Injuries — when to use ice or heat therapy?
Dr Ravinder Chadha

Certain myths are prevalent in some sections of society as regards first-aid measures. Since olden times it has been a practice to apply hot fomentation and analgesic ointment after injury. These measures not only increase the problem but also delay healing.

Hot fomentation increases swelling by enhancing blood circulation to the injured part. It is imperative to use first aid measures, which do not allow swelling to increase so that healing time can be reduced. Once an injury has occurred and has been diagnosed to be involving soft tissue (contusion, sprain, strain, etc), immediate action should be undertaken to avoid any further worsening of the lesion. This entails the restriction of one’s activities to prevent the extension of the lesion and place the injured part in a comfortable and safe position. This may be facilitated by the use of a sling, crutches, protective padding, strapping or bracing. The mainstay of the management of most sports injuries is based on the principle of minimising the extent of initial damage.

In order to minimise the extent of tissue damage, associated bleeding and pain, the following measures should be taken:

Rest, compression and elevation helps in lowering blood circulation and consequent leaking from the damaged blood vessels in the injured tissues.

Next comes in the role of ICE, which is now well accepted in the management of acute soft tissue injury. Its capacity as a pain- reliever, or its role in the reduction of bleeding and swelling is well established if applied immediately after the injury. Its effect diminishes 48 hours after injury.

· Ice therapy leads to immediate pain relief by slowing the nerve impulse in the area and decreasing the nerve cell swelling.

· It reduces inflammation and swelling by constricting the blood vessel.

· Ice therapy reduces muscle spasm by making muscle less sensitive on being stretched.

· Ice, like local anaesthesia, numbs sore tissues relieving pain.

· The recommended maximum duration for continuous ice treatment is 10 minutes, which can be repeated after a 40 - 60 minutes break, depending on the improvement in swelling. This limitation is to avoid the chances of freezing the superficial body fluid leading to an “ice burn” (frost-bite) injury.

· Never apply ice to the skin directly to avoid excessive cooling. There should be a protective barrier between ice and skin. Ice can be applied through a moist cloth or ice chips in plastic bag, a can of frozen beans, frozen gel packs, etc.

· Ice therapy should not be given to an individual suffering from rheumatoid arthritis, paralysis and impaired sensation.

Certain activities undermine the effectiveness of ice regimen as they increase circulation to the injured area, leading to enhancement of swelling. These four factors are heat, alcohol, running and massage.

Heat therapy should be started after 48 hours of injury. It increases blood flow to the injured area, thereby enhancing metabolism.

· It improves the flexibility of tendons and ligaments, and reduces the muscle’s spasm.

· It relieves pain, which is believed to be due to the inactivation of the nerve fibers and also the release of endorphin, a powerful opiate, which blocks the transmission of pain.

· Heat application can be used for chronic injuries or injuries that do not have inflammation.

· Heat can be applied for five to 20 minutes.

· Moist heat is very effective due to better absorption and can be applied with hot wet towels.

It is ideal to use ice therapy during the first 48 hours after injury and heat therapy afterwards.

The writer is a former doctor/physiotherapist, Indian cricket team

Asthmatic children can lead normal life
Dr Shakuntala Lavasa

Asthma is indeed an anxiety-provoking disease. This is basically due to lack of scientific knowledge.

Any child who has asthma to the severity of requiring nebulisation frequently is not likely to grow out of disease without specific treatment. Parents often are made to believe that children grow out of asthma.

Children often have extrinsic (due to allergic/environmental factors) asthma as compared to adults. It is possible for children to be completely normal if they are treated scientifically.

Steroid inhalers are the cornerstones of asthma treatment. They are safe. Children can achieve normal growth if they are on treatment.

There is no need for asthmatic children to be excused from PT and games; there is no need for school bus to come at their doorstep. It is seen that many parents come and request for such medical certificates. In fact exercise is a positive trigger. Games should be encouraged. Some of the asthmatics have won in the Olympics. Proper medical advice is a must.

Children do not need to stop taking milk, curd, banana, rice, etc, unless they have food allergy, which can be tested easily. Such discrimination of food articles for growing children without any reason can be disastrous for their physical and psychological growth.

Even educated parents take the help of astrologers for this disease and stop white food articles on their recommendations. In fact, adults need not follow food discriminations unless they have food allergies.

In adults, occupational asthma is a very important cause, which can be tested and can be cured if a patient cooperates.

Asthma is not contagious. Somebody asked how my son got Asthma as I did not let him go near his asthmatic grandfather. It’s a pity that there is lack of knowledge to this extent in the 21st century. This is a serious social concern.

Antibiotics mostly have no role in asthma treatment.

There is nothing like the prevention of secondary infection. We are unnecessarily straining the patients’ body and pocket and harming the community by increasing drug resistance. This issue is important for doctors to register.

Allergy tests, if done by specialists scientifically to identify major allergens, can be useful. Immunotherapy is successful if allergy tests are perfect and the therapist is trained to modify dosage and purified allergens are used for treatment.

We must attack asthma by all means. Let us not allow asthma to attack us.

The writer, who was earlier associated with the PGI, Chandigarh, is an allergy and paediatric specialist.

Acupuncture has measurable effect on brain

NEW YORK: Acupuncture has a measurable, if mysterious, effect on the brain, a new study has said.

The study adds to evidence that patients benefit from acupuncture not simply because of their expectations, Nature magazine has reported.

The research team used brain imaging to show that treatment with genuine needles activates brain areas beyond the ones that light up when trick needles are used.

“This is the first brain-imaging study that has shown an effect beyond placebo,” George Lewith, an expert in complementary medicine at the University of Southampton who led the study, was quoted as saying.

Acupuncture is an ancient Chinese treatment for illness, pain or even addiction, which uses fine needles in defined points of the body. The mechanism behind this is far from understood, and clinical trials into acupuncture have had mixed results.

“It has worked in some trials, it hasn’t worked in others, it’s very complicated,” Ted Kaptchuk, an acupuncture researcher at Harvard University in Boston, Massachusetts, was quoted as saying. — PTI