[mikejones]

Hey UKB,
I've had a reoccurring niggling pain in the base of both my ringer fingers, has been diagnosed as possible A1 or A2. Anyway to get to the point of this post, I'm trying to speed recovery and have been using both ice and contrast baths.
The ice bath only seems to have any affect after 30 to 40 minutes and only after I've removed my hand does the blood flush back into the hand.
Contrast baths seem to have a noticeable affect within 10 minutes but after 30-40minutes the effect feels less intense than that of the ice bath (does that make any sense?).

I was wondering if anybody could offer some advice, personal experiences etc with using this treatment method.
Cheers!

P.S. Circulation to my extremities generally sucks, if that has any effect..?

[krymson]

after experimenting with both I've stuck with contrast baths.

I had a good experience with cool water therapy once, but most of the time i just feel like my hand is getting cold, whereas with contrast therapy as long as the temperature difference is enough, i get a pretty strong tingle.
The key with the contrast therapy is that you have to keep the hot water hot, so i will reheat it a bit once it starts cooling down.

this all is just my personal experience though. I have a friend who says the cool water works for him.

[mic_b]

The cold water treatment (I think Dave Macleod refers to as this as the lewis reaction) was only working for me very occasionally. Mostly I'd just end up with very cold fingers and little blood flow until I'd taken my hand out of the water and it started to warm up. I noticed to get this to work for me I needed to be very warm and then it would work really well. It looks a bit daft but I'll do some star jumps to warm my body up a bit then sit in front of the TV wearing my down jacket with the hood up any my hand in a jug of water with about 6 or 7 ice cubes in it. After about 5 - 10 minutes my fingers start to feel warm and I could feel the blood circulating around them. It would kind of cycle then between hot and cold then until I took my hand out usually 30 - 40 minutes.

[duncan]

I wrote a pile of stuff about cold treatment here.  Different people respond differently to the cold, ranging from an almost instant Lewis reaction to full-on Reynaud's and everything in between. Do what works for you. If contrast baths promote vasodilation better than cold then go with them. 

This applies to aches and pains past the recent injury stage; very recent injuries don't want vasodilation.

[mikejones]

Cheers for feedback guys!! I'll attempt warming up with star jumps and push ups (which I should be doing anyway) and give the ice bath a few more attempts. If still no effective results I'll stick with contrast method.

I'll try and remember to most how I find it for future reference for anybody.

Cheers again guys,
Mike

[dave]

I'd heard anecdotally that contrast baths if you're not careful can bust capillaries etc. When I've iced finders before I stick them in ice for as long as, then take em out to room temperature, basically to induce hot aches. This is based on the advise of Scouse who has been injured more than just about anyone, plus he's a doctor.

[SamT]

Rather than start a new thread.  Thought I'd tack this quicky on here. (I've had a quick search but nowt obvious)

Friction massage then ice
Or
Ice then friction.

(Historic ring finger A2 niggle)

Gut feeling says the first but thought I'd canvas opinion.

[mrjonathanr]

I I'd think 2 is risky. Surely tissues are more fragile when cold? We warm up before exercise in part to a oid injury  surely?

[mikejones]

Re-attempt of ice bath after 60 pressups and some star jumps all while wearing a synthetic. Results: hand remained freezing cold while in cold water for 30 minutes. Water possibly too cold?

Dave: Cheers for feedback, any idea how I might get in contact with Scouse? Be great to hear his experience with the A2 injury first hand.

Sam: I've read about friction massage to help break down scar tissue, think Dave Macleod has posted about it and (http://thomasbondphysio.blogspot.co.uk/2012/12/pulley-injuries.html). Maybe increased blood flow promotes production of aligned scar tissue?

[Baldy]

I'm in the same situation right now.

Last night I made an ice bath with 10 cubes, for 20-30 mins. I thought it would be too cold, but ended up being perfect.
I think my fingers react really nicely to the cold though...

FWIW I only use cold on myself, because when I try to do contrast baths I get bored of the faff and give up treatment after a few rounds.
It also means that you have to pause things that you are watching to get the contrasting heat.

Waaaay too much effort!

Ice has always worked all right for me 

[chris j]

Re-attempt of ice bath after 60 pressups and some star jumps all while wearing a synthetic. Results: hand remained freezing cold while in cold water for 30 minutes. Water possibly too cold?

Quite possible. I find a saucepan of water straight from the cold tap with no more than 5 or 6 ice cubes is what's right for me. Anything more is too cold. I'll probably add one or two more ice cubes through the 30 mins but that's it. Experiment a bit more & see if you find can find what works for you.

[SamT]

Sam: I've read about friction massage to help break down scar tissue, think Dave Macleod has posted about it and (http://thomasbondphysio.blogspot.co.uk/2012/12/pulley-injuries.html). Maybe increased blood flow promotes production of aligned scar tissue?

Yeah- I know about friction - I just wondered if there was any prescribed method of combining it with icing.  specifically - if it was dodgy to friction massage after icing - which, as MrJ noted - is probably right.

I'll stick to massaging either before, or well after icing.

[krymson]

pretty curious about this as well.  Contrast baths have greatly sped recovery of my pinky, but scar tissue in the area is less than optimal(i have a slight bump at the injury site, and pinky ROM is not full) -- I feel like i should have done more friction massage while the injury was still in the recovery stages.

My gut instinct is it's something to be done before increased blood flow, like the way a doctor might rebreak a bone to get it to later heal in proper alignment. but that's just wild ass guessing.

[Tombondphysio]

Thanks for the share of my blog guys

And with regards to ice and frictions, friction first, due to breaking down the scar tissue is easier when warmer, and that the ice will increase pain thresholds and therefore cause more damage when frictioning, potentially
I would be tempted not to combine the two, but to seperate them into different sessions, as ice will cause vasoconstriction and so the blood supply will not be able to remove the result of the frictions

With regards to contrast baths themselves, there is no real evidence out there that I've found with regards to best times and method, so personal preference is the way to go (I'm currently researching this topic because of this discussion, with view to a new blog post)

[krymson]

The cold water treatment (I think Dave Macleod refers to as this as the lewis reaction) was only working for me very occasionally. Mostly I'd just end up with very cold fingers and little blood flow until I'd taken my hand out of the water and it started to warm up. I noticed to get this to work for me I needed to be very warm and then it would work really well. It looks a bit daft but I'll do some star jumps to warm my body up a bit then sit in front of the TV wearing my down jacket with the hood up any my hand in a jug of water with about 6 or 7 ice cubes in it. After about 5 - 10 minutes my fingers start to feel warm and I could feel the blood circulating around them. It would kind of cycle then between hot and cold then until I took my hand out usually 30 - 40 minutes.

This is  legit! Warm-ass day today so  my body was plenty hot already- skipped the star jumps and coat and put my hand in a  bowl of cold water.

My hand did the cycling thing - flushed, then the opposite, then flushed again. Took my hand out of the water during a flushed phase and it felt really hot.  very nice.

Don't get the tingling feeling I get with contrast baths, but there clearly is some significant circulation going on, and like Baldy said it's a lot less hassle than setting up a proper contrast bath.

[mikejones]

Cheers for all the feedback guys! I thought I'd share my experience over the last 10 days, but reactions seem prity varied and based on how well you're extremities react to the cold so not sure how useful this is.. but here goes!

Ice baths: Still minimal results. Attempted after much warming up, wearing down jacket while sitting infront of a heater after exercise, no noticeable flushing of blood, just a bloody cold hand. One query about the ice bath method ,which might make a difference is, do you guys constantly move your hand while in the water or keep it motionless the entire time?
I ask this because I generally constantly move my hand, keeping it in contact with cold water which makes my hand colder than if I were to keep it motionless in which it feels like it heats up slightly.
I still feel like the water might be too cold, either that or my body sucks at reacting to the cold. I use cold tap water and a re-freeze-able ice block.

[andyd]

With regards to contrast baths themselves, there is no real evidence out there that I've found with regards to best times and method, so personal preference is the way to go (I'm currently researching this topic because of this discussion, with view to a new blog post)

When I dislocated my finger a consultant friend who specialised in trauma including hand stuff (how very specific of me) laughed at me when I was doing this. She said it was BS...

[Nigel]

Ice baths: Still minimal results....

I've used these on fingers before and had it work with a big bowl of water plus 5/6 ice cubes. Using on my ankle it works with a full bucket with a frozen 1l water bottle in. However in winter/early spring in my pretty cold house just straight cold water works. Everyone reacts differently to temperature changes, so if you are just getting a cold hand it might be worth you trying just cold water, no ice.

[krymson]

A good way to make the best of the situation if you just come out with a bloody cold hand is to warm up some water and do an impromptu contrast bath.

[Tombondphysio]

you may find this helps:

http://thomasbondphysio.blogspot.co.uk/2013/04/physiological-response-to-injury-and.html

[krymson]

just wanted to follow up on this. average temps in the 30s these days, pretty damn hot, stuck my hand in cold water with 5 cubes and almost immediately get the reaction going on, as opposed to the colder winter days when it was more of a battle. ice cubes dissapear right quick, indicating lots of blood flow to the area.

if u find the ice baths arent working for u, read mic_b's post, get yourself genuinely warmed up to the core and try again. its no theory it really works

[shurt]

Rather than start a new one, injured A2 last week - small audible pop, pain, swelling. Any guidelines for how long to wait until trying all of this stuff? Swelling has reduced with pills and ice. Do I have to wait till pain free and full ROM is back?

[krymson]

seems like a question that really isnt best answered on an internet forum but dave has some good advice here.

[Sasquatch]

or here:  http://thomasbondphysio.blogspot.co.uk/2012/12/pulley-injuries.html

[shurt]

or here:  http://thomasbondphysio.blogspot.co.uk/2012/12/pulley-injuries.html

Ta. I found that more useful than Dave's blog which i had read before...