when tissues are still stagnant and stuck will provide limited benefit.


Holistic healing of sports injuries

A key consideration of any treatment is the total health of the individual. Your hormone levels, your sleep schedule, your level of stress, and your diet all play an important role in whether your body has sufficient resources for a healing and therapeutic response to an athletic injury. 

If you’re not healthy, you won’t have the resources required for healing to take place. Breaking down a natural approach to healing an injury:

  • Osteopathic manipulation – ensures the tissues are functional and moving
  • Medical Acupuncture – helps create movement, modulate pain, balance hormone levels, and increase blood flow
  • Regenerative injections – boost your body’s own healing response and help create complete stability of the new tissue.
  • Diet changes – eat foods rich in omega-3 fatty acids and fish oil supplements to help with inflammatory phase of healing.

I recommend my patients also see a good physical therapist to start corrective exercises. Often times, the problem that caused the injury to occur in the first place has existed for a long time. It’s hardwired into the neurology of your brain and the way you move, walk, run, and lift needs to change; otherwise, after properly healing one injury, the original problem will cause future injuries to occur.


Final thoughts & Summary

I believe any approach taken for rehabilitating athletic and sports injuries must consider the total health of the patient. Nobody likes dealing with injuries but they do happen. The best thing you can do is to give yourself the time and support to heal completely.

  • RICE does not offer long-term healing because it inhibits inflammation and limits blood supply to the damaged area
  • To ensure long-term healing, allow the inflammation process to occur
  • Minimize pain with acupuncture and try to avoid taking too much anti-inflammatory medications
  • Restore tissue movement in damaged area with movement, osteopathic manipulation, and deep breathing
  • If necessary, increase blood flow to area to ensure proper inflammatory response and drainage of area using prolotherapy and PRP injections
  • Change your diet, lower stress levels, and ensure proper amount of sleep. Your body has the innate ability to heal itself. My job, and the job of your physician, is to help augment that natural process.

 

Thank you for reading!

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Dr. Dan Williams is an internationally trained doctor of osteopathic medicine (DO) and a certified acupuncture practitioner. Dr. Dan is based out of Indianapolis. You can find more information by visiting drdanielwilliams.com.

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Dr. Dan Williams, DO