Joint and Muscle First Aid

When to Use Ice and Heat

You're at the park on a glorious Saturday morning playing a friendly game of basketball with your fellow weekend warriors. You jump for a rebound and land awkwardly, twisting your knee, and drop to the ground in pain. Moments later, you've been helped off the court by teammates and are watching your knee slowly but surely start to swell.

What should you do next? Too many people essentially shrug off the pain and return to the game after a few minutes of "rest," hoping everything will return to normal. That attitude can turn a simple strain or sprain into a chronic injury that limits your activities for weeks or even months.

When joint and muscle injuries occur, immediate application and continuation of first aid is vital. Delayed or incorrect first aid will slow the healing process dramatically. What do you do when you or someone you know suffers this type of injury? Here are a few things you can do immediately to start the healing process.

The R.I.C.E. Recovery Formula

Remembering the acronym R.I.C.E. is of great help whenever joint or muscle first aid is needed. The acronym stands forRest, Ice, Compression and Elevation. Immediately following an injury involving the muscles or joints, these four steps should be taken:

Resting an injured area reduces the stress and strain which, in turn, reduces the chance of further injury. When an injury occurs, immediately stop using the injured area.

Ice applied to an injured joint or muscle reduces swelling and bleeding by slowing blood flow to the area.

Compression (wrapping or taping the area of injury) reduces swelling and gives extra support to injured tissues. Compression applies primarily to the extremities (arms and legs).

Elevation of the injured body part above the level of the heart slows blood flow to the area by forcing the heart to pump "uphill." Reducing blood flow reduces swelling. Elevation applies primarily to injuries involving the extremities (arms, legs, feet and hands).

Heat or Cold: Which to Use?

Actually, heat and cold are both important components of recovery following an injury, but it's important to understand which to use and how to achieve maximum benefit. Remember these general rules when considering whether to apply ice or heat:

Applying Ice Properly

WHEN: Ice or gel packs are the first choice of care during the first 48-72 hours following injury.

HOW: The application of ice directly to an injured or painful area of the body can be quite a shock at first. To avoid this, apply the ice pack as follows: Apply the ice, or gel pack over a towel which will allow for a gradual cooling and more comfort. Place the towel under hot (but not scalding) running water, wring out the excess water and place the towel on the affected area.

FREQUENCY: Each application of ice/gel packs should be 20-30 minutes, with 3-5 applications per day.

WARNINGS: Never apply ice for longer than 30 minutes at a time, and not at all if the injured party is suffering from any of the following: frostbite, areas of decreased sensation, Raynaud's disease, severe circulation problems,rheumatoid or gouty arthritis, or a worst-case scenario such as coma. Also do not use chemical ice bags that require shaking or have to be struck to be activated. Shaking and striking these bags may result in leakage of the active chemicals. The chemicals are usually caustic and may result in burns or other injuries.

Applying Heat Properly

WHEN: Moist heat may be applied 48-72 hours after injury. Heat increases circulation by dilating blood vessels and letting more blood into the area.

HOW: Moist heat provides more soothing relief than dry heat. Gel packs, hot towels, hot baths, hot showers, whirlpools, steam saunas, and moist heating pads are examples of heat with moisture.

FREQUENCY: Each application of moist heat should be 20-30 minutes, with 3-5 applications per day.

WARNINGS: Never apply moist heat for longer than 30 minutes. Never sleep on a heating pad.

Gel Packs: Two Treatments in One

The most versatile piece of home therapy equipment you can own is a gel pack. Gel packs can be utilized for both cold and hot applications. Most are stored in the freezer until the need arises for cold application. If heat is needed, the pack can be transferred from the freezer to the microwave and heated as directed. Gel packs come in a variety of sizes and stay flexible at all temperatures. Constant flexibility allows the pack to be molded to the area of injury. Remember, it is always a good idea to place a towel between your skin and the gel pack.

Cut these instructions out and tape them on the inside of a medicine or kitchen cabinet so they will always be readily available whenever you or someone you know suffers a joint or muscle injury requiring first aid. Remember, the type, severity and circumstances surrounding the injury can impact the precise course of treatment to be pursued. For example, joint or bone deformity, uncontrollable bleeding associated with injury, loss of consciousness, loss of feeling in the area of injury, convulsions, etc., require immediate medical attention. Always consult with your doctor if you are unsure of the severity of an injury or if you have further questions regarding appropriate first-aid treatment.

Drugless Pain Solutions

Easy Ways to Reduce Your Reliance on Over-the-Counter Pain Medications

Americans take an inordinate amount of medication to reduce pain and inflammation, most notably acetaminophen, aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen. In fact, it is estimated that each year, Americans purchase literally billions of over-the-counter (OTC) anti-inflammatory drugs. How do these medications work? By inhibiting the enzymes that normally convert dietary fatty acids into inflammation-producing chemicals that can cause pain.

So, our dietary choices directly contribute to inflammation, pain and suffering, and then we take medications as a short-term "fix," rather than getting to the source of the problem - poor diet - and making changes. By the way, the side effects from these medications range from intestinal ulcers to reduced bone health, stroke and heart attack. Clearly, it is a good idea to use these medications sparingly.

Painful Diet Choices

The modern diet consists largely of nutrient-free calories: approximately 20 percent from refined sugar, 20 percent from refined flour and 20 percent from refined oils derived from corn, safflower seeds, sunflower seeds, cottonseeds, peanuts and soy. Oh, and don't forget another 10 percent to 20 percent from overweight or obese animals. That means for too many people, 80 percent of the calories they consume promote inflammation and thus pain, and lack any appreciable nutrient quality at all.

It is highly unlikely that taking NSAIDs or supplements will reduce pain and suffering for those individuals who subsist largely on these types of foods. That means the first order of business is to reduce the consumption of foods that cause inflammation and pain. Refined oils and fatty meat are known to contain an excessive amount of omega-6 fatty acids, which are generally inflammatory compared to omega-3 fatty acids. Oily potato and corn chips are excellent examples of foods whose calories are derived largely from the oils mentioned above (which contain only omega-6 fatty acids). In contrast, omega-3s are found in green vegetables, certain seeds (flax, chia and hemp), fish, and wild game or grass-fed animals, from which less than 10 percent of the average Americans calories are derived.

Alternatives to Pain-Relieving Drugs

Most of our calories should come from vegetables, fruit, fish, lean meats and nuts. These foods are the best sources of calories to reduce heart disease because of their anti-inflammatory nature. In 1991, this type of diet was used in a study with patients suffering from rheumatoid arthritis, a debilitating, painful disease, resulting in a substantial reduction in pain.

When considering supplements to help reduce pain, it is important to realize that pain expression is based on physical, psychological,and biochemical factors. From a biochemical perspective, it is important to remember that the chemicals which cause inflammation are the same ones that cause pain. Therefore, our goal with supplementation should be to help reduce inflammation.

Fish oil is one of the more popular supplements on the market today and can be taken by almost anyone who is not taking blood-thinning medications such as warfarin (Coumadin). Studies have shown that supplemental fish oil is helpful for patients with neck pain and back pain, as well as joint pain associated with rheumatoid arthritis, psoriasis, and ulcerative colitis. The common supplemental recommendation is 1-3 grams of EPA/DHA, which are the omega-3 fatty acids found in fish oil. This typically means 2-5 capsules daily if a concentrated fish oil is used for supplementation.

Vitamin D has emerged in recent years as a vitamin that has anti-inflammatory and anti-pain benefits. Autoimmune diseases, such as rheumatoid arthritis, are inflammatory in nature and known to be associated with vitamin D deficiency. Low back pain and widespread pain that can be confused with fibromyalgia are also known to be associated with vitamin D deficiency. We get vitamin D from the sun, but its production is reduced 95 percent when a sunscreen with a sun-protective factor (SPF) of 8 or greater is applied to the skin. There are no foods that contain adequate amounts of vitamin D, so we must either get vitamin D from the sun or from supplements.

Levels of vitamin D in the body [25(OH)D] can be assessed via a simple blood test. The currently accepted normal range of 25(OH)D is 32-100 ng/ml, and there is evidence that 40-60 ng/ml is optimal. For the average person, 2,000-5,000 IU of supplemental vitamin D3 will push levels to at least 40 ng. I personally have taken 10,000 IU per day for three years and get modest sun exposure; my current level is 85 ng/ml. (Vitamin D researchers recently created a nonprofit organization through which individuals can inexpensively have their vitamin D levels assessed. The cost is a mere $30 per test and can be acquired at www.grassrootshealth.org. The test kit is sent to your home and results are e-mailed to you.)

Magnesium: Ever since I can remember, we have been bombarded with information about calcium, while magnesium is rarely emphasized. This is an odd situation because more than 300 enzymes require magnesium, so it is involved in an inordinate amount of metabolic reactions. From a clinical perspective, the average American's intake of magnesium is well below the recommended daily allowance (RDA) and this has been associated with the expression of numerous conditions including heart disease, hypertension, diabetes, osteoporosis, headache, chronic inflammation, and an increase in nervous system excitability. Approximately 400 mg of supplemental magnesium per day is thought to be adequate for most individuals. (Note: The most common side-effect associated with magnesium supplementation is diarrhea; this is a totally individual experience. I take 1,000 mg of magnesium every day and have normal bowel function, while others take 400 mg and get diarrhea. The average person is able to tolerate 400 mg. As always, talk to your doctor before taking any supplement for the first time.)

Probiotics: Research is emerging that implicates poor digestive function with musculoskeletal pain expression. This speaks to the need to drastically reduce our consumption of sugar, flour products and refined oils that are devoid of fiber and known to compromise healthy gut bacteria. Supplementation with healthy bacteria called probiotics (Lactobacillus acidophilus and Bifidobacteria) are known to reduce intestinal inflammation, and for many this translates into less musculoskeletal pain as well.

Ginger and Turmeric: Most herbs that we use to spice our meals are known to have anti-inflammatory functions. The most well-studied in the context of inflammation and pain are ginger and turmeric. Each has been shown to reduce musculoskeletal pain. The most economical way to take ginger and turmeric is with meals as an added spice. However, supplements are available and widely utilized. I personally spice my meals and take a ginger/turmeric supplement.

B Vitamins: The creation of cellular energy requires most B-complex vitamins. While B vitamins are not traditionally viewed as anti-inflammatory or analgesic, human and animal research suggests that B-vitamin supplementation may offer pain-reducing benefits. Life is challenging enough without having to deal with the additional burden of physical pain and suffering. Simple dietary and supplement strategies and supplements have brought substantial relief to many individuals - so what are you waiting for? Instead of turning to drugs for temporary relief to your pain, discuss drugless solutions with your doctor today.

What's in Your Cereal?

Do you know what's in the cereal you're feeding your children? That "Delicious and Nutritious!" message on the box may just be hype, according to a recent report that exposes what's really inside the carton (more often than not): serious spoonfuls of sugar and salt in each serving.


Consumer Reports' nutrition ratings report (November 2008 issue)
found that some popular cereals marketed to children are 40-50
percent sugar, comparable to a glazed doughnut. Considering that
most children eat more than the standard serving size (1 cup),
your child may be consuming much more than you've bargained for.

The report compares the nutrition information of 27 leading
cereals, giving each cereal a rating of "very good," "good" or
"fair." Only four of the 27 cereals were rated "very good" -
General Mills' Cheerios (at the top of the list), Kix and Honey
Nut Cheerios, and Quaker Oats' Life. With regard to sugar
content, Post's Golden Crisp and Kellogg's Honey Smacks were
rated "fair," with more than 50 percent sugar by weight per
serving, and nine other cereals were determined to have at least
40 percent sugar. Kellogg's Rice Krispies, long considered a
relatively healthy cereal with little sugar, rated only "fair"
due to high sodium content and zero grams of dietary fiber. The
report suggests parents look for cereals high in fiber (5 grams
or more), low in sodium (140 milligrams or less) and low in sugar
(1 teaspoon or less per serving).

What's the lesson to be learned here? The next time you're
strolling the cereal aisle deciding what's best for your family,
spend some time reading those nutrition labels on the back of the
box before tossing it into your shopping cart. The ingredients
list will tell you a lot more about what's inside the box than
the colorful characters and happy messages on the outside ever
will. Your doctor can give you more information on the essentials
of proper nutrition.