Rest, Recovery and Regeneration Part IV

Before I go any further with this series of posts, I want to take the time to post a link to another blog.
Patrick Ward is also an LMT and ran a series of similar, okay almost identical blog posts, back in 2010. Now our content is slightly different but our tittles are the same. I know there are many of us who discuss these topics, I just felt weird stumbling across one of his post the other day when I was preparing this one. I don’t want to be Rob…or Fab here…I bet most of my reader’s don’t even remember Mili Vanilli???
They were lip syncing long before Jessica Simpson or Beyonce were singing into their hair brushes.
Enough with the disclosure stuff!
We were talking about the three R’s, rest, recovery and regeneration. I stopped last time with the promise to cover contrast therapy next. Contrast therapy is another recovery tool used in rehabilitation, performance and wellness programs. 

“The Turks, Russians, Finns, Romans and Chinese have all used the idea of contrast therapy, transferring the body from very warm temperatures to very cold temperatures, as part of a regular health and wellness routine. The theory behind contrast therapy is simple—the heat from a hot sauna brings blood (and its nutrients) to the surface, which can soothe pain and ease sore muscles, then shocking the body in a cold plunge, which in most modern bathhouses remains at about 50 degrees Fahrenheit, increases circulation and pushes that nutrient-rich blood back into the body’s core.”-Erika Allen.

Contrast therapy works off of the principle of convection, the transfer of heat from one place to another via the movement of fluids. 

There is literature available on this subject due to it’s inclusion in physical therapy and athletic training protocols. Here are links to a few abstracts: It may not impact deep muscle temperature as much as we thought. Following an ankle sprain, ice reduces swelling better than heat and contrast therapy. Decreases blood lactate level and heart rate after sprinting better than active recovery.
The best time to apply contrast therapy may be within 20-30 minutes of a workout to maximize recovery even though it can be used on off days as part of a regeneration or injury rehabilitation program. There are many approaches to applying these treatments. 

Dr. Wnornowski suggests applying hydrotherapy as the use of a hot tub or whirlpool which ideally includes turbulent flow with water at 38-45 degrees C for 20-30 minutes. Whole body immersion should be avoided at temperatures greater than 40 C (normal body temperature being <38 C), due to the potential for hypotension. This can lead to light “headedness” pretty quickly. Contrast baths induce alternating periods of vasoconstriction and vasodilation and are useful for relatively subacute afflictions of joints and extremities, e.g.- ankle sprains. The affected body part is alternated between hot (38-45 C) and cold (10-18 C) baths, usually spending about 10 minutes in hot water, and then 1 minute in cold water then progressing to a cycle of 4 minutes hot, and 1 minute cold. This can be continued for up to 30 minutes total.

Don’t have a $1500 a year membership to a swanky health club? There are other ways to experiment with this type of therapy. A hot pack, hydrocollator pack, hot shower or hot water bottle can be substituted for a hot tub and ice cups, cold shower, frozen vegetables and cold packs can be substituted for a cold bath or cold plunge in a pinch.

Ice alone can be used after a pulled muscle, joint sprain, or traumatic tendonitis. When swelling is noted, a good rule of thumb is to use cold therapy for the first 48-72 hours (acute period), or until after swelling and pain have peaked. Thereafter, heat or contrast therapy may be more advisable, as one enters the subacute phase (3-7 days), or for prolonged symptoms lasting beyond a week.

Cryotherapy (ice therapy) dates back to Hippocrates and the ancient Greeks but it took until the 1940’s for cold/ice therapy to be used extensively for the treatment of acute and subacute injuries, and rehabilitation. It works off of constriction. Temperatures of 10-25 degrees Celsius  are common when applying ice packs or submerging tissues in water. 
Using ice alone has advantages, especially immediately following an injury. Tissue damage sustained during an injury can cause uncontrolled swelling. This swelling can increase the damage of the initial injury and slow the healing process. Applying ice immediately following a musculoskeletal injury will reduce the amount of swelling. Ice decreases: swelling, tissue damage, blood clot formation, inflammation, muscle spasms, and pain. At the same time, the ice enhances the flow of nutrients into the area, aids in the removal of metabolites (waste products), increases strength, and promotes healing.
According to Laurel Freeman ice initially constricts local blood vessels and decreases tissue temperature. This constriction decreases blood flow and cell metabolism, which can limit hemorrhage and cell death in an acute traumatic injury. After approximately 20 minutes of ice, blood vessels in the injured area then dilate (open) slowly, increasing the tissue temperature, an effect which is termed “reactive vasodilation.” A study reported in the Journal of Orthopedic Sports Physical Therapy in 1994, found that, despite the reactive vasodilation, there was a significant sustained reduction in local blood volume after ice was applied. On the other hand, some people may argue that this can slow the healing process…more on that debate another day.
Submersing a body part, or entire body, during hydrotherapy may increase the effectiveness of the treatment. Areas with large blood vessels, particularly around the head, neck, chest and groin, are more susceptible to heat loss because those blood vessels don’t constrict as effectively as the smaller ones near the skin. Reaching these areas with ice or heat packs may take longer to achieve the desired effect. I would avoid submersing the head in hot or cold water however, for obvious reasons. 
Yes the ice can hurt, but hey if this guy will give you a shoulder rub while you sit in a trash barrel full of ice and cold water, what the heck?
Using heat first then ice second is thought to enhance the flushing effect, shuttling metabolites and toxins out of an area and fresh blood and nutrients back into an area with even greater speed. The thought process is to end with the ice to minimize inflammation.  You may find the traditional approach of heat pre-workout and ice post workout to prove effective. I know for a fact that heat helps me get ready for a workout and a study has indicated that ice prior to exercise may decrease a joint’s proprioceptors ability to work optimally, I stay clear of ice before unless I am in significant pain or I am utilizing contrast therapy.
No time for the ratings I alluded to in my last post, guess I’ll get to that next post!
Thanks for reading!
Eric Beard
Corrective Exercise Specialist
Integrated Manual Therapist
Have you seen my SMR DVD? Click below for a short excerpt.
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