Monday, November 12, 2012

The Case Against Ice-Why Inflammation Can Be Good

Let me begin by stating the fact that I am not a physician or have any sort of medical training whatsoever.  This post is purely my opinion based on careful thought and observation.  

Now that we have that disclaimer out of the way we can get down to my latest crazy talk.  I'm sure this won't surprise anyone who knows me.  I ran barefoot to relearn how to run naturally.  I don't believe in arch supports or cushioning to the chagrin of my multiple doctors.  I quit using anti-inflammitories last year for my arthritis because of this article.  I have chickens roaming my backyard.  Half of my backyard is a vegetable garden.  I have 2 beehives.  I had a Ron Paul sign in my front yard for most of the year.  So I'm not exactly what you would call normal.  But I don't think I'm really crazy either.  Maybe I just think about things too much.  

Shortly after I rolled my ankle and the swelling was spreading from the outside of my ankle to the inside of my ankle and the top of my foot, I was sitting on the couch with an ice pack.  And I got to thinking.  Why does the body inflame the part that's been injured?  I knew it had something to do with increased blood flow and fluid, but why exactly does it do that?  And more importantly, why do we try to stop it?  We are repeated told to RICE (rest, ice, compress, and elevate) and to take copious amounts of vitamin I (ibuprofen).What are we trying to fight here?  So I did what any person would do and googled it.  (Dr. Google and I are pretty tight.)  I found pretty much the same answer every place I looked.  Here's an example:

A localized protective response elicited by injury or destruction of tissues, which serves to destroy, dilute, or wall off both the injurious agent and the injured tissue. adj., adj inflam´matory.  

The classic signs of inflammation are heat, redness, swelling, pain, and loss of function. These are manifestations of the physiologic changes that occur during the inflammatory process. The three major components of this process are (1) changes in the caliber of blood vessels and the rate of blood flow through them (hemodynamic changes); (2) increased capillary permeability; and (3) leukocytic exudation.

Hemodynamic changes begin soon after injury and progress at varying rates, according to the extent of injury. They start with dilation of the arterioles and the opening of new capillaries and venular beds in the area. This causes an accelerated flow of blood, accounting for the signs of heat and redness. Next follows increased permeability of the microcirculation, which permits leakage of protein-rich fluid out of small blood vessels and into the extravascular fluid compartment, accounting for the inflammatory edema.

Leukocytic exudation occurs in the following sequence. First, the leukocytes move to the endothelial lining of the small blood vessels (margination) and line the endothelium in a tightly packed formation (pavementing). Eventually, these leukocytes move through the endothelial spaces and escape into the extravascular space (emigration). Once they are outside the blood vessels they are free to move and, by chemotaxis, are drawn to the site of injury. Accumulations ofneutrophils and macrophages at the area of inflammation act to neutralize foreign particles by phagocytosis.

A less complicated explanation is this:

Inflammation is the body's attempt at self-protection; the aim being to remove harmful stimuli, including damaged cells, irritants, or pathogens - and begin the healing process. When something harmful or irritating affects a part of our body, there is a biological response to try to remove it, the signs and symptoms of inflammation, specifically acute inflammation, show that the body is trying to heal itself. 

So after reading those explanations of inflammation, I wondered why we try so hard to fight this response from our bodies to try and heal itself.  Maybe inflammation is good.  Yes, it causes pain and we don't like pain.  But what if pain is good?  Like the kind of pain that protects you from injuring it further, from overextending it.  We try to fight pain, but maybe we shouldn't as much.  

After the explanations was this list of treatments:
  • Ice is the best treatment.

    • Applying ice to the injury will help decrease pain.

    • Ice counteracts the increased blood flow to the injured area.

    • It reduces swelling, redness, and warmth.

    • Applied soon after the injury, ice prevents much of the inflammation from developing.

I don't want to confuse acute inflammation with chronic inflammation that destroys healthy cells such as in Crohn's disease, asthma, rheumatoid arthritis, or ulcers.  I understand that kind of inflammation is not good.  But after an injury or any kind of trauma to the body, it seems that inflammation is just trying to help our bodies recover faster.  Why are we trying to fight the bodies response to bring blood in, and take the bad stuff out?  Is the main reason to fight pain?

Check out this study by neuroscientists at the Lerner Research Institute at the Cleveland Clinic in Ohio. The title:  Inflammation helps to heal wounds- Surprise Discovery.

And check out this blog post by MobilityWOD about why he is convinced icing is bad and will become a thing of the past.

After thinking and doing some research, I quit icing.  In fact I only iced twice.  My swelling is almost gone.  And boy did it swell and bruise.  The bruising is almost gone as well.  I'm not limping anymore, although I think I'm still a ways from being able to run again.  Going down stairs and sitting cross legged is still painful.  I did go to the doc and have an x-ray taken to see if I had broken anything.  I didn't.  And I disobeyed my doctor when he told me to ice it and take Celebrex.  Whether not icing has actually helped or hinded my healing is yet to be seen.  But I like the idea of bucking the system especially when it makes sense to me.  

What do you think?
Wouldn't you love an excuse to quit taking those ice baths?
Do you have a good answer to my questions?  
Do I just not understand this stuff correctly?

Monday, November 5, 2012

I hate unhappy endings

Alternate titles:  Life sucks, Not again, Clumsy Idiot, Hidden Dangers Under Leaves, Trail Running is Dangerous...

I'm the kind of girl that likes a happy ending.  Especially in movies.  If you can't get a happy ending in a movie, there is no point in watching it.  There are enough unhappy endings in real life that I won't pay  money to see that in a movie!

I had a glorious running week.  I was pretty sore from the half last Saturday so Monday I just hiked 4 miles with a friend and really enjoyed myself.  Tuesday I ran some of fastest 6 miles ever and loved every minute of it.  

Wednesday I ran again and had a fall snow globe moment.  Really, it was magical.  The sun was just coming up over the mountain, the tall line of poplar trees lining the streets were lit up from the sun making their yellow leaves absolutely shine.  

Then a stiff breeze came along and the loose leaves from the trees started raining down on me.  I stopped in my tracks, looked up, and took the moment in and drank it deep.  The wind swirled the leaves on the ground all around me and it was really one of those magical moments that never would have happened if I wouldn't have stepped out the door that day.  

I had a smile on my face for the rest of the day. Funny how something so small made me so happy.  Thursday I went to spin class and Friday I rested anticipating a long run with my brother the next day.

Saturday started early in Mantua with an Eagle Scout and his crew building new trail on the mountain bike/hiking trail that our city is building.  

He had quite a group there and they made such good progress.  We're in the trees now and it's beautiful. 

The view isn't bad either!

I ran home, ate a snack, and my brother arrived.  We headed to the canyon that I love and couldn't wait to share with him.

We decided to take the White Rock loop which is about 10 miles.  Only we ran it backwards from the only other time I've ran it, so I was questioning myself the whole way until I finally figured it out.  We climbed to the top of the big rock at the half way  mark and enjoyed the view.  

I really love running with my brother.  He really tolerates a lot from me.  He doesn't complain when I have to walk or when I stop every couple of feet to pick up or look at a cool rock.  (I found one that looked like gold that I brought home to Logan! It was very cool!)  After about 8 miles and on our way back, we were booking down the trail pretty quick.  The thing about trail running on leaves is that you can't really tell what's underneath.  I roll my ankles often and it never hurts.  I kind of pride myself in having strong ankles especially after last year.  But as I rounded a corner a little too fast, I twisted and rolled my ankle and it stopped me in my tracks.  After a few minutes I walked it off and it seemed o.k.  And I started running again but slower.  Pretty soon we were back to normal when I hit something else and that same ankle just collapsed.  I went down.  It was some pretty brutal pain, enough to make me cry a bit although the cramp in my abs as I went down was almost worse.  I had my brother help me get up so that I could stretch out the ab cramp and then get my bearings.  It really hurt.  I couldn't put full pressure on it.  But I didn't hear it pop either.  We made our way down slowly the rest of the mile or so that we had left.  I was bummed but not devastated. 

I've done most of the traditional stuff like elevating it, resting it as much as possible, wearing my compression socks, soaking it in an Epsom salt solution, and even taking a Celebrex.  I did ice it the first day for about 20 minutes but have decided that I'm not doing that anymore.  I've come to the conclusion that inflammation can be good.  It might hurt, but isn't it the body's defense system kicking in to help it heal?  I've also been ultra sounding it twice a day.  I got that little handy dandy machine this last winter to help heal my stress fracture.  I really think it works.  My cankle is pretty nasty.  It is bluish in areas and the swelling has just sort of moved around to the inside of my ankle as well as the outside and onto the top of my foot.  It still hurts and I probably will go get it checked out, but I'm hoping that it won't be long until it's back to normal.  But since I've never done this before I'm not sure how long it will take to heal?  Anyone out there with similar experiences?  

One of these things is not like the other.  Sunday.

Monday morning
Until then, I got my bike back downstairs and as soon as I can wear that shoe for more than 10 minutes I'll be back on it for as long as I can stand it.  I also can concentrate more on lifting my upper body as well.  I guess being injured earlier this year has taught me that it's not the end of the world and I can find things that I can do in the meantime.   

I do have to say that things are just not lining up for me the way I thought they would.  I had this plan to do the Grand Slam this year and really get good at the marathon.  I got on the website and it's already sold out.  I entered the Ogden Marathon lottery and didn't get in.  Although I know there's still hope, it just seems like my plans are not working out.  I just started a new training schedule last week.  Is there a pause button?  Time to come up with a new plan and hope for a happy ending.  

Oh, and if you come up with a clever alternate title for my post, please share.  I could use a good laugh about now!