Agatsu West Classics are articles I wrote in 2007 when I had just graduated from the Somatics Institute of Massage Therapy, and had just started BJJ. I wrote them to give a unique anatomical and pathophysiological point of view on the techniques I was learning, that inquisitive minds might better their understanding of "why" certain techniques worked the way they did, rather than just being satisfied with "how" to do them. Some were basic rehab and prehab concepts as well. This one deals with one of the most widely used forms of physical therapy in the world - heat and cold.
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The "How" and "Why" of Proper Hydrotherapy
What is Hydrotherapy?
For those of you that are not familiar with the term hydrotherapy, it describes the application of heat or cold to help with the healing process of an injury, or to produce some other physiological response. Hydrotherapy forms one of the staples of an effective massage treatment, and is also widely used in sport, but as well-meaning as coaches or comrades are, there are many misconceptions about the proper application and timing of hydrotherapy for an injury as the result of training, and make no mistake, incorrect hydrotherapy can have a significant effect on the completion and speed of the healing process. Cold hydrotherapy, as a general rule, draws fluid out of the area of application, and heat draws fluids in. Common knowledge usually extends at least this far. But when exactly do you want fluids drawn into the site of injury, or out? Can both hot and cold be used in the same treatment? And how long and often should the hydrotherapy be applied? For that matter, what do cold and heat actually do, beyond their effect on fluids? To answer these questions, I first have to explain the physiological effects of hot and cold, and the three stages of healing that every injury undergoes.
What Heat Does:
-A local increase in tissue temperature, studies have shown that an application of heat on the surface of the skin can affect tissues about 3-4 cm into the fascia and superficial muscles.
-Increase in vasodilation, as well as blood flow both to the skin and muscles. This results in an increase in metabolism, oxygen and nutrient supply, and an increase in sweat production. Applications to the limbs is proven to increase bloodflow two-fold, with the effect persisting for approximately one hour after the application was removed.
-Pain perception is decreased, as a result of decreased nerve conduction velocity.
-Muscle spasms are decreased, because heating of muscle spindles causes them to decrease their sensitivity and rate of firing.
-General relaxation and sedation occurs.
What Cold Does:
-Local reduction of the temperature of skin and muscle.
-Local vasoconstriction, decreasing blood flow. Decreased cell metabolism and leukocyte migration results in a decrease in inflammation.
-Pain may be decreased if the skin is hypersensitive to cold, in this case the ice may act as a counter-irritant, decreasing the stimulus of the pain.
-Collagen extensibility (muscle flexibility) is decreased.
**VERY IMPORTANT: Stages of Stimulus with Ice Application**
When ice is applied to the skin, the client will experience the following stages in order over several minutes:
1) a sensation of cold
2) tingling or itching
3) aching or burning
4) numbness
An application of ice should not be removed before all four stages have been experienced, and to remove the application after numbness has been experienced for a couple of minutes is an effective guideline for the length of each treatment.
Stages of Healing:
Acute: This is the first stage of an injury, the stage immediately following the onset of the injury, whether it was some kind of trauma such as a car accident, or something more gradual, perhaps related to some kind of overuse over time, such as tendonitis. This stage usually lasts about a week at most, and for a traumatic injury is usually characterized by significant inflammation, a significantly decreased range of motion, and severe pain (or at least, the most severe the pain from the particular injury is ever going to be). During this stage, cold hydrotherapy is appropriate. A local application (ice pack) is ideal, To control inflammation but also to quarantine the appropriate amount of it. If you read the explanation of what heat does, you may be wondering why you wouldn't want an increase of oxygen and nutrients, and decreased pain sensitivity. Always remember that pain and inflammation are tools that the body uses to protect itself, and to let you know that something is wrong, and they are both useful and necessary. However, the body often overcompensates with inflammation, so ice is a good way to make sure there's enough inflammation to splint and protect the joint, but not too much.
Sub-Acute: This stage usually lasts for 2-3 weeks after the acute stage. There may still be swelling and inflammation, but not as much. Usually pain will be decreased as well. Most if not all range of motion will usually be recovered, but if there was any loss of strength as a result of the injury, it will be noticed during this stage. During sub-acute it is appropriate to apply heat, as well as contrast hydrotherapy, which means to apply heat for a period of time, then immediately apply ice for about a third of the time the heat was applied. This will create a pump action within the site of injury and help to clear away what is left of the inflammation, and restore functionality to the surrounding muscles.
Chronic: This stage lasts from whenever sub-acute ends, until either the injury is resolved or the person dies. During this stage, heat and contrast hydrotherapy are appropriate, but a short application of cold can be used after activity, especially if the activity aggrevates the injury.
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