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Old 1 November 2011, 19:59
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Why do we reduce swelling when injured?

After blowing out my hamstring yesterday after not listening to what my body was telling me, (my bad), I've been reading up on treatment / rehab for a torn hamstring.

There's a lot of focus on reducing / preventing swelling, and I'm wondering why.

Why is swelling so "bad"?

Our ancestors wouldn't have worried about swelling, and I'm pretty sure they were a bit more active that us, so why this focus on swelling after injury?
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Old 1 November 2011, 20:27
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Thank you for posting this question. I had never considered it, and searching for some ideas on the topic myself, I stumbled upon THIS ARTICLE. I need to read more -- it seems like this is something we can all benefit from knowing....
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Old 1 November 2011, 20:46
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PM WCG175, he is dealing with this issue right now.

Yesterday I went to see a doc that specializes in the Feldenkrais method. One thing he did school me on was how to get rid of some lower extremity swelling.

I might get this wrong but, lie on your back legs bent and elevated, think on floor with legs on couch. Gently push on your glands near your crotch with flat hands. Seems to work for me.
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Old 1 November 2011, 22:22
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...I've always been told that NSAID (motrin/etc) would pro-long muscle recovery process...I guess it ties in with the discussion in the article posted. Acknowledging of course, that the inflamation processs actually contributes to the healing process.

I guess if you're hindering the inflamation process, to a degree, you're pro-longing the healing process...

On the same note though, I'd imagine there's a fine line that needs to be maintained between keeping the inflamation down to a managable/tolerable level, and at the same time not over doing the candy...


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Old 1 November 2011, 23:47
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For a brief time I worked as a NCAA and then a professional strength and conditioning coach before USN got their hooks in me. One of the interesting things we found was that some guys focused on quad work so much (especially leg extensions) that in simple athletic pursuits such as pushing off from a standing start, that their quads would overpower the hamstrings. Anecdotal evidence, of course. But, when we had our players add in one more set of leg curls, the hamstring pulls all but disappeared.
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Old 2 November 2011, 00:01
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Originally Posted by SOTB View Post
Thank you for posting this question. I had never considered it, and searching for some ideas on the topic myself, I stumbled upon THIS ARTICLE. I need to read more -- it seems like this is something we can all benefit from knowing....
That's an interesting read. When you think about it, our bodies are made to take care of themselves (to a certain extent)...swelling likely occurs for a reason.
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Old 2 November 2011, 01:33
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Apparently minor internal bleeding can take days to stop. Capillary skin bleeding may take 2-5 minutes to stop while the same thing inside might take 2-5 days.
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Old 2 November 2011, 02:13
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The issue I have with the PRICE / RICE method, (as outlined in SOTB's link), is that the main goal of reducing inflammation, from my limited reading is to reduce pain.

But, this creates the situation where you may then start to think you are healing faster than reality, as you have reduced the swelling and the resulting pain, causing you to possibly re-injure the injury / worsen the injury / prolong the healing process by attempting an exercise / movement that the injury is not ready for.

If I do not try to control the swelling, IMHO, my body will tell me when it is pain free, and that it's ready to handle some exercise. It also tells me if a certain movement is bad, which would not occur if I reduced the swelling and resulting pain.

If I try to stretch the site, which is recommended, the injury will tell me, via pain, what is a good stretch, and what is bad. If I control the swelling / pain, I could be making it worse.

So....I'm going to let the swelling do as it will, and listen to my body. It was not listening to my body that caused the injury in the first place.

Dozer, I probably do slightly more deadlifts to squats - And I think the heavy deadlifts the day before contributed to the tightened hamstrings. I believe I simply should have warmed up properly before my sprints.
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Old 2 November 2011, 02:35
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I dont think the swelling is a good thing. It might be adding to the damage?
After I hurt myself doing a deadlift I started taking the bar off a squat rack at about waist height rather than hefting it off the floor for the first movement. Its a bit pussy but allows you to sense whether your body is up to it.
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Old 2 November 2011, 05:39
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I dont think the swelling is a good thing. It might be adding to the damage?
I haven't read that anywhere. It seems to be a perfectly natural, and somewhat protective, reaction to injury.

But I am not even close to being an expert on these matters. I'm just one of these people that doesn't take things on face value.
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Old 2 November 2011, 06:31
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Originally Posted by nofear View Post
I haven't read that anywhere. It seems to be a perfectly natural, and somewhat protective, reaction to injury.

But I am not even close to being an expert on these matters. I'm just one of these people that doesn't take things on face value.
I'm no expert either, but it would seem "swelling" is the body's way of dealing with an injury. Same as a fever is a body's way of combating a virus/bacterial infection, etc. I have this latter argument with my wife and MIL every time my young ones get a cold/fever. They want to dose them to the gills with children's Tylenol at just the slighest increase in core temp. I have to tell them that fever is a good thing in that it's the body's natural way of fighting off infection. They remain highly skeptical though. I'm of the mind that things like swelling and fever to a certain extent are good things and are there to help in recovery. Just my non medical opinion.
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Old 2 November 2011, 07:35
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Swelling is a good thing. When we strain muscles, pull muscles, etc, what is happening is that muscle fibers are being torn. The body's response is to immediately start the healing process. Chemicals are released (cytokines, hormones, etc) that first result in an increased blood flow tO the affected area, increasing the number of cells that affect the healing process. These cytokines also make the capillaries and lymphatics more leaky, to accommodate bigger scavenger cells that clean up debris, and promote prompt removal of dead tissue.
The downside to capillary and lymphatic leakage is that more fluid leaves the bloodstream and enters the tissue compartment, causing the swelling. Whereas this fluid helps promote the healing process, the somatic response is that it causes pain, because that muscle compartment wasn't made to accommodate that extra fluid, faulting in nerves getting pinched (I.e. pain). Normally the swelling is a tightly-controlled process, but massive muscle injury can trigger a large-enough inflammatory response that more fluid enters the compartment than that compartment can accommodate. The pressure rises too fast, and the nerves and tissue lose their blood supply (pressure in compartment> venous pressure), and compartment syndrome ensues. If the compartment isn't opened promptly (I.e. surgical decompression or fasciotomy), the tissue and nerves will die.

This is the CliffNotes version, but in a nutshell, swelling is good and, if the pain is tolerable. Should be left untreated. Bad pain should not be ignored, and conservative measures like ice will decrease the blood flow and swelling, and prevent subacute compartment syndrome. NSAID's like Advil can also decrease swelling by blunting the chemical and hormonal response that triggers the swelling in the first place.

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Old 2 November 2011, 09:25
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Apologies for the typos. Damn iPhone.
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Old 2 November 2011, 18:56
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Originally Posted by Chesie View Post
Normally the swelling is a tightly-controlled process, but massive muscle injury can trigger a large-enough inflammatory response that more fluid enters the compartment than that compartment can accommodate. The pressure rises too fast, and the nerves and tissue lose their blood supply (pressure in compartment> venous pressure), and compartment syndrome ensues. If the compartment isn't opened promptly (I.e. surgical decompression or fasciotomy), the tissue and nerves will die.
Now this makes sense.

Massive / Extreme injury cannot heal itself, hence the need for intervention, but lesser injuries do not require intervention, simply the ability to listen to what your body is telling you.

After 48 hours of not trying to prevent the swelling in my leg, and occasional stretching, my range of motion is almost back to normal. Was able to manage some skipping this morning, but I'm sure it will be a few days before my leg is ready for some light running.

I doubt that trying to control the swelling / pain would generate a better result.
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Old 2 November 2011, 19:07
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nofear,

Thanks for a great thread!!!

Anyone that read it should now know what to do.

asg
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Old 2 November 2011, 20:18
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i always do my leg presses and leg curls to get that balance.i dont do leg ext.only because i figure the LP takes care of that.do dead lifts and chest one day,another body part one day and do legs separately,something like that so you dont overtrain.watch your shoulders they can get overtrained real quick
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Old 2 November 2011, 20:23
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Yesterday I went to see a doc that specializes in the Feldenkrais method. One thing he did school me on was how to get rid of some lower extremity swelling.
Good God man, just go punch the clown. What's so special about that?
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Old 3 November 2011, 06:33
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Our ancestors wouldn't have worried about swelling, and I'm pretty sure they were a bit more active that us, so why this focus on swelling after injury?
Let's not forget that the average lifespan of the male caveman was like - MAYBE 30?

Reduction in swelling is primarily, as a developed culture, we are pussies.

We have pills and potions, remedies and manipulations because the "modern human" doesn't like being uncomfortable any longer that they have to be.
A swollen and painful joint or muscle is flooded with fluids to help protect and repair whatever damage is done. Pharmacological adjuncts may reduce swelling, but they also reduce the inflammatory response and speed the healing process. Much in the way that a cast will "heal" a fracture more quickly (and efficiently) than allowing the bone to rebuild and bridge the fracture on it's own (which it almost always will - it just won't be nearly as pretty or as fast).

There is no doubt that the body has mechanisms in place to heal itself. In almost every aspect of our physiology, there is a mechanism for self repair of insult to the flesh. Clotting factors for blood, osteoclasts for bone, epithelials for skin etc...and the edema (swelling) and pain that goes with those injuries is to remind us that "I am indeed injured, and please allow me to heal". Indeed 90% of common illnesses and injuries will resolve on their own without ever seeing a health care provider. Sometimes, we just help it go away more quickly, and or make you more comfortable until it goes away on it's own.

Which is why, when we give someone meds AND EDUCATION and say, take these meds for 10 days (even if you feel better and don't think you need them) and don't run, jump, ruck, lift, whatever for 2 weeks, it is a combination process to promote your speedy recovery since we have removed one of your protective mechanisms.

Unfortunately, almost everyone knows better than their "Doc" (whose advice and education they sought out) and they take the meds for 36 hours, decide they aren't going to work and then head back to the gym or out running anyway. Then they come back in a month and tell us that they are still in pain, we don't know what we are talking about, I need something else.

There are lots of approaches to medicine, East / West / non traditional / hollistic / etc...hence the "PRACTICE" of medicine. In days gone by, people did what the doctor told them, sometimes they got better, sometimes they died. With the internet and TV commercials about the latest and greatest designer drugs, everyone knows more than the guy they came to see. Hence the "Relationship" between Dr. and patient is no more....it is now a "stump the chump - I know more from 12 minutes on Google than your measly 12 years of wasted medical school you quack.

Effective treatment to minimize your discomfort is usually at your request. But it also takes your participation.
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Old 3 November 2011, 09:14
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Reduction in swelling is primarily, as a developed culture, we are pussies.
Alot of this is due to the parents that rush the kids to the Dr. everytime they cough. Wifey and myself argue about this all the time.

Quote:
With the internet and TV commercials about the latest and greatest designer drugs, everyone knows more than the guy they came to see. Hence the "Relationship" between Dr. and patient is no more....it is now a "stump the chump - I know more from 12 minutes on Google than your measly 12 years of wasted medical school you quack.
The demise of the Doctor/patient relationship cannot only be blamed on the outside influences of Google and infomercials, The healthcare provider takes alot of the blame in that they cant spend time with the patient anymore. Most Dr. offices feel like assembly line medicine today. The Dr. doesnt take time to talk and get to know you because he has to get to the next customer. When you take up your alotted time your done. The General practitioners just dont take care of you like the used too.

Dont even get me started on the some Doctors "Omnipotent attitude"
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Old 3 November 2011, 09:31
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Originally Posted by Cold1
The demise of the Doctor/patient relationship cannot only be blamed on the outside influences of Google and infomercials, The healthcare provider takes alot of the blame in that they cant spend time with the patient anymore. Most Dr. offices feel like assembly line medicine today. The Dr. doesnt take time to talk and get to know you because he has to get to the next customer. When you take up your alotted time your done. The General practitioners just dont take care of you like the used too.

Dont even get me started on the some Doctors "Omnipotent attitude"
+1. And sometimes, I know this might seem like blasphemy, but the doctor is wrong. And sometimes, that time spent on Google can prove itself valuable.

I dont mean to imply that I disagree with the comments of ussfpa, because I truly don't -- but I want to buffer my agreement with his comments by stating that I've found over the years, just a little more than a handful of instances where the doctor was wrong. And in two of those cases, where it resulted in some serious issues for me. I survived, no biggee, but I've since learned that while you should put an awful lot of attention to the advice you are receiving from your medical provider (especially if you are paying him/her), you owe it to yourself to resolve any doubts or concerns you might have with that advice, and to also simply educate yourself as to the whys behind the advice being given....
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