“Any sort of injury is just you being mentally weak. That includes getting shot.”
A friend who works in a higher tier special operations unit recently said the above quote to me. It was in reference to my recent hamstring injury, but there’s more weight in these words.
Injuries can be great or small, yet it’s up to the person to decide how they’ll let their injuries affect them. There will be injuries that prevent specific activities — doing an exercise or a type of job — but the rehabilitation rate is relative to perception.
Consider two dichotomous mindsets. Two people have muscle strains that require massage to break up the scar tissue. The area is tender and painful. When the massage begins for the first person, whether administered by a friend or self, they tense up and contort their face in pain. The second person welcomes the pain calmly, knows they will endure it, but does so stoically. Their massage, rehab, and recovery will be more efficient not only because of their acceptance, but their bold mindset going into it. They don’t cringe at discomfort; they let it wash over passively.
Pain is a part of life, and mindset determines perception. The mentally weak fear pain because, well, it hurts. It’s discomforting and upsetting. The mentally strong expect pain and are ready for it. They are willing to endure and ignore it. It takes a tough sonofabitch to look at their injury and say, “Let’s roll.” Whether it’s a girl powerlifting with one leg, a girl (who I know from high school) who has lost her limbs from a flesh-eating disease, or a soldier who returns to combat after losing a leg, it takes guts.
Aimee Copeland does push-ups after losing limbs to a flesh eating disease
Pain and discomfort are relative to our situation, and we all aren’t faced with severed limbs or getting shot. But modifying our idea of pain can change our training, rehab, and life.
Again, consider two mindsets. The first approaches a difficult set of squats (e.g. 3RM, 5RM, 10RM, or 20RM) with dread and fear. They go through the motions of the set with failure as an option or possibility. The second approaches that same squat set aggressively, wanting to attack it. They are rabid; a caged, frothing animal ready to unleash hell on the bar. Which mindset do you think will be more successful?
Mental toughness in training will affect tenacity, bar speed, and completion of lifts. This doesn’t mean you should make stupid decisions on the account of “being tough”. Don’t make reckless decision, but use reckless intensity.
Mindset in rehab will be the difference between properly working structures and lack of progress. This is why Kelly Starrett tells you not to contort your face and go “into the pain cave” — it tenses your structures up and doesn’t work them properly.
Whether it’s training or rehab, embrace your pain. There is, of course, a difference between discomforting pain and injury pain. Each is a tool; the former is one that you will ignore while the latter informs you that your body is failing, even if your mind is not. People who are truly successful understand and use these pains every day. The next time you feel sorry for yourself, wincing in pain, just know that there’s a guy out there with a bullet hole in his body calmly rehabbing with reckless intensity.
Most trainees will benefit from some type of conditioning in their program once or twice a week. It’ll prevent them from becoming too unadapted to things they might need or want to do. That could include playing rec sports, chasing a dog, going on a hike, or running away from zombies and/or nuclear fallout.
Some trainees forgo conditioning because they hate it, are bulking, or are doing a linear progression. Then they’ll jump back into conditioning as if the layoff never occurred. This can easily result in irritated joints, strains, or muscle pulls, especially in “older” trainees. One common irritation is the shin splint.
Generic sources say that shin splints are caused by doing too much and give equally generic rehab advice. This post will teach you what mechanical issues lead to shin splints, how to avoid them, and how to treat them.
Causes of Shin Splints
“Doing too much” is a gross over generalization. Yes, subjecting your structures to stresses that they aren’t adapted to will have negative repercussions. In all of my books I’ve pointed out how new activities, especially conditioning stuff, needs to be easily progressed. If you haven’t been running, don’t sprint. If you haven’t been walking, don’t run. It’s pretty simple, but the “Tommy Tough Guy” mentality is prevalent. It’s better to ease into activity than inhibit training because of a stupid strain.
The same goes for “easing into more volume or intensity in a program”, especially with movements that you aren’t adapted to. I pointed this out in the “Transitioning to Olympic Weightlifting” post, yet I still know a lot of people who ignored the advice, had a high frequency of doing the Olympic lifts, and had elbow or shoulder irritations as a result. For example, don’t jump into a lot of running mileage to prepare for your PT test; ramp it up over several weeks.
Mechanics
Shin splints specifically arise from having poor mechanics, and this inefficiency is only exacerbated by ‘doing too much too soon’. To understand poor mechanics, you must understand foot anatomy. In Anatomy Without A Scalpel, Dr. Kilgore points out how Isaac Newton said, “The human foot is a masterpiece of engineering and a work of art.” It’s perfectly constructed — through natural selective evolution — to carry out it’s function of bipedal ambulation (i.e. two legged walking).
In the “Foot Awareness” post, I talk about how “navicular drop” (AKA flat feet that are probably habitually rotated out) has an effect on squatting, yet it also creates an inefficient loading on the foot and lower leg during movement. Running and hiking/rucking are activities where trainees usually see problems. Navicular drop is typically called “pronation of the ankle”. By looking at the picture (right), you can see that having a severe angle between the foot and shin would be problematic to efficient force distribution.
Even if the ankle is a healthy “neutral”, there still can be some mechanical issues. Dorsiflexion is when the toes are pulled up towards the knee. Plantarflexion is when the toes are pointed away, as if you are pushing down a gas pedal (see these and more in this beardless “Anatomy Motion Explained” video).
When running (with poor technique) or rucking, heel striking occurs with the ankle in dorsiflexion and the foot out in front of the center of mass. When the body shifts forward to be over the foot, the ankle plantarflexes, yet the dorsiflexion muscles on the front of the shin resist the motion (if they didn’t resist, then your foot would just flop to the ground uncontrollably). Said another way, the dorsiflexion muscles are eccentrically acting — the fibers are being elongated under a load. Eccentric muscle action is the most stressful, damaging kind and makes the muscle very sore.
Imagine doing several thousands of repetitions of a movement that eccentrically acts on the front of the shin. Now imagine that there is a significant additional force. Running slow applies three to four times the force of body weight (the fore foot phase can be between four and seven times body weight) whereas rucking is going to apply a force that is a multiple of the sum of body weight and the weight being carried. Now imagine being unadapted to this type of force in one instance of exposure. Now imagine being exposed to this several times a day, every day, until there’s a problem. It’s easy to see how people will develop shin problems, huh? I know a fella who was medically dropped from phase one of BUD/S (Navy SEALs’ selection and training) because he had severe shin splints…twice. They run six miles a every day just to go to the chow hall (one mile to and from), then whatever else they do that day. Yikes.
Ignore the “tibialis posterior” — that’s on the back of the leg and not labeled well. This ankle is pronated pretty bad.
Let’s specifically look at the musculoskeletal anatomy involved. The muscles that dorsiflex are the tibialis anterior and the muscles that extend (or pull “up”) all five of the toes (note that the big toe, the hallucis, has it’s own muscle that is separate from the other digits). This collection of muscles originate along the tibia (the bigger shin bone on the medial side), the fibula (the smaller shin bone on the lateral side), and the interosseus membrane (a fibrous tissue that fills the space between the tibia and fibula). The tibialis anterior is easy to see and palpate; simply dorsiflex your ankle and look at the muscle that bulges up a few inches below your knee.
Imagine those muscles attaching along the shin bones and the fibrous tissue in between them. The “heel strike followed by resisting the toes to the ground” eccentric movement is repeatedly yanking on those origin attachments. If you repeatedly yanked on a rope tied to a wall, eventually something is going to give, whether it’s the wall or the rope. The same thing happens with the muscles, except with repetitive stress the attachment sites are what get irritated. In this case, the interosseous membrane and the tendon/bone sites are stressed repeatedly and continued exposure prevents them from repairing the damage. Compounding harmful stress without recovery results in achy pain, and can continue to be extremely painful when more significant structural damage occurs. Without time to recover, the yanking tension will actually create little fractures on the shin called “stress fractures”. Worst case scenario it can get more damaged, reduce circulation, and cause anterior compartment syndrome where tissues die. And that, my friends, is the pain you call “shin splints”.
Note that this area can get sore from a single exposure, especially when the trainee isn’t adapted to it. Merely one exposure won’t be enough to cause long-term problems, but it can interfere with training if it’s really sore. Overt pain can alter mechanics since the body instinctually tries to avoid pain (e.g. limping is something that pulls weight off a sore joint). Also, sore and damaged muscles won’t be able to exert force as well as fresh, healthy muscles.
The above explanation focusing on dorsiflexion is the simple version, because when you add in the likelihood of the ankle being pronated, the arch being collapsed, and the toes pointed out, it will only make all of this worse. Especially with heel striking. Heel striking shoots the force right through the structures, and when the structures are out of alignment because of poor foot mechanics, it isn’t distributed up the leg and dispersed through the thighs and hips; it’s sent right into the foot and shin. Cleaning up foot and ankle mechanics can reduce the chance of injury.
Treatment
The best way to treat shin splints is to prevent them to begin with. Work to correct foot mechanics (“Foot Awareness“) and use exercises to help re-develop the arch and lower leg muscles (“Foot Drills“). Progress into new activity that would put a lot of pounding on the lower legs. If you know that stressful activity is imminent ahead of time, start a train-up program to prepare yourself (i.e. pepper your angus).
As for treating shin splints, you’ll have two likely scenarios: a) you did something stupid once and are sore or b) repetitive stress was applied. With the former, you should cease or reduce the activity that caused it, massage the area (including trigger point work), and ice. If you’re already sore, then the window for effective icing might be past, but it’s not really going to be harmful. If this is a “repetitive stress” issue, then also cease or reduce the activity significantly, and massage the hell out of the area. Focus on the muscle bellies all the way up and down the shin and dig into them with at least ten purposeful strokes with a hard object. Follow it up with the foot drills (links above) and ice after. This process could occur several times a day, every day. Feel free to use any ankle rehab exercises, especially ones that work dorsiflexion. Do ankle circles as much as you can, especially before activity.
Shin splints are usually an indication that you were unprepared. Now that you know how they are caused, prepare thyself. If you want or need to do a lot of running, learn the POSE/Chi/forefoot running technique (progress that slowly, too). If you want or need to do a lot of hiking/rucking, then introduce it several months before you hit the longer or heavier stuff. You can mitigate the problems from shin splints by strengthening your feet and lower leg muscles with the above drills. If you’re in a situation where you cannot help the activity, (BUD/S, Ranger School, multi-day backpacking, etc.), then massage the muscles whenever you’re off your feet and do your best. Remember: the best treatment is prevention.
Kelly Starrett’s MobilityWOD put out the message that icing is no longer recommended. After a lot of discussion and digestion, I posted a response about whether or not we should still ice. It looked at several issues from the MWOD post, including the cited research. The conclusion was that the research and practice were conflicting, and therefore it’s too inconclusive to definitively throw icing out the window. Furthermore, there were just too many unanswered questions about the effect of ice on things like lymphatics permeability and prostaglandins. The MWOD post also didn’t distinguish between different types of injuries, which is incredibly important.
To clarify, none of this is an attack on Kelly himself. Remember that he’s arguably done more for prehab and rehab in the last few years than anyone else. The fact that he’s so well respected is why I’m researching and discussing the “do not ice” claim in depth. It’s okay to disagree with someone; at the same time it’s still possible to learn from them, support them, or respect them.
Ultimately, the issue of icing comes down to the differentiation between injury types. For a brief literature review, look at yesterday’s post. We’ll try to generally talk about some injury types today and basic approaches to rehabbing them on your own at home. Take note that injuries are individualistic; each one is specific to a specific individual. Good PTs will have a specific protocol made for your specific injury, circumstances, and activity or performance goals. When in doubt, go to a PT. If you can’t, then always always always do the least invasive rehab and then wait until the next day to see if it’s the same, worse, or better. You’re doing all of this at your own risk.
Contrast Baths vs Acute Icing
First we need to clarify between two different types of icing. “Contrast work”, which can include ice baths, is not the same as icing a specific spot on your body. Trainees anecdotally report positive results with contrast baths or showers to improve general or systemic recovery. However, they are used by some PTs to treat acute soft tissue injuries or general inflammation in a body part. “Soft tissue” would include muscle, tendon, or ligament issues — usually in terms of sprains, pulls, or partial tears (the most common associated with training). “General inflammation” isn’t referring to total body systemic inflammation, but instead refers to something like soreness in the traps and shoulders or forearms from a lot of volume (e.g. lots of overhead work or farmer’s walks respectively).
One of my PT friends has found that ten minutes of cold immersion alternated with a heating pad works best. He uses five cycles of starting and stopping with ice. He found that by ending with heat left the lymphatic channels open and encouraged swelling, but he admits this may be contradictory to what we are learning now (referencing yesterday’s post and how ice seems to increase the permeability of the lymphatics). Remember that this is used for a specific acute injury or a specific body part.
This particular PT has had clinical and personal anecdotal evidence of this protocol working with acute soft tissue injuries. It has helped with lingering injuries that have lasted up to two months and removed the pain after one week of daily treatment. Interesting to say the least.
I think that this approach could be generally applied for systemic recovery, which can also be caused by high volume, frequency, and/or intensity training. In this method, the heat would be applied to the entire body as opposed to just an afflicted area. Think in terms of hot and cold showers, ice baths and hot tubs with spa covers, or ice baths and hot showers. Use caution when dealing with extremes in temperatures and I suggest you ask a PT or doctor before trying it.
The (admittedly) conventional wisdom behind why contrast stuff can work is that the alternating temperatures contract and relax the body and lymphatic channels, which helps push the waste up through the lymphatics. Take note that this also occurs in movement — we’ll talk about it regarding active recovery below. The contracting/releasing of the lymphatics idea is one line of reasoning as to why this helps both general systemic inflammation and acute soft tissue injuries.
Acute, Single Location Icing
Contrast work requires some preparation and a lot of time. For a non-professional athlete who has other responsibilities in life, they’ll need to get the most benefit with techniques that most efficiently use their time. Icing a specific spot will be a little easier, albeit potentially not as effective as what is written above.
Immersion is always better than a bag of ice, and a bag of ice is always better than a commercial ice pack.
Immersion can include a bucket of ice water for ankles or wrists, but it gets a little tricky for elbows, knees, shoulders, or the back. I suggest a standard blue ice bag that you can get at any pharmacy or grocery store. Source pharmaceutical items at https://rxoneshop.com/pharmacy-distributor. I like these because they don’t produce condensation and therefore don’t drip down your body or clothing. I suggest also getting some heavy ace bandage wraps — they can hold the ice on the awkward spots and they can be used for compression rehab.
The research showed that some superficial tissue damage can occur with prolonged icing as well as the potential “increase of edema” issue. Therefore, the recommendation said not to exceed 30 minutes and probably not 20. We’ll just use 15. Apply the ice on an area that encompasses the painful area and wrap it to ensure solid contact. Set a timer for 15 minutes. The heavy ace bandages can be useful for busy people since they can go about their business despite icing their knee.
Under What Circumstances Should You Ice
One supportive argument for icing is that when it’s applied soon after the onset of injury that it helps prevent secondary hypoxic cell damage. Edema is a result of more blood flow to the area along with the waste products. Specifically an “increase in the permeability of the vessel wall (with a) subsequent increase of the extracellular protein concentration” (Meeusen, 1986 — the article from yesterday). There are varying levels of capillary permeability and cellular response, and it’s dependent on the injury. Icing decreases the temperature of the tissues and reduces blood flow in the area. If icing occurs soon after the onset of injury, then it can help slow the blood flow to an area that is in the process of “increasing the permeability of the vessel wall” and dumping extracellular proteins — the thing that causes edema. This is how icing can prevent secondary hypoxic cell damage.
Of course, that edema is the body’s response to the injury. So we should let it be, right? If the goal is to expedite healing, then no. Look at the “Ancestral Argument” section from yesterday. If we wanted the inflammation process to occur unheeded, then we wouldn’t conduct massage, compression, elevation, or e-stim to the area either. These rehab protocols, combined with icing, return athletes to activity faster, and that’s shown in clinical research (and we’ve probably all seen it in anecdotal situations too).
Take very careful note that the situation I’m talking about here is an acute injury, specifically an acute soft tissue injury. This includes muscles, tendons (attaching muscles to bones), and ligaments (attaching bones to bones). This does not include broken bones, joint dislocations, bursa issues, etc. Your n=1 experience of your orthopedic doctor telling you to only move, compress, and elevate your dislocated finger is not proof that icing is useless.
Aim to get ice on the injury as soon as possible and continue icing on and off for the first 24 hours, but no more than 48 hours. The more severe the injury, the closer to 48 hours you could ice. After this deadline, rely on other rehab protocols to heal and alleviate the injury. They will be discussed below.
Lastly, I want to point out that if you notice a significant increase in swelling and you deem it to result from ice exposure, then stop doing it. I have a friend who does a lot of ballistic lifting, smokes regularly, and takes a lot of NSAIDs. Icing ends up making his situation worse, but he is not a relevant piece of data due to his smoking and NSAID use.
A Note On NSAIDs
A major injury will necessitate some NSAIDs. Or deca.
My general philosophy for minor soft tissue injuries is to not use NSAIDs. Quality nutrition (paleo) with appropriate protein and smart supplementation (fish oil, vitamin D, ZMA, and magnesium to start — post on this soon) will help keep non-training systemic inflammation low and facilitate healing these minor issues. Stuff like ibuprofen can be problematic for the gut, yes, so let’s avoid them…unless there’s a more serious injury. In such a case, you’ll probably be prescribed something. To be perfectly clear: I’m not anti-NSAIDs, but save them for the major stuff and let your efficient body and rehab protocols deal with the minor stuff.
Chronic Soft Tissue Injuries
As a general rule, you will not ice chronic soft tissue injuries. As I’ve said a hundred times before, chronic soft tissue injuries are usually due to improper mechanics or conducting mechanics with improper mobility. Barring a past acute injury, there’s an underlying cause as to why this chronic issue exists. Identify and diagnose what that is and fix it — if you don’t then the issue won’t go away no matter what treatment you apply.
Icingcan help chronic issues, but only when it is applied after aggressive rehabilitation. If you are self-massaging a tendon to break up scar tissue, you should follow up with movement to get blood flow, lactic acid, and proper structural stress to the tendon. After the movement-based rehab — which is absolutely necessary for recovery — you can ice. This helps people from an anedcotal perspective all of the time. The icing is okay and helpful because you’re essentially re-injuring the area via the “scar tissue breaking massage”. You created an injury, and the motto is that “icing helps acute soft tissue injuries”. That’s why it’s okay.
A specific example is what I did with Brent a few years ago. He primarily did the Olympic lifts, but expressed a mild desire to bench again so that high school football players wouldn’t embarrass him and make him look like a shit head. However, the bench ROM was incredibly painful on the anterior portion of his shoulders, specifically the proximal biceps tendon. When I palpated them, they were significantly raised and inflamed with built up scar tissue. I worked on them with my thumbs, and he squealed like in this video, and then I had him press and bench the bar for some high reps followed by icing. We did this protocol several times (separated by at least a day or two), and in a week or so he was able to bench pain free.
If aggressive massage and movement are not applied to a chronic issue, then I would not recommend ice unless the person wants to use it as an analgesic. Ice relieves pain because it “numbs” the area. In the Reinl video, they claimed that it severed the “muscle and nerve connection”, yet this would take significant cold exposure to do. It does decrease the temperature, but if done within the parameters of our “15 minutes rule”, it’s not an issue. Whether or not icing a chronic issue such as this is detrimental to the recovery process is not known, but, again, the person can ice if they want to relieve pain. My opinion, which is not based on anything in the research, is that icing for 15 minutes will not be detrimental to the recovery process, yet it’s not going to accomplish anything other than analgesia.
Remember that I said that most chronic soft tissue injuries are due to bad mechanics or faulty mobility, but they can be from simply doing too much without enough recovery:
However, the degradation of collagen is also increased after exercise, likely at a greater level than the increase in synthesis. Consequently, for the first 36 h after exercise, the collagen metabolic system is in a negative balance with degradation greater than synthesis (Fig. 1). This may explain that repeated exercise without sufficient rest can leave an athlete in a state of repeated collagen breakdown, and the development of overuse injury (Magnusson et al., 2010).
— “Tendinopathy in Athletes.” Physical Therapy In Sport, 13, 2012: 3-10.
Hmm, too much volume and frequency with no rest. Sound familiar? This is almost every CrossFit injury ever. It’s also related to the actual acute injuries that occur from not having recovered structures. I wrote about this a long time ago, but hopefully people are starting to pay attention to the prevention and treatment of these things. The prevention is proper programming. The treatment consists of comprehensive recovery methods.
Rehabilitation Modalities for Acute Injuries
If you read yesterday’s post, then you know that the benefit of icing was always linked with at least one other method of rehab. At the very least, the raising of this “to ice, or not to ice” issue should teach or remind you that rehab must be multi-faceted to be efficient. We have addressed icing above, so let’s touch on the others.
Here’s a good spot for a random pic
Elevation
This is useful because it helps the lymphatics clear waste. The lymph system is similar to veins in that they have a one-way track to the center of the body. There are valves that prevent backward movement, and muscular contraction helps pump and pulsate contents through each type of vessel back to the trunk. Elevating a limb will a) help prevent blood or lymphatic waste pooling (which would increase edema) and b) allow gravity to assist the lymph system in pulling out the waste (in the same way that it helps drain the blood flow from the area).
Compression
It’s known that massage helps clear extracellular waste — the stuff of edema (it is known). Compression sort of does the same thing by preventing the increase of swelling and perhaps even helping to squeeze the bad fluid out. It facilitates the clearing of blood and waste from the area, especially when compounded with elevation. We’ll also see that compression with movement is very useful too.
Rest
In the Reinl/Kelly video, they poopooed rest because movement is necessary to recovery. And it is, but an initial period of rest is probably necessary. Let’s use the same “icing timeline” and say rest for 24 to 48 hours; the more severe the injury, the longer the rest. For example, you wouldn’t want to start moving a severely sprained ankle around a couple hours after the injury. Usually you’ll only rest for 24 hours.
Movement
This is the single most important thing for rehabilitation. Ever. I’ve written about this hundreds of times — soft tissue injuries need to heal by receiving stress through a full range of motion. If they heal or scar with no motion, then any new motion will irritate or re-injure the area. And obviously healing with a partial range of motion isn’t helpful for when you eventually hit that end ROM that it isn’t prepared for. I’ve successfully rehabbed hundreds and hundreds of people, and movement is always the reason.
Keep in mind that the movements need to be progressed. I’ll repeat one of my rehab rules:
When rehabbing, try the least invasive movement and then wait until the next day to see if it’s the same, worse, or better.
The key is the “least invasive movement”. If you can’t put weight on your sprained ankle, then just move it through a range of motion. If you’ve already moved it through a full ROM, then add light resistance. If the light resistance doesn’t make it worse, than slightly increase the resistance or number of reps. In this Q&A post I give an example of an ankle rehab protocol. Is it comprehensive? Perfect? Perhaps not, but it’s a progressive plan. I might tweak those icing recommendations a little, but the basic tenets are there: ice initially, then progressively load it. I’d add compression and elevation to the protocol — these should be done as much as possible when not icing or moving the afflicted area.
The concept revolves around a progression. I get creative with how I’m going to work a structure. At first, it might need to be in isolation, but the structure is always integrated back to compound movements. And it’s steadily, but consistently progressed. This is so important because you guys are so friggin’ impatient with your progress or don’t attempt to make any at all. I’ve talked to so many people who have an injury and they decide not to squat for three months. I’m not suggesting you squat with weight, but a body weight squat is a starting point. If that’s too much, then figure out a way to put work on the area. It’s your hip flexor? Then lift your thigh up. Groin? Move your thigh in and out, get on the yes/no machines (adduction/abduction) — just do SOMETHING.
It’s impossible to be comprehensive because there are so many different types of soft tissue injuries. Just know that you can ice initially, but then you need to perform movement that applies an adaptive stress to the injured structure. The structure has been reduced in its ability, so you have to progress it back to its uninjured state. This is the same exact concept of making a muscle strong, but now you must limit the stress to what that particular structure can handle.
Throughout the rehab process, I deem it acceptable to ice after the movement rehab, and especially if it’s still tender during rehab. Movement or massage may sort of “re-injure” the area by applying a stress that it isn’t adapted to. After recovering, it should be able to handle that same stress again easier, and that’s why you will progress to doing more in the next rehab session. Nevertheless, if the rehab resembles a re-injury (determined case-by-case), then icing after the movement rehab is probably not going to be detrimental. If edema occurs as a result of icing, then don’t do it anymore; it usually won’t swell with minor soft tissue stuff.
Whether or not you need to ice, compression and elevation will help. But, to hammer this point home, consistently moving the injury and progressing the adaptive stress over time is necessary to returning to normal function.
Movement With Compression
Wrapping your segments or joints with heavy ace bandages and then performing rehab movements will help them recover. The first reason is because it helps clear the cellular waste through the lymphatics through the effective methods of compression and muscular contraction. But the compression also applies a bit of tack and stretch to the muscles, which is similar to ART treatment where pressure is put on a tendon or muscle belly while the muscle lengthens and shortens through a full ROM. If you have used the “voodoo bands” — a term I absolutely hate — then you’ve experienced this before. I’ll be doing a post on this topic soon, but just note that light to medium wrapped segments or joints with rehab movement will add a bit of resistance compared to simply doing the movement without the compression. I’ve successfully used this on ankles, wrists, knees, and elbows.
Cryokinetics
This is the concept of icing to reduce pain, and then taking joints through a full range of motion actively or passively. I do not suggest any of you try this without the aid of a PT, because your Tommy Tough Guy attitude will probably just lead to you making your injury worse. However, if you’re going to be a Reasonable Rick, then you could do something like this: ice the knee, then passively take the knee through a full ROM. Just remember that since the ice is an analgesic, it’s going to block any pain you would normally experience. That pain is your body’s signal of saying, “Hey, don’t do this because it could or is causing injury.” We often push beyond this in our standard “movement based rehab”, but not receiving this message of pain could mean you do too much. The most stressful thing I would have you do after icing is a body weight squat in your living room.
Sequence of Events
Injury occurs. Ice it. Compress it. Elevate it. After day one, start figuring out how you can apply progressive stress via movement. After rehab, it is okay to ice. Otherwise, try to compress and elevate the injury as much as possible. Rinse and repeat, but ween off of the icing (since it will eventually not do much other than numb the pain after the early stages). For chronic issues, review the earlier sections of this post.
Conclusion
This all started with a conventional wisdom-breaking statement that said, “Do not ice.” After reading, discussing, and digesting all of the information, yesterday we concluded that the “do not ice” statement is premature and unspecific. It will depend on the type of injury and how icing is employed. This post looks at the benefit of icing and how to place it in a proper rehabilitation program. Whether or not you decide to ice is ultimately up to you. It can be helpful in some cases, irrelevant in others, and in a few cases (mostly within the context of non-injury pathology) it can be harmful. Most of all, I hope that this brings an awareness of comprehensive rehab. Kelly argues that a person should know how to work on your body and I agree. Icing is an effective rehab tool if you use it properly. It’s a tool that trainees, lifters, and athletes have access to even if we can’t get to a PT, yet it’s just one piece of rehab. Knowing how important compression, elevation, and — most of all — progressive and consistent movement are in treating an injury will make you a more knowledgeable trainee and help you perform better.
