Ice Therapy - When and How to Use It
You just hurt your back (ankle, knee, shoulder or elbow, etc.) and are wondering what to use - heat or cold. The best rule of thumb for a recent injury, known as the acute stage of care, is to apply cold in the form of ice. In this phase, the injured area will likely feel warm, swollen, painful to contact or with movement, and has developed a localized muscle spasm. This initial phase will only last about 24 to 48 hours when ice therapy is immediately applied to reduce inflammation and allow healing to progress. For maximum benefit, ice needs to be applied at least five times over a 24-hour period, with at least one hour in between for circulation to return before starting the next ice treatment.
Sensations of Ice Therapy
If the area in question is allowed to become cold enough, you will feel a numbing or analgesic effect. This is the ultimate goal of ice therapy. The normal sequence of sensations with ice therapy are as follows: initially the ice will feel cold, then you'll feel burning (like the area is on fire), followed by aching (which lasts only about a minute) and finally numbness (where you can't feel the ice any more).
| Size of Body Area | Sample Area | Length of Ice Application in Minutes |
| Small | Hands, Feet, Elbow | 5 Minutes |
| Medium | Neck, Shoulder, Knee, Leg | 10 Minutes |
| Large | Low Back, Buttock | 15 to 20 Minutes |
Staying within these general time lines is a safe bet. The old saying, "a little is good, therefore a lot is better" does not apply here, If ice is left on too long, it will produce increased swelling and make the condition worse. After the acute phase has passed, the other phases of healing can proceed. Unfortunately, I have seen patients 12 months post-injury who still have swelling, heat and local muscle spasm because they forgot to apply ice and take the injury through the acute phase of care.
Guidelines to Exercise & Your Heart
Exercise can be divided into two types anaerobic and aerobic. Anaerobic exercise occurs when oxygen in the muscle is consumed but is NOT immediately replaced by the body during the workout. Examples of anaerobic exercises include sprinting, weight lifting, short runs up stairs, yoga, etc. Usually anaerobic exercises are of short time duration and do little to exercise the heart muscle. As a result, your exercises should include those of the aerobic type.
Aerobic exercise, on the other hand, occurs when oxygen in the muscle is replaced as quickly as it is consumed during activity and is the BEST form of exercise for the heart. Examples of aerobic exercises include walking, jogging, swimming, and bicycling.
The following guidelines are provided to assist you in getting the most out of an aerobic workout.
Length of time for the aerobic workout depends on your gender. Men need at least 30 minutes of aerobic exercise while women need a little more - about 45 minutes to receive maximum benefit. This is because men generally have a higher metabolic rate than women. Keep your heart rate in the TARGET HEART RATE RANGE for the exercise period, which is 70% to 85% of your heart maximum, which is determined by your age. For example, a 20 year old has a greater cardiac output than a 70 year old. The older we become, the lower our heart capacity.
Use the following formula to determine your TARGET HEART RATE RANGE:
Your Lower Range in Beat/Minute is 220 - (Your Age) x 70% = BPM
Your Upper Range in Beats/Minute is 220 - (Your Age) x 85% = BPM
For example, a 55 year old would be
220 - 55 x.70 = 115 BPM ----- Lower Range of 115 BPM
220 - 55 x.85 = 140 BPM ----- Upper Range of 140 BPM
Therefore, someone 55 years of age would want to keep their heart rate between 115 to 140
beats per minute for 30 minutes (for males) and 45 minutes (for females).
Your heart rate is easily assessed after two minutes of exercise; continue to exercise while taking your pulse by placing your index and middle finger very gently over the artery in the grove between your windpipe and neck muscle. This is the location of the carotid artery. Count the number of beats for a six-second interval, and then multiply by ten. This is only accurate if your heart rate is over 100 beats per minute.
For example, if you counted 15 beats in six seconds then your heart rate would be 150 beats per minute. If your heart rate is faster than it should be, slow your pace. Conversely, if your heart rate is slower than desired, gradually quicken the exercise activity within your comfort zone. Recheck every minute or two until you establish the desired pace.
Over a few months, you will find the need to quicken your pace as your heart and other muscles get into shape. This is the best way to exercise and also lose weight.
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Vitamin Update
Vitamin C and Vitamin E
A recent study demonstrated a synergistic or mutually beneficial effects when Vitamin C and Vitamin E were taken together daily, over a 12 month period, as compared to taking one or the other. Also, the heart muscle seems to benefit when Vitamin E intake is greater than 800 IU per day (anything less did not show cardiac benefits). Similarly, Vitamin C at 1,000 mg per day was shown to enhance both the heart muscle and the immune system.
Selenium and Cancer
Researchers conducted a wonderful study which assessed the benefits of selenium, frequently touted as a cancer preventative. One group of participants in the study was given selenium as part of their daily routine and the other group was given a placebo. Neither group knew whether or not they were taking the selenium. The study concluded that the group taking selenium had a reduced incidence of cancer. Of those individuals who developed the cancer and were taking the selenium seemed to have a better recovery rate.
In Pain? Your Serotonin Levels May be Too Low
For many years, tryptophan, a precursor for serotonin - a naturally occurring substance in the body which rises especially during sleep and allows us to reach a more restful state, was used to treat many conditions, including insomnia and depression, as well as withdrawal symptoms from smoking, alcohol, cocaine, etc. A recent study also demonstrated that patients with Fibromyalgia, have lower than normal levels of tryptophan in their blood.
Serotonin is a necessary element in our blood stream which allows for normal function. A few years ago, a tainted batch of tryptophan came into this country from Japan and was sold to the American population, which prompted shows like 60 Minutes and 20/20 to alert us to the problem. Rather than monitoring the quality of this beneficial supplement, the FDA overreacted by pulling all tryptophan from the shelves and has prevented further sale in the United States.
Fortunately there is still hope for those in need with a modified version of tryptophan called 5-HT Tryptophan. It is available in the health food stores and should be taken in the evening before bed because it causes one to become sleepy. It should also be taken in short trail periods of one to two months at a time then discontinued for a month or so or until the symptoms return.
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Therapeutic Touch Under Attack by the AMA
Therapeutic Touch is a treatment approach based on the principle that a trained practitioner, using his or her hands, is able to alter a patient's energy field to help restore wellness. The concept of energy fields is not new to us. In India, an ancient healing method known as Ayurvedic uses the term prana to describe the concept of life force. The Chinese use the term Qi (Chi) to describe energy movement in the body and apply the use of acupuncture, herbs, Qi Gong, etc. to influence these fields. In the United States, during the late 1800's, a similar technique was practiced known as Magnetic Healing where the practitioner placed their hands on or near a patient to influence healing properties. Many of the early chiropractors, including its founder D.D. Palmer, used energy field based healing on their patients.
Over the years, Therapeutic Touch has gained recognition in the United States health care system. It is used by at least 43,000 health care professionals, taught in more than 100 colleges and universities in 75 countries, and applied by nurses in over 80 hospitals in North America, often without the permission or knowledge of the attending physician.
Therapeutic Touch has been promoted by the Order of Nurses of Quebec, the National League for Nursing and through workshops held by the American Nurses' Association. Numerous studies have been conducted which demonstrate its benefit for a variety of conditions to include reducing burn victim recovery time and increasing lactation in breast-feeding mothers, among others.
The Journal of the American Medical Association (JAMA) published an article on April 1, 1998 by several authors to include Stephen Barrett, M.D., a self-proclaimed quack watcher. The paper, "A Close Look at Therapeutic Touch" examined the ability of a trained Therapeutic Touch practitioner to detect the presence of a human energy field. This was performed by placing a barrier between the practitioner and the investigator -- a 9 year old. The Therapeutic Touch practitioners were asked to identify which of their hands was closest to the investigator's hand. The study concluded that the 21 Therapeutic Touch practitioners were unable to detect the investigator's "energy field".
These results are not surprising given the flawed methodology. Do you ask a wine taster to detect a delicate bouquet by having another person drink it The JAMA study is reversed. The investigators should have been given a blindfold and then asked if they could detect any difference in sensation while being touched by a trained Therapeutic Touch practitioner versus a non-trained individual. This would be a more appropriate study.
The value and benefit of physical touch is as old as recorded history. There are not many living beings who have not felt comfort from the touch of a loved one, family member, friend, four-legged companion and yes, even a healer. Without touch, children have been shown to suffer physical and developmental consequences. Without touch, the human species would be hampered in its ability to communicate, love, show compassion, understanding, comfort and healing. It seems ironic that the AMA is publishing a Journal of "Alternative" Medicine when it has had a long history of trying to eliminate all non-M.D. health care professions. Is this journal a true science-based journal seeking truth or simply another way to influence JAMA readers with a prejudicial view and biased articles? As other forms of healing become part of the American consciousness, look for similar negating studies to come from the AMA. Recently, Vitamin C and its benefits have been questioned, will mom's chicken soup be next. Stay tuned.
Caution with New Medications
Many patients ask about the latest and greatest in new medications on the market. If it's not hair growth or weight loss, it's about increasing your energy or self-esteem. One rule of thumb on any new device or medication is to wait five years while the general American population uses the product. Too often problems or side effects become evident over time than were originally claimed. Do you remember a device used to crush kidney stones where the person was put into a tub of water and ultrasound waves were directed at the stone to crushed it? Later, this device was found to cause local tissue damage and reduce kidney function? Needless to say, it is hardly being used anymore. Or do you remember the aerosol can that put a mist into the air to imitate a room humidifier, but caused people to die; or that weight loss medication which caused heart valve damage? After a five year "trial period" on the general public, reassess your need for these new devices or medications. If they truly are good for you, they will still be on the market.
Two Easy Preventions to Reduce Injury in a Car Accident
A study of the body mechanics in an auto accident demonstrated two simple changes you can make to reduce injuries. First, raise the head restraint to the level of your ears or above, which will keep the head from snapping back upon impact. During in a rear-end collision, the body is forced backward against the seat and simultaneously goes up which is known as ramping. If the head restraint is set at neck level, the neck over-extends and increases the chance of injury.
Please note that most car seats are designed for a maximum body height of 5 feet 10 inches. So someone taller would be unable to raise the head restraint high enough. This is definitely a design flaw which needs to be addressed by the automakers. Unfortunately, adaptations to head restraint for individuals over 5 feet 10 inches are not yet available.
Secondly, the seat back should be upright enough to allow two inches between the head and the head restraint. Excessively reclined seat backs put a greater distance between your head and the seat, thus allowing for more ramping (moving back and up in the seat upon impact) to occur.