April 30, 2023 • 17 mins
Getting hurt really takes the wind out of your sails. It interferes with day-to-day functioning, and in some cases can be completely life altering. However, we've been sold some bad advice about how to get better. Today we tackle some age-long conventional wisdom that isn't rooted in great science to better understand how healing works and how we can get out of our own way so we can get back to being healthy.
Show Notes:
1:18 - 3 phases of healing - https://www.ncbi.nlm.nih.gov/books/NBK470443/
7:41 - Wolff's Law - https://www.webmd.com/osteoporosis/what-is-wolffs-law
7:48 - Davis' Law - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5342900/
11:57 - Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture? - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173427/
12:01 - Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline - https://www.mygcphysio.com.au/wp-content/uploads/2019/08/Ankle-sprains-consensus-statement-2018.pdf
14:40 - Factors That Impair Wound Healing - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4495737/
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
welcome to Primedy where we find simple techniques to help address modern problems for our primitive
bodies my name is Andrew Pafford and I'm a health and wellness professional with over a decade of
experience helping Olympic level athletes desk jockeys and seniors achieving their goals and
improving their quality of life life is well and truly cruel while it has its highs the lows can
(00:23):
be particularly bad and seem to last longer at times and by that I'm referring to injury
it's a result of when our wonderfully imperfect meat machines fail whether we were the victim
of a stroke of bad luck like being in a car accident or falling down the stairs or if we
had just finally written too many checks that our body couldn't cash like exercising with bad
(00:45):
form at any rate injury is unpleasant and it makes life infinitely more difficult than it already is
however there are a number of things about injury recovery that we may not be getting right
as a matter of fact sometimes by being wussies we can elongate the healing process or Worse
exacerbate the damage to know if our approaches are correct or not we need to understand what
(01:09):
goes on in the normal healing process to better understand how we can better optimize these
processes and get back to feeling great so let's discuss the three phases of healing in the body
first phase of healing is relatively instantaneous very noticeable painful and quite frequently
demonized and that is inflammation inflammation serves a number of functions that are critical
(01:35):
to our well-being the pain elicited during the inflammation stage is twofold
it draws our attention to the injury so we know it's there but it also protects us
from us doing further damage if I broke my finger and I continued to use that finger it
might do more damage to the finger and result in poor healing but since my finger hurts I'm
(02:00):
going to want to leave it the heck alone and even protect it allowing at the time it requires to
heal and hopefully prevent further damage another important part of the inflammatory phase is the
signal markers released by the damaged tissues tell the body that there is an injury this is what
allows healing to even begin in the first place it mobilizes an immune response to the area not only
(02:24):
to break down damaged tissue so that new healthy tissue can take its place but in the event of a
wound you can imagine that potentially harmful microbes may have been introduced to the body
it would be nice if the immune system was summoned immediately to help stem any possible Invaders
before they can take hold and create an infection second phase of healing is the proliferative phase
(02:47):
it wouldn't do much good to leave a gaping hole in our skin or to leave torn tissues flapping about
right phase two is all about Shoring up the broken pieces one could mostly think of this
as scar tissue or scar tissue or fibroblasts for you physio nerds is essentially our body's way of
putting a cast on things it's temporary meant for protection and designed to kind of hold things in
(03:11):
place until healing can finish up third phase is the remodeling phase and it can be a little tricky
in remodeling we see the new actual cells begin to form muscle tissue returning skin
cells repopulating the body trying to go back to normal paviad is that the fibroblasts from
(03:31):
phase two don't magically disappear just like a cast for your broken arm doesn't suddenly fall
off when your arm is healed the fibroblasts don't dissolve the moment the new healthy cells return
the healthy cells can form within the fibroblasts scar tissue leaving a bit of a mess that's not as
(03:52):
good as the OG cells that were there prior to injury we'll discuss more in a bit on what can
be done about this now injury is injury obviously different types of injuries will require different
approaches to how these three phases are handled but these three phases will happen nonetheless
before we can get into Nuance about injury type and tissue type let's
(04:15):
talk about things we can do to help get out of our own way and I'm talking about rice
not the food but the acronym that stands for rest ice compression and elevation r-i-c-e rice
this is the conventional wisdom that has been passed down of what to do
in times of injury and unfortunately the majority of it doesn't make sense
(04:39):
let's tear this apart shall we firstly is rest is complicated because too much of anything can be
bad if we don't rest AKA we continue to use the injured tissue we're likely to cause more damage
however if we completely rest like we sit on the couch and go on a 72-hour Bender
(04:59):
of the Great British baking show only to be interrupted by Sleep food and potty breaks
then we could also be doing ourselves a great disservice you see the human body is designed
around movement not only do we have a fantastic muscle that pumps blood throughout our entire body
but the rest of our muscles actually do a fair amount of pumping juices too
(05:23):
once the blood gets far enough away from our heart it loses that pressure that makes it go in order
to get the blood back we need to encourage it with some mechanical pumping from our muscles
never wonder why some of the biggest advice for flying is to tap your feet especially for my
older group out there because being stuck seated in that cramped space causes your blood to pool
(05:46):
in the veins in your legs and when blood stops moving it tends to coagulate or as the lay person
may know it as a clot this ladies and gentlemen is what is known as a DVT or deep vein thrombosis and
they like to be deadly and the best way to keep them from forming keep moving hence the foot taps
(06:07):
this causes the calf muscles to pump away in turn pushing and pumping the surrounding veins in your
leg and keeping the blood in your legs flowing back towards your trunk even if you're stuck in
a seated position while not nearly as deadly your lymphatic system uses this mechanical compression
to move lymph through its system too so so much so that it doesn't have a way to generate pressure so
(06:32):
it relies completely on muscle activation to move lymph through the body you can think of lymph as
the water runoff in your body and the lymphatic system is the sewer that collects it and returns
it to be redistributed there's no water pressure in sewers like there is in the water line that
delivers drinking water to your house same goes for our lymph ask anyone who has a job that needs
(06:56):
to stand all day what happens to their feet they swell up because gravity causes that fluid to pool
at the bottom and if they don't move enough to pump it back into circulation then it stays put
this is an important anecdote for our injury if we have pooling of fluid in an area AKA swelling
how is it supposed to escape if we've shut off our mechanical compression because we're resting
(07:21):
this is also mainly addressing the inflammatory phase of healing as I briefly alluded to in the
third phase when new tissue begins to appear its replacement is not always as quote ideal
as its predecessors this is because of two things known as Wolf's Law and Davis's law
Wolf's law states that natural healthy bones will adapt and change to stressors that it
(07:47):
is subjected to Davis's law is essentially the same thing but for soft tissue that says soft
tissues remodel along lines of forces while each one pertains to a different tissue bone versus
soft tissue like skin or muscle they effectively say the same thing physical force is necessary
for healthy healing and repair of tissue this means once outside of the initial inflammatory
(08:12):
phase it's critical to begin using tissues albeit gently and lightly especially initially
in order for the placement of new tissue to be placed appropriately as an example our muscles
run in striated parallel lines when a load is applied the force pulls along those lines
(08:35):
during healing however new units are not placed in a particular order and thus
are not as well equipped to resist the same forces that its pre-injury predecessors were
however if force is applied during the healing phase the force encourages those units to line up
in order to better resist the forces applied this encouragement if you will can help better restore
(09:03):
functioning by aligning tissues this means too much rest can actually contribute to allowing the
laying down of misaligned cellular units leading to compromised functionality of skin muscle bone
tendon Etc so injury should not mean getting a free pass at becoming a couch potato if anything
(09:24):
it means being tender with injured tissues but it becomes more critical to be gently active during
the latter stages in healing and not too restful the second letter in rice is going to make some
people gasp when I say this and I'll laugh at the hate mail and I'll surely get but the reality is
icing sucks now hear me out before you skip out on me and change the station
(09:47):
for starters let's talk about what we can agree on inflammation is excess lymph gathering in one area
in this case the lymph gathers as a byproduct of the inflammatory markers being released by
damaged tissues and increases the blood flow to start addressing those damaged tissues
swelling can cause surrounding tissues to stretch which can be unpleasant and can trigger
(10:12):
our surrounding stretch receptors and nociceptors known as pain sensors which in turn make us go ow
because swelling don't feel good our first inkling is to try and Abate the swelling to make
our injury not so owl now let's talk about what ice does well eyes reduces the swelling okay how
(10:39):
how can ice cause swelling to go down well on a chemical level that doesn't make sense our lymph
is predominantly water what happens to water when it freezes yeah expanding is the opposite of what
we want so that's not a viable explanation even if it's not totally freezing water still expands
(11:02):
when it gets cold so that doesn't jive what happens to our blood vessels when we get cold
they vasoconstrict or rather get smaller this means that less fluid is getting to the area
so if applied initially and almost instantaneously this may slow swelling from setting in or help
(11:24):
control the amount of swelling but if something's already swollen how is the swelling supposed to
escape we've just Shrunk the pipes that could carry it away and likely turn the lymph a bit more
jelly by making it cold so how does ice physically help swelling go down well it doesn't one possibly
(11:45):
good thing it can do is numb some of those pain receptors making the injury slightly less
uncomfortable but the moment the ice comes off so too does its numbing effects what's more prolonged
application of ice can cause damage to the skin or even prolong the healing process think about it if
my blood vessels are constricting from the cold and I'm getting less blood how are the tissues
(12:10):
supposed to get nutrients that they need to heal now there may be one useful application aside from
the initial onset of injury but we'll come back to that when we get to the dues in injury healing
so the third letter in rice is compression I like compression we just talked about how compression
is good in our resting portion depression makes the fluid move it brings blood flow and nutrients
(12:36):
in and it ensures continued blood return and lymph return which in turn is the swelling
so compression can help swelling leave the site of injury put it simply groceries in garbage out
now compression should not be confused with constricting or tourniqueting cutting off the
flow in or out is not great however compressing and releasing is necessary to keep the flow of
(13:04):
fluids going which is what keeps our healing going we'll definitely expound upon this in our news
section also now the last letter in rice stands for elevation this one is also equally silly
again Common Sense exercise if I hold my arm over my head what happens
(13:26):
the blood drains from my arm so if I'm preventing blood flow from reaching my injury
how is it healing any swelling that is already there doesn't just pour out of my arm and back
to my body like the bloodwood it is stuck between tissues or rather it is now interstitial fluid
(13:47):
it is up to the lymphatic system to pull the swelling out and if there's no fluid flow because
it's too busy Fighting Gravity then there's no Escape either final piece of what is likely a knot
to do is medication management specifically what we would know as non-steroid anti-inflammatory
drugs or NSAIDs this would typically be your over-the-counter drugs like aspirin or Tylenol
(14:13):
as the name implies these drugs are designed to prevent inflammation anti-inflammatory
as we discussed inflammation is a necessary step in healing it is what tells the body there's an
injury that needs tending to if we suppress the inflammatory markers using medication we
are effectively masking injury from the body the body doesn't know the tissues are injured and so
(14:39):
healing takes longer or Worse doesn't happen at all because it's completely suppressed
additionally NSAIDs taken during the proliferation phase can lead to excessive scarring leading to
reduced functionality as we mentioned starch is used not the same as normal healthy tissue
so it will not function as such so if you're contemplating popping an inset after an injury
(15:03):
you'd likely be better served not touching a pill bottle if you are prescribed and said by
your doctor or say on a daily basis get in touch with them and have a discussion about whether
it be wise to continue them during your healing period remember I am not a doctor so when it comes
to medication or altering your prescription you absolutely must consult with your physician first
(15:26):
so now a quick recap of what we covered today injuries are no fun but regardless of the type
of injury the same three phases occur phase one inflammatory phase tells the body you're
injured and begins the process while adding some layers of protection phase two proliferation
Works to shore up the injury with its own caste to hold things together usually scar tissue
(15:52):
phase three remodeling is when normal tissues begin to reappear to go back to normal
outside of the three phases of healing things that we shouldn't do is rice resting to the point of
becoming one with your couch can lead to longer healing and poor remodeling tissues ice utilized
(16:15):
incorrectly can lead to longer healing times and possible suppression of healing and damage
to the site of application depression is good but not if used to restrict blood or fluid flow
elevation prevents fluid circulation and impedes healing and finally NSAIDs can be
quite detrimental to healing and should likely be avoided or consult with your physician if you are
(16:40):
currently being prescribed them we had to cover a lot of information today to understand how healing
works and subsequently why some conventional wisdom Works counter to the natural processes
that said we will be covering all of the dues on our next episode so check back for that
thanks again for tuning in to Primedy we're interested to hear what you're interested in so
(17:01):
please send your questions comments and feedback to info at primedy.org and as always strength
comes in many forms from within and without so be strong to be useful take care and stay strong
welcome to Primedy where we find simple techniques to help address modern problems for our primitive
bodies my name is Andrew Pafford and I'm a health and wellness professional with over a decade of
experience helping Olympic level athletes desk jockeys and seniors achieving their goals and
improving their quality of life life is well and truly cruel while it has its highs the lows can
(00:23):
be particularly bad and seem to last longer at times and by that I'm referring to injury
it's a result of when our wonderfully imperfect meat machines fail whether we were the victim
of a stroke of bad luck like being in a car accident or falling down the stairs or if we
had just finally written too many checks that our body couldn't cash like exercising with bad
(00:45):
form at any rate injury is unpleasant and it makes life infinitely more difficult than it already is
however there are a number of things about injury recovery that we may not be getting right
as a matter of fact sometimes by being wussies we can elongate the healing process or Worse
exacerbate the damage to know if our approaches are correct or not we need to understand what
(01:09):
goes on in the normal healing process to better understand how we can better optimize these
processes and get back to feeling great so let's discuss the three phases of healing in the body
first phase of healing is relatively instantaneous very noticeable painful and quite frequently
demonized and that is inflammation inflammation serves a number of functions that are critical
(01:35):
to our well-being the pain elicited during the inflammation stage is twofold
it draws our attention to the injury so we know it's there but it also protects us
from us doing further damage if I broke my finger and I continued to use that finger it
might do more damage to the finger and result in poor healing but since my finger hurts I'm
(02:00):
going to want to leave it the heck alone and even protect it allowing at the time it requires to
heal and hopefully prevent further damage another important part of the inflammatory phase is the
signal markers released by the damaged tissues tell the body that there is an injury this is what
allows healing to even begin in the first place it mobilizes an immune response to the area not only
(02:24):
to break down damaged tissue so that new healthy tissue can take its place but in the event of a
wound you can imagine that potentially harmful microbes may have been introduced to the body
it would be nice if the immune system was summoned immediately to help stem any possible Invaders
before they can take hold and create an infection second phase of healing is the proliferative phase
(02:47):
it wouldn't do much good to leave a gaping hole in our skin or to leave torn tissues flapping about
right phase two is all about Shoring up the broken pieces one could mostly think of this
as scar tissue or scar tissue or fibroblasts for you physio nerds is essentially our body's way of
putting a cast on things it's temporary meant for protection and designed to kind of hold things in
(03:11):
place until healing can finish up third phase is the remodeling phase and it can be a little tricky
in remodeling we see the new actual cells begin to form muscle tissue returning skin
cells repopulating the body trying to go back to normal paviad is that the fibroblasts from
(03:31):
phase two don't magically disappear just like a cast for your broken arm doesn't suddenly fall
off when your arm is healed the fibroblasts don't dissolve the moment the new healthy cells return
the healthy cells can form within the fibroblasts scar tissue leaving a bit of a mess that's not as
(03:52):
good as the OG cells that were there prior to injury we'll discuss more in a bit on what can
be done about this now injury is injury obviously different types of injuries will require different
approaches to how these three phases are handled but these three phases will happen nonetheless
before we can get into Nuance about injury type and tissue type let's
(04:15):
talk about things we can do to help get out of our own way and I'm talking about rice
not the food but the acronym that stands for rest ice compression and elevation r-i-c-e rice
this is the conventional wisdom that has been passed down of what to do
in times of injury and unfortunately the majority of it doesn't make sense
(04:39):
let's tear this apart shall we firstly is rest is complicated because too much of anything can be
bad if we don't rest AKA we continue to use the injured tissue we're likely to cause more damage
however if we completely rest like we sit on the couch and go on a 72-hour Bender
(04:59):
of the Great British baking show only to be interrupted by Sleep food and potty breaks
then we could also be doing ourselves a great disservice you see the human body is designed
around movement not only do we have a fantastic muscle that pumps blood throughout our entire body
but the rest of our muscles actually do a fair amount of pumping juices too
(05:23):
once the blood gets far enough away from our heart it loses that pressure that makes it go in order
to get the blood back we need to encourage it with some mechanical pumping from our muscles
never wonder why some of the biggest advice for flying is to tap your feet especially for my
older group out there because being stuck seated in that cramped space causes your blood to pool
(05:46):
in the veins in your legs and when blood stops moving it tends to coagulate or as the lay person
may know it as a clot this ladies and gentlemen is what is known as a DVT or deep vein thrombosis and
they like to be deadly and the best way to keep them from forming keep moving hence the foot taps
(06:07):
this causes the calf muscles to pump away in turn pushing and pumping the surrounding veins in your
leg and keeping the blood in your legs flowing back towards your trunk even if you're stuck in
a seated position while not nearly as deadly your lymphatic system uses this mechanical compression
to move lymph through its system too so so much so that it doesn't have a way to generate pressure so
(06:32):
it relies completely on muscle activation to move lymph through the body you can think of lymph as
the water runoff in your body and the lymphatic system is the sewer that collects it and returns
it to be redistributed there's no water pressure in sewers like there is in the water line that
delivers drinking water to your house same goes for our lymph ask anyone who has a job that needs
(06:56):
to stand all day what happens to their feet they swell up because gravity causes that fluid to pool
at the bottom and if they don't move enough to pump it back into circulation then it stays put
this is an important anecdote for our injury if we have pooling of fluid in an area AKA swelling
how is it supposed to escape if we've shut off our mechanical compression because we're resting
(07:21):
this is also mainly addressing the inflammatory phase of healing as I briefly alluded to in the
third phase when new tissue begins to appear its replacement is not always as quote ideal
as its predecessors this is because of two things known as Wolf's Law and Davis's law
Wolf's law states that natural healthy bones will adapt and change to stressors that it
(07:47):
is subjected to Davis's law is essentially the same thing but for soft tissue that says soft
tissues remodel along lines of forces while each one pertains to a different tissue bone versus
soft tissue like skin or muscle they effectively say the same thing physical force is necessary
for healthy healing and repair of tissue this means once outside of the initial inflammatory
(08:12):
phase it's critical to begin using tissues albeit gently and lightly especially initially
in order for the placement of new tissue to be placed appropriately as an example our muscles
run in striated parallel lines when a load is applied the force pulls along those lines
(08:35):
during healing however new units are not placed in a particular order and thus
are not as well equipped to resist the same forces that its pre-injury predecessors were
however if force is applied during the healing phase the force encourages those units to line up
in order to better resist the forces applied this encouragement if you will can help better restore
(09:03):
functioning by aligning tissues this means too much rest can actually contribute to allowing the
laying down of misaligned cellular units leading to compromised functionality of skin muscle bone
tendon Etc so injury should not mean getting a free pass at becoming a couch potato if anything
(09:24):
it means being tender with injured tissues but it becomes more critical to be gently active during
the latter stages in healing and not too restful the second letter in rice is going to make some
people gasp when I say this and I'll laugh at the hate mail and I'll surely get but the reality is
icing sucks now hear me out before you skip out on me and change the station
(09:47):
for starters let's talk about what we can agree on inflammation is excess lymph gathering in one area
in this case the lymph gathers as a byproduct of the inflammatory markers being released by
damaged tissues and increases the blood flow to start addressing those damaged tissues
swelling can cause surrounding tissues to stretch which can be unpleasant and can trigger
(10:12):
our surrounding stretch receptors and nociceptors known as pain sensors which in turn make us go ow
because swelling don't feel good our first inkling is to try and Abate the swelling to make
our injury not so owl now let's talk about what ice does well eyes reduces the swelling okay how
(10:39):
how can ice cause swelling to go down well on a chemical level that doesn't make sense our lymph
is predominantly water what happens to water when it freezes yeah expanding is the opposite of what
we want so that's not a viable explanation even if it's not totally freezing water still expands
(11:02):
when it gets cold so that doesn't jive what happens to our blood vessels when we get cold
they vasoconstrict or rather get smaller this means that less fluid is getting to the area
so if applied initially and almost instantaneously this may slow swelling from setting in or help
(11:24):
control the amount of swelling but if something's already swollen how is the swelling supposed to
escape we've just Shrunk the pipes that could carry it away and likely turn the lymph a bit more
jelly by making it cold so how does ice physically help swelling go down well it doesn't one possibly
(11:45):
good thing it can do is numb some of those pain receptors making the injury slightly less
uncomfortable but the moment the ice comes off so too does its numbing effects what's more prolonged
application of ice can cause damage to the skin or even prolong the healing process think about it if
my blood vessels are constricting from the cold and I'm getting less blood how are the tissues
(12:10):
supposed to get nutrients that they need to heal now there may be one useful application aside from
the initial onset of injury but we'll come back to that when we get to the dues in injury healing
so the third letter in rice is compression I like compression we just talked about how compression
is good in our resting portion depression makes the fluid move it brings blood flow and nutrients
(12:36):
in and it ensures continued blood return and lymph return which in turn is the swelling
so compression can help swelling leave the site of injury put it simply groceries in garbage out
now compression should not be confused with constricting or tourniqueting cutting off the
flow in or out is not great however compressing and releasing is necessary to keep the flow of
(13:04):
fluids going which is what keeps our healing going we'll definitely expound upon this in our news
section also now the last letter in rice stands for elevation this one is also equally silly
again Common Sense exercise if I hold my arm over my head what happens
(13:26):
the blood drains from my arm so if I'm preventing blood flow from reaching my injury
how is it healing any swelling that is already there doesn't just pour out of my arm and back
to my body like the bloodwood it is stuck between tissues or rather it is now interstitial fluid
(13:47):
it is up to the lymphatic system to pull the swelling out and if there's no fluid flow because
it's too busy Fighting Gravity then there's no Escape either final piece of what is likely a knot
to do is medication management specifically what we would know as non-steroid anti-inflammatory
drugs or NSAIDs this would typically be your over-the-counter drugs like aspirin or Tylenol
(14:13):
as the name implies these drugs are designed to prevent inflammation anti-inflammatory
as we discussed inflammation is a necessary step in healing it is what tells the body there's an
injury that needs tending to if we suppress the inflammatory markers using medication we
are effectively masking injury from the body the body doesn't know the tissues are injured and so
(14:39):
healing takes longer or Worse doesn't happen at all because it's completely suppressed
additionally NSAIDs taken during the proliferation phase can lead to excessive scarring leading to
reduced functionality as we mentioned starch is used not the same as normal healthy tissue
so it will not function as such so if you're contemplating popping an inset after an injury
(15:03):
you'd likely be better served not touching a pill bottle if you are prescribed and said by
your doctor or say on a daily basis get in touch with them and have a discussion about whether
it be wise to continue them during your healing period remember I am not a doctor so when it comes
to medication or altering your prescription you absolutely must consult with your physician first
(15:26):
so now a quick recap of what we covered today injuries are no fun but regardless of the type
of injury the same three phases occur phase one inflammatory phase tells the body you're
injured and begins the process while adding some layers of protection phase two proliferation
Works to shore up the injury with its own caste to hold things together usually scar tissue
(15:52):
phase three remodeling is when normal tissues begin to reappear to go back to normal
outside of the three phases of healing things that we shouldn't do is rice resting to the point of
becoming one with your couch can lead to longer healing and poor remodeling tissues ice utilized
(16:15):
incorrectly can lead to longer healing times and possible suppression of healing and damage
to the site of application depression is good but not if used to restrict blood or fluid flow
elevation prevents fluid circulation and impedes healing and finally NSAIDs can be
quite detrimental to healing and should likely be avoided or consult with your physician if you are
(16:40):
currently being prescribed them we had to cover a lot of information today to understand how healing
works and subsequently why some conventional wisdom Works counter to the natural processes
that said we will be covering all of the dues on our next episode so check back for that
thanks again for tuning in to Primedy we're interested to hear what you're interested in so
(17:01):
please send your questions comments and feedback to info at primedy.org and as always strength
comes in many forms from within and without so be strong to be useful take care and stay strong
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