Ice vs Heat Dilemma

People always ask which is better when it comes to sore muscles and soft tissue injuries, Ice or Heat.

Before a good answer can be given we must first understand what inflammation is and how it works with the body.

A basic definition of inflammation is the appearance of Heat, Redness, Swelling and Pain in and around an area of the body.

Inflammation is our body's response to disease, illness, infection or trauma. It is part of the body's immune system's first line of defense. When the body detects a foreign invader/substance or trauma it begins a chemical reaction. The resulting substances from the White Blood Cells are rushed to the site through an increase in blood flow. This increase in blood flow is seen and felt as heat and redness. Due to the rapid increase of the volume of immune substances in one area fluid can leak into the surrounding spaces which is then noted as swelling. The expansion of tissue and the response to this tension on the surrounding tissue can activate local nerves to transmit a pain response. As long as this event is short term/acute the process is reparative.  In the short term inflammation helps an injured area by increasing oxygen, proteins and other nutrients, destroying pathogens and toxins, and delivering repair materials and molecules. 

In general there are 3 phases of healing. Inflammation which can take between 1-3 days. Then Proliferation occurs which is the process of repair and requires a sufficient and proper supply of oxygen, nutrients and fibroblast. Finally is the Maturation phase which happens once the surface of the wound is closed.

The immediate response in the inflammatory phase is a contraction of the damaged area's blood vessels to prevent an excessive amount of blood loss. When the area switches to active inflammation the blood vessels dilate. Vessel dilation helps to increase the flow of blood and  increase the level of oxygen and nutrients. 

However, if inflammation goes on past 3 days it then is considered chronic and could then become damaging to the process of healing. The key factors in an area remaining in a state of healthy repair vs unhealthy is the degree and duration of blood vessel dilation, degree of permeability of blood vessels to properly regulate the amount and type of fluid, proteins, leukocytes into the healing area. For a healthy repair response blood vessel dilation should begin within 30 mins after the initial constriction of the blood vessels and the closure of the wound.

The main factor when determining when to use ice vs heat comes from the timing of the area requiring the blood vessels to be in a state of constriction vs dilation. If the blood vessels remain constricted for too long then the delivery of oxygen, nutrients and fibroblast is delayed and healing is thus delayed. However, blood vessels constriction does reduce or eliminate the experience of pain by inhibiting the communication of nerve impulses in the affected area. Sometimes it is necessary to initially inhibit the transmission of pain in order for the brain to allow the person to begin to calm down and thus direct the energy toward repair rather than defense. 

For many years the Gold Standard was set by Dr. Gabe Mirkin who developed the concept of RICE= Rest, Ice, Compression and Elevation. Due to the surfacing of new research Dr.Mirkin has now begun to alter his stance on ice. The key factor in the change came with the discovery that the macrophases (part of the immune cascade) produce as substance called Insulin-like Growth Factor (IGF-1) which is the determining hormone for healing. The presence of this factor is required for both wound healing and muscle/soft tissue damage. 

When discussing soft tissue or muscle issues/damage, I believe we must now be considering whether the area is experiencing fascial dehydration rather than blood vessel damage or fiber damage. We would start by learning if there was a direct incident of trauma i.e. cut, hit or fall that could have resulted in broken bones or damaged tissue.  With a lack of contact trauma we then ask for an indication of tissue damage such as sign of broken blood vessels, bruising, redness, swelling or heat. If none of those signs and symptoms are reported but rather the person speaks of being unable to pin point the pain, there being a sensation of burning or pulling or a sharp stabbing pain that comes and goes and if these symptoms come following a minor task such as bending over to pick up a towel, repetitive motion tasks or after extreme exercise then we more then likely are dealing with a circumstance of fascial dehydration.

Ice is a tricky substance to use when treating the body because just like inflammation or any other beneficial thing too much of a good thing can lead to trouble. Ice is also tricky when used on an area which has signs of inflammation because the indications ice has been left on an area too long is redness, swelling, tingling and pain. See the problem? We usually know the negative affects of prolonged cold as an area turning blue, purple or black. These are extreme signs and if you see these it is too late. The other more settle sign is a white appears with a surface hardness. Again you don't want to get to this stage because that means you will lose the surface tissue due to cell death. 

Alrighty, so you are now probably saying OK Colette get with it and tells us when and how we should use ice. 

In general, if you are experiencing pain and you feel called to use ice, I would recommend using an ice cube and gentle rubbing it over the painful area. As the ice begins to melt stop and pat the area dry. This gives you a chance to determine if the pain is beginning to decrease. I would not do more that three passes and no longer than 10 mins total of ice in one area. If the area is too big or you are not able to reach it to move the ice cube then use an ice pack, bag or strap but only allowing it to remain in any one area for no longer than 10 mins and staying closer to 5 mins or less is ideal. By doing this you will be able to reduce pain, start taking the nervous system into a parasympathetic state which will calm the body and remain within the optimal time frame for the initiation of vessel dilation and the production of IGF-1.

If there is no pain then it is best to avoid ice!

New research involving the recovery time and performance of athletes now also offers more reasons to avoid ice. These studies show ice can reduce an athlete's strengthen, speed, coordination and endurance. In my opinion we must again consider fascia. When we understand fascia is in every cell of the body,  it runs through muscles fibers and it has 10 times more nerve ending in it than muscles carry; it makes sense that if the vessels flowing through it are constricted, then it will become dehydrated and without fluid there is less nerve communication. Less nerve communication means there will be a decrease in the sensation of strengthen, there will be a delay in motor response leading to a decrease in speed, there will be miscommunication from one area to another resulting in poor coordination and finally with nerve inhibition there will be muscle fatigue which means a decrease in stamina or endurance. 

Ligaments and tendons are a form of fascial tissue and they have less blood vessels than muscles. The limited number of blood vessels makes these tissues prone to delayed healing when compared to muscles and other soft tissue injuries. From what you now know about ice you see that icing these tissue will only decrease an already compromised state of wound repair.

When looking at duration of ice application we must bring our attention to research as far back as the 1980s that revealed the body will remain cold for several hours following stagnate ice of only 20 mins. When the body remains cold for this long the nerves again will decrease in conduction and can lead to permanent damage with the appearance of nerve palsies. However, if after icing, the area is rewarmed soon enough the risk of damage is greatly reduced, if not eliminated all together. This then speaks to the benefit of contrast thermal therapy. One can either accomplish this through a contrast shower or topical application in which one alternates cold, hot, cold, hot. If there were pain one would start with hot, cold, hot, end hot. If there was swelling one would start with cold, hot, cold, end on cold. In either case you would only apply the cold for no more than 10 mins.

Now for heat. You want to avoid heat where you see acute inflammation. If there is already an increase in blood flow, redness, and swelling you do not need heat. Heat will only further dilate blood vessels and increase the inflammatory response. 

Warm moist heat is the best when it comes to tissue repair. Using a hot water bottle, whirl pool or hot tub are the best options to providing a soothing environment to stimulate the rehydration of fascia and the relaxation of contracted muscles.  Water conducts heat better than air, with better conduction the heat is retained longer and can penetrate deeper into the muscle layers. The heat then is mimicking the inflammatory process of dilating blood vessels which increases blood flow and the delivery of oxygen and nutrients which allow the muscle to recover faster.  Dry heat such as from an electric heating pad can actually dry out the skin. Dry skin leads to dehydrated fascia, dehydrated fascia leads to pain. The best results are to apply the moist heat for no longer than 30 mins at any given time.

In conclusion, when trying to decide between ice and heat your choice will depend on how much you can tolerate pain and if there is swelling present. To achieve the best and longest lasting healing results and performance when it comes to sports, avoid ice unless there is pain or swelling. In those cases do not use ice for longer than 10 mins and if possible alternate ice with moist heat.  Moist heat is your best options when it comes to general, chronic muscle tension.

I hope you were introduced to new information and you find this information helpful.

Remember, I always advise you see a doctor if you suspect you have injured yourself so we know for sure if there is any bone damage or other serve tissue damage.

www.colette.massagetherapy.com

Drinking Water But Still Dehydrated?

You may be saying, " I'm good, I drink water all day." Or you may be saying, "I drink water all day and I still feel thirsty." Maybe you are the person who drinks water all day and also has to go to the bathroom 20 times a day because of it. Just because you are drinking all of this water does it mean you are hydrating your cells efficiently? The answer is no.

Even with all the water drinking most people's body is still actually dehydrated.
What are some signs and symptoms of cellular dehydration and fascial dehydration?
1. Thirst
2. Bad breath
3. Headache and migraines
4. Constipation
5. Dry skin
6. Difficulty falling asleep
7. Waking in the night to urinate
8. Brian fog, short attention span
9. Joint stiffness and pain
10. Soft tissue pain that doesn't go away with stretching or exercise
11. Muscle pain, chronic knee, hip, low back or neck pain
12. Craving sugar or carbohydrates
13. Wrinkles of the skin
14. Hot flashes for women

What does it mean to be dehydrated? Basically, anytime a person uses or loses more water than it takes in and absorbs that person's body will be in a dehydrated state. There are degrees of dehydration from mild to the extreme which can result in death. The body can tolerate a 3-4%  loss of body water. We begin to notice some or all of the above symptoms when the % moves to 5-8%.  Besides degrees of dehydration there are 3 types of dehydration: losing equal amounts of water and sodium at the same time, losing more sodium than water or losing more water than sodium. If you lose more water than sodium your cells and possibly your brain will shrink. On the other hand if you lose more sodium than water your cells and possibly your brain will swell. If cells swell too much they will burst and thus you have cell death.


The body is composed approximately of 50-65% water. This varies depending on gender, fat composition, age and other factors. The most important thing you can do for your health is maintain optimal levels of water in your body. When we discuss how an individual should hydrate the first thing we speak about is water intake. There are some who say everyone should drink at least 2 liters a day.  In my opinion I think it is more important to look at individuals and go with the baseline recommendation of 1/2 a person's body weight in ounces over a 24 hour period. This ensures there is a safe and proper balance between the fluid inside and outside a person's cells. As always too much of a good thing can be bad. Too much water can burst cells. In the extreme, too much water, consumed too quickly can cause death. We have all heard of this related to college hazing where students drink an entire Sparkletts bottle of water in less than an hour and end up dead.

Ideally we want to be consistent with our water intake. Which means its better to sip from a 32 ounce bottle of water throughout the day than to down the whole 32 ounces in a couple of hours.

Besides the speed at which we drink water, what is the main center regulating how we absorb the water we put into your mouth? The small intestine is where we will get most of our water absorption.  Making sure you drink water at least an hour before meals is another good way to help increase your ability to effectively hydrate. If we eat while drinking water then the water has to wait in the stomach as the stomach breaks down the food. Some of the water will bind to the food and actually be passed out the bowel instead of being absorbed into the blood stream or cells.

Now many of you know I'm big on coconut water after a massage or some kind of electrolyte water. The reason is due to the need to hydrate effectively after a massage. Water by itself is not enough to get it into the cells to be absorbed, it must have a companion. Coconut water is filled with minerals that serve as companions to water. The biggest water carrier is sodium. Sodium in turn requires glucose and amino acids for its transport across a cell.  Again all of these can be found in coconut water. Basically, to achieve the proper balance between the inside and outside of a cell you need the proper balance of electrolytes (sodium, potassium, magnesium, calcium etc), the proper amount of glucose, the correct amino acids and clean water. After a large majority of the water is absorbed in the small intestine, the next up take will be in the large intestine and then finally in the colon. Therefore, it is the utmost importance to have a highly functioning digestive system. Hence, the reason for periodic cleanses to increase the changes of effective absorption of water and other essential nutrients.

When there is too much water outside of the cell the body will eliminate it through the bowels and the urine. Mostly, we see excess water leaving via the urine. So when you are drinking your 20 glasses of water and going to the bathroom every 5 minutes you know you have more water outside your cells and you have not been absorbing it into your blood stream where its going to do the most good.

In speaking about intracellular hydration you can also get water from certain foods to help with your, 1/2 your body weight baseline. Consuming pears, celery, cucumber, watermelon and spinach (to name a few) will help increase your water intake (as all of these have a high water content), if you just can't get all the water you need in a glass.

Now when factoring in consuming the proper amount of water you also have to take into account your activity level. The more active you are the more water you will need.  You will also need to factor in your environment and the temperature of that environment. Water helps regulate body temperature. The hotter it is outside your body the more water your body will need inside. For women, when you lack a water reserve and your hormones are out of balance if the room temperature is warm your there won't be enough water to cool you down. In the face of inadequate internal water the body's alternative means of cool the body down is to sweat. Thus during menopause if you are dehydrated you will experience more hot flashes. Going along with this women, at night your body produces less water. If you already have a low reserve in general then your body will sweat at night to help keep you cool, leading to one reason for your night sweats during menopause. So ladies entering or in menopause, consider drinking coconut water or electrolyte water of some kind an hour prior to going to sleep.

Moving away from the fluid inside cells we come to extracellular fluid. The Extracellular Fluid (ECF) serves as a bridge between cells and organs, while also influencing the volume and strength of the intracellular fluid (ICF). When speaking of ECF we are also discussing the plasma and interstitial fluids as well as fluids such as cerebrospinal, intraocular and synovial fluids. Research is not showing these fluids are the world of fascia. Therefore, the desire to hydrate the fascia is a need to bring the proper water content to the ECF regions of the body.

Through journals such as the Journal of Canadian Chiropractic Association, we are being introduced to the new and current research on Fascia and the make up of ECF. Because fascia and the ECF come in so many forms it can be considered a colloidal substance changing between a free flowing water state to a more gel state. In it's most unhealthy state is acts like rawhide and does not move at all. From the new research we learn about the histology of fascia being a type of cell called a fibroblast. It is these fibroblast we are attempting to affect when we seek to hydrate fascia and thus the ECF matrix. A dehydrated fibroblast becomes like rawhide and becomes difficult to re-hydrate. You can think of this journey to a rawhide state similar to leaving a soft contact lens out of water for too long. If you realize soon enough that you missed putting the lens into its container and find it on the counter you can soak and gently rub it in contact solution and it will re-hydrate and you can wear it without issue. Now miss your container and go to bed. Well, when you wake up in the morning and find that lens on the counter, it is now rolled in on itself and is hard and brittle. You will not be able to re-hydrate it and definitely will not be able to wear it.  Ideally, you want to catch your fascia before it becomes like a contact lens left out over night. Getting to your fascia soon enough to hydrate it properly can be related more to the action of putting water into a sponge. You want to add water to the sponge, then apply a force ( a squeeze) to extend the water through all parts of the sponge and allow excess to leave. Now you are ready to use the sponge most effectively. This is true of your fascia and how massage (manual manipulation) helps to hydrate your tissues. 

If we think of the sponge again, let's put that sponge in a bucket of water. Take it out but don't squeeze it and now try to use it. What happens, the sponge won't absorb more fluid and it is a dripping mess. This is another answer to why after drinking your 20 glasses of water you go to the bathroom every 5 minutes. The water is just accumulating in the spaces but isn't being taken into the fibroblast (there was no squeeze to take in it) to be utilized. We need a homeostasis between the water the fibroblast squeezes into the extracellular matrix as fluid and the water the fibroblast moves around as the gel like substance. The pressure between these two states is what keeps our joints cushioned and is our general means of stability. Therefore, when your massage therapist applies a gentle, slow and steady compression lasting for a short period of time, applies a short, slow stretch, or a gentle knead or twist to your tissue they are hydrating your fascia.

What can you do at home to complete the hydration process after you drink your water and lower the risk of the unfavorable signs and symptoms of dehydration? You can apply a pumping action to your arms and legs, you can do a gentle little twist to your tissues or you can learn to Melt. By doing these techniques and tips I provided above, you will truly be hydrating and improving your overall well-being.

For more information on how to begin to learn the Melt Method visit my website: www.colette.massagetherapy.com

If you have any question feel free to email me at: 2dolphincolette@comcast.net

A Peek Behind the Logo- The Lotus

Ever wonder about the meaning behind a business' logo?

I thought I would periodically tell you a little about the aspects of my logo.

My logo is about what I want to bring to the people I serve in massage. It is also about how I relate to the world at large. While also speaking to the ideals I hope to create for myself and my clients.

Let's start with the Purple Lotus.

From the start of my massage career my friends and clients have told me my massage is unlike most other massages they have received in the past. The purple lotus is unique in the flower world, and spoken of as unlike most other lotus flowers.

The human body is born in water and birthed from water going through an amazing journey to take it's first breath, so too does the purple lotus.

My most common saying is my massage space is where science embraces intuition. A pillar of my practice is my ability to work with the energy of the body. In doing this there is a spiritual connection involved in each technique at some level. The purple lotus has long been associated with the spiritual realms. It represents spiritual kindness.

A large part of my massage practice is helping people reconnect to the sacredness within them, the origin of the purple lotus provides an example of being able to overcome any obstacle in life. This lotus grows from the muddy muck at the bottom of the pond, yet it emerges regal and beautiful. From this it is held as a sacred flower in Buddhism and Hinduism. Each person who comes to my office comes with their own unique story and journey. Like the lotus each of my clients is a beautiful blossoming flower.

This flower can not be grown in just any environment, it needs special care and patience. As is true of caring for the grow of a person who is trying to over come pain, injury or just daily life stress.

Through the purple lotus I fill my space with gentleness, peace, kindness and the sacred aspects of nature. I hope after experiencing massage with me you too fill these aspects of the purple lotus.

Photo taken by me in Thailand