Common Misconceptions About Swelling & Injury
We’re back for another episode of the Unreal Results podcast after a much needed hiatus! If you’ve been here for a little bit, you know my stance on swelling after injuries is to have it pretty much eliminated after 48-72 hours. Unfortunately, that opinion about swelling often gets confused with inflammation and tissue healing. In this episode, I talk about common swelling reduction strategies like R.I.C.E (Rest, Ice, Compression, Elevation) and the newer P.E.A.C.E. & L.O.V.E. protocol and why they may not fully optimize the body’s natural healing processes. You’ll also hear specifics and my experience using my Swelling Reduction Protocol with my athletes for acute injuries, as well as managing excessive, stagnant swelling that can impede recovery. This episode will challenge your assumptions about swelling and help you to elevate your practice to the next level.
Resources Mentioned In This Episode
Episode 3: Swelling Reduction Protocol That Works Like Magic
Episode 25: The Peripheral Heart
Episode 37: Swelling Protocol Update
Episode 47: Always Check The Distal Pulses
FREE - Get the Swelling Reduction Protocol HERE!
Online Course: Magical Swelling Reduction Protocol
My Podcast & YouTube Guy: DocJoeO IG
My Photography IG Account: AJH_lensofview
IG Post: FAQs About Swelling
Learn the LTAP™ In-Person in one of my upcoming courses
Considering the viscera as a source of musculoskeletal pain and dysfunction is a great way to ensure a more true whole body approach to care, however it can be a bit overwhelming on where to start, which is exactly why I created the Visceral Referral Cheat Sheet. This FREE download will help you to learn the most common visceral referral patterns affecting the musculoskeletal system. Download it at www.unrealresultspod.com
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Anna Hartman: Hey there and welcome. I'm Anna Hartman and this is Unreal Results, a podcast where I help you get better outcomes and gain the confidence that you can help anyone, even the most complex cases. Join me as I teach about the influence of the visceral organs and the nervous system on movement, pain, and injuries, all while shifting the paradigm of what whole body assessment and treatment really looks like.
I'm glad you're here. Let's dive in.
Hello, hello. Welcome back to another episode of the Unreal Results podcast. The day I'm recording this is Joe's birthday. So, DocJoeO, who is my podcast editor and YouTube guy. He's the Joe I talk about every time I mention, um, A link I'll share in the show notes. And so, um, very thankful for him. Very, um, happy to celebrate him today.
So, happy birthday Joe. Um, I hope you had the most wonderful day. And, um, if you're listening, uh, find him on Instagram. Wish him happy birthday. I know it will be belated by the time you hear it, but still, like, give him some love. Um, I actually, Joe came to one of my in person classes, um, last summer, and some of the people were like, oh my gosh, this is Joe you always talk about in your podcast, it's so good to like, put a face behind the name.
So on Instagram, he's at docjoeo. You better link that in the show notes, Joe, so people can go give you some love, um, but I hope you had a wonderful birthday. It's also the first day of March, um, I don't know where February went, it went by, so quick, after January was so long, and I know every year, we're saying these same things.
So, it's not like it's new information, not like it doesn't happen before, or not, doesn't, it's not like it doesn't always happen, but yet, here we are in March, and, um, two days ago, it was looking like, on my schedule, March was going to be like, fairly open for me to be at home, to get a lot of like, business work done.
Which, I have a lot to get done this month, um, but then, this is the nature of working with athletes and working with the way I do and how I work with them and how they don't live in my same town and so when something comes up and they need me, I kind of have to drop everything and rearrange my schedule and so now, March is looking.
Really busy for travel as well and just not being at home as much as I would like. And that is tough because I was also counting on March to do a lot of like personal appointments. I have my, which I'll still like, I'll fly back for a couple of them that I, I have to go to, like I want to go to, but it was just like, oh, this was supposed to be the month I was like catching up on everything.
And I don't mean to be complaining because I'm not. It's just, um, what I deal with and I like to share what I deal with. So it's not all, um, well watching and beaches around here. So. Even though I would like it to be. I just shared in my newsletter this past week, um, my email. Like the email I sent to my email is funny to still call it a newsletter because I don't think people do that anymore. But anyways, I just shared in my email like I actually did like a little intro about me because I've had a lot of new people join my email list and I'm like, I don't know if you even know who I am So I did that but um, and I did share some pictures from this last week in Maui.
I was on vacation, that's why we've had a little break in the podcast. I was on vacation from Tuesday to Tuesday, so that's basically like two podcasts worth, even though it was one week of vacation. And, um, man, it was so nice. Like, first of all, the weather was amazing. Which, you're like, Anna, it's Hawaii, duh.
But, The weather's not always amazing in Hawaii. Um, the last time I went there, in February, for whale watching, um, which was actually two years ago because of the fires. We didn't go last year because of, you know, they were still recovering from the line of fires. But, um, two years ago when we were there, it rained.
Every single day and not just like Hawaii rain of like, you know, as they call the mist like pineapple juice. But like poured down rain all day long gray cold rainy. We still went watching and saw some epic whale stuff but we were like soaking wet the whole time and I didn't even get a tan and wasn't able to lay on the beach didn't really go snorkeling and so Um, though it was still enjoyable and it was still vacation, it was like not my idea of the perfect vacation.
So, this year was back to sort of like normal Hawaii style. It was like 80 degrees all week during the day and cooled off a little bit at night. You know, something like good for a light jacket. And um, the whales were amazing, the water was clear, the, got to snorkel. Spent a lot of time snorkeling actually.
And, um, we got our blue water swimming off the boat, which is one of my favorite things. Um, so many whales. I shared pictures of the whales in my email to everyone, but also if you want to see pictures of the whales and you've missed them when I, when I shared them in real time, I have an entire Instagram account that I'll have Joe link in the show notes, uh, for my photography, which mainly is wildlife, like whale photography, whales, dolphins, sea life, kind of marine life.
Um, it's on Instagram, it's AJH, which is my initials. Um, underscore lens of view, um, and I share things there and I'll be continuing to share things. I mean, I took 2, 000 pictures, like, minimum. So, I just, you know, it takes a while to go through them, especially since it's not my main job. Um, what I most liked about the trip is actually being in the vacation bubble.
The vacation being, the vacation bubble being, like, I told people I work with to, like, pretty much not bother me. Um, and my sister's actually also pretty good about not, not like, I mean, she still talks to me when I'm on vacation, but she tries not to, like, bother me too much when I'm on vacation. The time change difference, like, helps with that too.
But, um It was just really nice to not deal with life, if that makes sense, like, just to ignore everything. Ignore all of my to do lists, ignore all the things I had to do, and just enjoy Hawaii. And as much as I love being on Hawaii because I love the people, and the food, and the weather, and the water, and the animals, and like, the beauty of Hawaii, Um, I tried to extend my trip, mostly because I just wanted that feeling of vacation.
It's like, I guess I can only explain it as like the day I had to come home was like a little bit like the Sunday scaries of like, oh, I have to go back to it. Which is kind of crazy because I love what I do and I love the athletes I work with and I love like my work. It's just, for whatever reason, it's been feeling really overwhelming.
So, um, Just, I think it's just the season of life and things and, and like, you know, probably even a combination of me not doing great and taking care of myself lately. Um, you know, worrying about a lot of other people more than myself. And so, I know, I know, I know all the things I need to do to do to, to like feel better, but I was just like I haven't felt that feeling for a vacation in a long time or on a vacation in a long time.
And I was just like, wow, I really needed this. And also maybe because I felt that way and maybe because I'm in this space because last year I didn't take my normal planned vacation because one of my main athletes had a significant surgery and we were trying to get him back on like a tight timeline.
And that was It's very time intensive, but more so very emotionally intensive, uh, for all of us. And so it was, like, last year was really draining and just kind of hit the ground running this year. And so, um, yeah, I still am like, I'm glad I took that vacation, but I feel like I need another one. So hopefully I'll get to do that.
But anyways. I don't want this whole podcast to be like a Dear Diary like therapy episodes. So super excited for things that are upcoming, even though I clearly just complained about it. I am excited for it. I'm excited for the delivery of it to be in it. I'm not excited for all the things I need to do to prepare for it.
Um, but we have the, well, we have the Denver in person LTAP coming up April. There's only two spots left in that course. So my Denver, like, Mid America people, like, this is your chance for a local ish course. Um, it's also opening weekend of baseball, and if you're a baseball fan, the Rockies are in town that week, so you can come in a day early or stay a day late and catch a Rockies game.
I'm actually trying to do that, because that's the only stadium in the West that I haven't been to, so we'll see. Anyways, so that is in person course. The other in person course, Durham, North Carolina, mid May, that's also filling up. I think I have If I remember correctly, I think there's seven spots left in that course and then, um, the April or the online LTAP level one course starts April 14th.
So if you're new around here, you might not know that before the online course, I usually do a free little like week long taster course that introduces you to this whole organism paradigm and, um, It teaches you the first test of the LTAP, which is the SI Joint Locator Test. And, um, last year I called that the Missing Link.
Previously I've called it the Results Cheat Code. I'm anticipating it being called the Missing Link again this year. Um, it's free. Registration for that opens March 14th, I believe. Um, and then that will run March 30th. So, um, looking forward to that. And If you're on the waitlist for the online LTAP level one, um, the pre sale, the secret, the secret pre sale to the waitlist is March 10th through 13th.
So if you know you're interested in joining the online LTAP level one already and they're like, let's go, I'm ready to sign up. Make sure you're on the waitlist and you'll get some extra bonuses for enrolling earlier and you will also be the first. people to hear the new in person course locations and dates for the rest of the year.
So looking forward to announcing those. Um, that actually is harder than you think finding locations. Um, cause it's not just like picking the right city. It's, you know, a little bit the right city, um, for me, um, in the right time of year. Um, but then it's also like, working around my schedule, my athlete's schedule, but then it's the, the hardest part, actually, that's not even the hard part.
The hardest part is finding a host location that has enough space and enough tables. We need 12 tables for a full course, um, like 10 minimum, and, and so a lot of people who are interested in hosting don't have that many tables, which I get. And don't really feel like they have the network in their communities to like bring in enough tables.
I can't bring that many tables everywhere I go. Um, and I also, um, can't, I refuse to ask the participants to bring their own tables. The Barral Institute does that to this, and it drives me fucking bonkers. And, I just, I can't. I can't. I get it, why they do it, but I also, I'm like, they make so much money in those courses.
I don't make as much as them. I have 24 people in my classes, they open it to 60. So it's like, maybe if I had that many more people, I would supply tables. But I'm like, uh, I don't know. Can't make everybody happy, it's hard. But for right now, I have a firm. Like, no, I'm not asking the participants to bring their own tables.
I do that in San Diego for my local people. Because I'm more of the course host. Luckily in San Diego. Not only do we have a big, beautiful space to use at Olympus, um, movement and performance, but it's right near Earthlight, which is the maker of really amazing massage tables, and Earthlight often gives us tables to use, which I'm, like, always, like, so grateful.
I will, from now on, when I'm buying a table, buy Earthlight just for that support that they're giving me. So. Anyways, so that's really what's coming up. Oh, and then also in March I have the beta version of the LTAP level 2 course. Yes, you heard it, level 2 coming out this year. I'm testing it out in my annual mentorship mastermind weekend, which since I'm teaching the whole weekend, it won't be a mastermind.
So I'm calling it the uh, the mentorship seminar weekend. It's going to be three days with alumni that have already gone through the LTAP level one and or the revitalized mentorship. So I'm super pumped for that. If you, if that is you, if you have heard about this, if you've, if I sent you the link for it, it means you are eligible.
Um, and I have four more spots in that too. So, um, there's still time to get into that. And I'm like so stoked to have that rolling out and have new content and then about half the group so far is going whale watching with me the day after and here in san diego on Gone Whale Watching. So super excited to share that with everybody because I love it so much.
So 15 minutes of updates. I Apologize that it takes that long but like it's been two weeks. I have a lot to say Uh, what this podcast episode about is going to um, kind of bring us back to it's funny because it was like my last episode was 100 episodes, which is a big like Hey celebration, but also this next episode is kind of like One of the first episodes I did was one of my most popular, um, free things I have, which is talking about the Swelling Reduction Protocol, right?
I have a free download, which I'll have Joe link in the show
notes, of the Swelling Reduction Protocol. It's definitely, like, the most popular thing that brings people into my ecosystem, um, from social media. And often when I, whenever I post about it, it gets a lot of, um, traction and a lot of conversation around it.
And it's also what I'm really passionate about, um, it's what my athletes are really passionate about, um, because it works. And so I wanted to talk about it again, um, I have multiple episodes on the Swelling Reduction Protocol. Um, so I'll have Joe link those in the show notes. The original one is like a deep dive into it.
It's almost like taking the course. And then the other episodes are sort of like things I would add into it. Um, the way I use it in post surgery, that kind of thing. This episode, I want to talk about the common misconceptions about swelling and healing that come up, um, often from people are just trying to be dicks on the internet and like question what I'm putting out there.
But also it comes from the questions they have. I see it comes from a place of like, this is what they were taught and this is what they're, they believe and so I'm challenging their deeply how belief about how the body works and I wanna clear it up. And so I do wanna give some like airtime to it because for every, I think for everybody who like
speaks up and does ask those questions I'm sure there's a handful of people who also wonder that too and so I don't want to always just like shit on those people because even though they can be rude sometimes in the way they ask it, it's valid questions and fair questions. And like, this is why I put it out there is because it is different than what we've learned in school.
It is different than industry standards. And so like, I get it. When I present something completely different from industry standards, there's a lot of cognitive dissonance because it's challenging deeply held beliefs you have about how the body works. That's the whole thing, right? This is the whole thing.
Even this podcast is about is changing the paradigm, changing your way of thinking a different lens of view that considers the whole organism, the viscera, the nervous system, the lymphatic system, and how everything is integrated, integrated together that creates this organism which relies on this nervous system response that is wired for survival.
And so, um, I get it. That's not the way we're taught. Um, in this industry, we're taught in a very biomechanical bias, musculoskeletal bias, lens of view. And, um, So, a lot of the things I teach are really challenging our beliefs, and when I, like I said, when, when you challenge your deeply held belief system, it doesn't feel good.
There's a lot of cognitive dissonance, and often, when it doesn't feel good, and I've created cognitive dissonance, right? Like, going back to the nervous system, what do people do? They fight back. And sometimes they fight back by being defensive and like being like, you don't know what you're talking about.
So, fair. Like, I, I get it. I, I struck a chord. I, I kind of, like, there's a fine line between somebody being defensive and curious and then someone being defensive and just a dick and is like, you don't know what you're talking about and I'm an asshole and I'm just trying to like, talk down to people, right?
You can usually tell those people and, and sometimes when it's that person I just block them and delete their comment, usually screenshot it for, for content. Um, but when it's somebody that is like actually curious and defensive, maybe could be nicer, but like not overly rude, then I'll write back. Um, oftentimes they don't respond ever again, whether they even read it or not, I have no idea.
But I get, I try to give people the benefit of the doubt. So, um, that's what we're going to talk about. So the swelling reduction protocol, um, as I've implemented it with my clients and as other people have implemented it with their people, um, it works amazing for acute swelling as well as chronic swelling.
And ultimately I've, I've talked about it a lot. Like I've talked about it a lot as like even A healing protocol because ultimately what the swelling reduction protocol does is it facilitates the body's natural vascular and lymphatic response to injury or natural vascular and lymphatic response, just systemically good function to maintain your fluid flow.
Right, so the swelling protocol basically is ensuring optimal flow of the vascular and lymphatic systems by making sure distal pulses are strong, right? Your distal pulse is a representation of the overall health of your vascular system. So the assumption is if you restore your distal pulses. They're optimized, then the whole fluid system of the vasculature is running well, and the lymphatic system is in the same areas of the vascular system.
So we can assume that if we improve the vascular system, the lymphatic system can be supported as well. And so the, what the swelling protocol does is ensures that the common areas that those systems get stuck in the body. which are at the thoracic duct, so at the thoracic inlet, um, for the majority of the body, the left thoracic duct, for the right side of the head and the right upper extremity, the right thoracic inlet, there's not really a duct, it's just more of the thoracic, um, lymphatic vessels, and then the area around the liver.
The liver itself can be like, um, a little congested, but the liver makes a joint around the vena cava and the cisterna chyli, a very large lymph node drainage spot in the trunk. And then your vena cava is your biggest vein bringing everything below it, all the blood below it back to the heart. The liver has a ligament.
That goes across from one side of the liver to the other side of the liver and those vessels Rest right there and the liver actually rotates around it. And so that can be a clogged spot for those vessels It also is right where the diaphragm is and the diaphragm can also be another clogged spot for it And then the anterior hip is an area that, um, of a common area of entrapment and the anterior hip can be entrapped for many reasons.
It can be coming from the posterior or the anterior itself, but addressing the anterior hip is one of the spots. That's the top of the adductor canal. The bottom of the adductor canal is the adductor hiatus. That's another spot. Which correlates also to the back of the knee, the popliteal space. And then, the, the last spot is really the lower legs.
The lower legs is, um, often gets neglected with people, but like, facilitating drainage and space within the compartments down in your lower leg. It's really powerful. In fact, that's where the role of the soleus comes in, which I did a whole episode about the soleus that Joe will link in the show notes.
And the soleus is also often called the peripheral heart because it plays such a huge role in helping bring fluid back up to the heart. So, that's really the swelling protocol, is those key spots and restoring the distal pulses. So it's that simple. Right? Like, in the original episode, I go in and I like, describe like, the anatomy of all those spots and like, how I would like, treat them, I have a whole course on it, of course, but that, that's really all it is.
So, let's go over the common questions. I did a whole Instagram post on this, which I guess I'll have, um, Joe, um, sharing the show notes, so it's like, you know, the, let's talk about, like, current industry standard in dealing with acute injury. We're gonna keep it acute injury because that's probably where the most questions come up versus chronic swelling and, like, optimizing healing.
Well, optimizing healing, we'll still talk about the acute injury, but chronic swelling, it's easier for people to appreciate how this plays a role in chronic swelling for some reason versus acute. So today we're going to be talking mostly about these like, um, cognitive dissonance pieces around acute swelling.
So excuse me. Strategies for an acute injury that involves swelling is, you know, previously it was R. I. C. E. is an acronym for Rest, Ice, Compression, Elevation. You know, five to ten years ago, ice, all of a sudden people are like, fuck ice, we're doing it wrong, ice actually impedes healing, ice is the bad guy.
But at the same time, the good guy because then cold plunges got really popular for like nervous system recovery. That's a whole nother conversation. But, um, so they threw the ice out. And they also said, along with the ice, anything that impedes the body's own healing response. is not good. So, at the same time, they're like, no ibuprofen.
Ibuprofen is a, um, non steroidal anti inflammatory drug, as well as an analgesic. So, a lot of people would take ibuprofen for both the decreased swelling as well as the pain relief factor. And so, people are like, don't take ibuprofen and don't take And don't use ice. So, ice was thought to be, well, ice got her battered up because there is some studies that show that it decreases, like, the body's, like, healing response because it slows, like, things down.
Which, yes, but, ice, really, the primary reason for using ice in the first place has always been analgesic, right? Analgesic meaning pain relieving and ice is a great pain reliever and it's not chemical, it's not pharmaceutical. So it's like pretty low risk and I would argue that the amount of decreased healing response that you may get from the ice is not as big as people think it is.
And in fact, an excessive amount or a of swelling and swelling that is stagnant actually clogs up and, and prevents the healing response more than a little bit of ice does. For the amount of ice you need for the analgesic, it's not that much. So it depends on the person too, right? Some people get injured and the pain they, they deal with just fine.
Other people get injured. And their pain is like through the roof. And so ice can be a very quick way to turn their pain signals off. So I don't throw out ice. I don't think we need to throw out ice. I think you just need to realize what the whole purpose of ice is to begin with. And then use your own clinical judgment if it's the right move or not.
If people are not having a high degree of pain, then yeah, there's no need to ice. But if people are really in pain, like ice. Please, please ice. It's so good at decreasing pain. And then if, if you're like, no, I don't really want to use ice because of the potential that it might have on the, whatever, okay, fine.
Don't use ice, but you better have some other non pharmaceutical ways to decrease pain. Are there? Of course there are. A lot of neurology stuff, right? Light gentle skin stimulation. Joint mobility in the other joints, eye exercise, humming, breathing, like there's so many ways to decrease the pain sensation because pain is an output Um, but just know that ultimately like ice in the whole rice acronym in the first place was for for analgesia for decreasing pain.
Not for healing, not for decreasing swelling. Those are not why it was used in the first place. So. So the, let's go back, the R was rest, the I is ice, the C compression. And we learned in school that focal compression is better than circumferential compression. That's why like when somebody sprains an ankle, we would use a horseshoe around the medial malleolus because it helps get the swelling out of that area better than just circumferential compression.
And then elevation, of course, elevation, meaning whatever. The injured or swollen part, you need to bring it above where the heart is to facilitate the drainage, to facilitate the return of the vascular lymphatic flow. Okay? So now people are like, that's not, that's outdated. There's a better way. And the better way they came up with is the acronym peace and love.
Now. I don't know about you, but remembering four letters of an acronym, like rice, is way easier than peace and love. I don't remember. That's a lot of letters. And, and some of the letters are repeated letters. So is the E in peace elevation or is the E in peace exercise? I don't really know. We gotta look it up.
Um, but the P, I'm like, I don't even, honestly, what is it? Let's, let's look it up together. And so where this came from, I never talk about peace and love because that's like, this is how you know you went to school as a millennial or newer generation, whatever the fucking names of those generations are, I have no idea.
I am like in that weird in between generation. I'm, I'm the Goonies generation. I was in 1980. So, um, I'm like, yeah, I know when you went to school, if you're using peace and love and, or you're just like in it. Evidence based practice lover. So peace and love. Let's look it up. so funny. Okay. Protect.
Elevate. So the first E is elevate. Avoid anti inflammatories. Compress and educate. Oh, gotta love it when people include education in as part of the rehab protocol. Which, I'm not against educating people about their injuries and about how to take care of their injuries, I just find it ironic that it needs to be in the acronym.
So, um, Peace is supposed to be used in the initial parts of an acute injury, and then followed by love, which is load, optimism, Vascularization, okay, and exercise. Um, again, maybe it's the generalization thing. I'm all about being optimistic. This is why I have a protocol that gets rid of swelling so fast and gets you back on the field, back on the court, back on the pitch, like, you know, back on the track, is because like, yeah, I'm optimistic that this ankle sprain isn't gonna hold you out from practices or sport.
But, that's neither here nor there, it's in the acronym. So, LOAD meaning progressively, load it, like move the joint, you know, you don't, they're throwing, it's basically a counter action to REST. In this, I've done podcast episodes on REST, I've done so many posts on like REST, Rest is not doing nothing. And rest is also not low levels of exercise.
So I would consider load and loading the joint, moving the joint exercise. I would consider rest things that promote your autonomic nervous system to facilitate rest and recovery, which is different than just not doing anything. Sleep is part of it though, right? Like sleep and rest can be part of it. But just doing nothing is not necessarily rest.
Um, but range of motion, mobility, and like gentle loading, that's also, um, not necessarily always just like rest or just like the thing to do, so again, it's always nuanced, right? So optimism, okay, like be positive that you're going to get through this, whatever. Vascularization, what do they mean by that?
They mean that you will need to make sure that blood flow to and from the area is restored because we know what happens in an injury is the swelling and the vascular system send white blood cells to the area and like, All these cells to the area to clean up the damage, right? The microphages, clean up the damaged tissue, and then the other cells lay down new tissues.
The fibroblasts and all the other blast cells that are taking the wound and approximating the edges and healing it. Stitching things back together. Whatever tissue was torn in the first place to create this inflammatory response. So yes, getting blood flow to and from the area is so important because the blood flow to the area, it gets you these healing cells, as well as these, um, garbage truck cells to clean up the area.
Well, what happens is this too much swelling, guess what it does? It clogs it up and you can't get the good vascularization. So, um, This is again, like why the swelling protocol works is it, it is doing this. And it like, at the end of the day, the peace and love acronym, it's not bad. I'm just making fun of it because I'm like rice wasn't bad.
Rest ice compression and exercise wasn't bad. Just how we viewed those things are, we're bad. Right. The protocol in itself, like I still do that. Like after you get hurt, like. Yeah, you should probably rest. Does that mean you can't move at all? No. It's not bed rest. It's not don't do anything, right? But you probably maybe aren't playing the rest of the day.
You probably aren't going to go on a 45 minute walk the rest of the day if you just rolled your ankle. and, like I said, ice is a good analgesic, so use the ice if you have pain. Compression is still part of peace and love. Elevation is still part of peace and love. Rest is the P, the protection, that's what we mean by fuckin rest, it's not bed rest, we mean like, protect the part, don't be dumb.
Um, avoid anti inflammatories, yep, I agree. Do we need to put that in the acronym? Sure, I guess. I guess, or you can just tell people like, only take medicine for pain relief. And, you don't even have to take medicine if you don't want because here's all these other ways we can relieve pain. Now, um, all the other pieces, agreed, compression, elevation, these are things to decrease swelling.
Movement. decreases swelling. Why does movement help to decrease swelling? Because the muscles controlling that movement are pumps for the vascular and the lymphatic system to pump the fluid out of the area. Here's the problem though. When those fluid systems are not flowing optimally, right, those spots I listed at the beginning, if they are clogged up, you can do all the protected mobility work in the world.
You can do all the ankle pumps in the world. You can do the massage, you can do the compression, you can do elevation, and the swelling is not going to go anywhere. And then what happens is because the swelling doesn't go anywhere, right? Like, house is closed, like spot is closed. You can't get any more vascularization and healing cells into the area to facilitate the healing response.
So you just get a stagnant, stiff, uncomfortable, painful joint that is just like swollen for days. Until we see this inflammatory response taper off at about 72 hours. This is what it usually is. And then you start to slowly decrease swelling after that. But the swelling protocol, what it does is it opens up all those spots.
So we have a free flowing system. So then the body gets to decide how much swelling is necessary in the area. To facilitate healing, that's what makes the body magic, is the body's response to heal itself. I'm not arguing with that, that inflammatory response needs to happen, and so yes, I'm on board with no anti inflammatories, but I'm not on board with assuming that a super swollen joint is needed to facilitate
healing.
That's the thing and because that's what we see because these common areas of treatment are so common what we see often after an ankle sprain or after a knee sprain or after you know, a contusion is huge amounts of swelling because we're used to treating people that have entrapment of these areas.
What I see in my athletes who do a good job of taking care of themselves and maintaining space in, in those areas of entrapment, that means that they're maintaining good fluid flow in their vascular lymphatic system is what happens is they don't actually swell up as much as quote unquote normal after issues.
If anything, that's, That's the one drawback, there's two drawbacks of utilizing the Swelling Reduction Protocol on a regular basis, two drawbacks. The number one drawback is when you use the Swelling Reduction Protocol in acute injuries and you get rid of, and I don't even like to say get rid of, but if you minimize the swelling response.
You actually have an increased pain at the joint the next day because part of what decreases the pain in a really swollen joint is the tissue distension. The skin stretch that is facilitated by the amount of swelling often stimulates the skin receptors to provide like a gait control theory of pain to decrease pain.
So usually what I see is if somebody has an ankle sprain, We do the swelling reduction protocol. They wake up the next day and they have very minimal swelling, but boy do they hurt more than they do actually post injury. And so but most, all of my athletes, they would choose that over the limitation that the swelling creates more than anything.
Because what happens when we have a swollen joint, the muscles around it don't function as well. We have arthrogenic inhibition of the muscles around the joint. Because the body knows, oh my god, there's something wrong with this joint. We don't want the person to move. We want them to rest and protect.
And so the body just It's not going to work for a million dollar, multi million dollar athlete who wants to play that week, who has to play that week, right? They want to be fully functioning so they don't have another injury. So they'll take the little bit of increased pain the next day because also we have ways to treat that pain.
We have all the neurology based ways to treat that pain. We have ice to treat that pain and we have other pharmaceuticals that treat pain that are analgesics but don't do anything to the inflammatory response. It's called acetaminophen or Tylenol. Is the brand name. No free shoutouts. I'm not sponsored by Tylenol.
It's just what, you know, commonly people know of it. So, that's the first drawback. The second drawback of this is when our body is running on all cylinders, like it's doing good with its fluid flow dynamics, and we don't see as much of a swelling response, sometimes, we miss injuries and it takes us a little while to diagnose what's going on, right?
Probably like the biggest I've seen in the last few years of utilizing it with my athletes. That's the biggest drawback is we do such good work together on keeping their body feeling good that when they do have an injury to the tissue sometimes we don't really realize it until like months down the road when we look in hindsight and it's like, man, every time we were doing a little good, we have a little setback and we do good.
And we have a setback. We do good. And we have a setback. The typical symptoms don't fit with, you know, what we finally find through MRIs or x rays or whatever, what's going on is because, you know, we're used to having, you know, settling on this big swelling response with the entrapment. And so, It will look different.
And so, that's tough. It's a catch 22, right? Because in some sense, especially during the season, we're just trying to get the athlete to play and do well. But, it is, it makes it, I'm not going to lie, it makes it a little bit more difficult to like really get a handle on like what's going on with them when you can decrease swelling so well and keep their muscles strong and active and like their joints feeling good So I don't think that's a bad thing because sometimes it actually avoids interventions like excessive cortisone injections or excessive like MRIs and like maybe things that they don't need like maybe things can just you know sometimes it's like yeah it can just heal on its own and we prevent a lot of like excessive need for more invasive intervention but sometimes it means that like oh shoot like we didn't realize like this whole season.
You had this tear, and we managed it the whole season, but like, fuck, now we're in the off season, and every time we try to train it, like, it's still having issues. So, this, this is the downside. And so, I want to be, like, transparent, like, that is the downside. But, I think every one of my athletes would, like, choose all the other benefits of the swelling reduction protocol.
Besides those, because at the end of the day, most of the time, it gets people back to doing what they need to do to function. And when we're looking at non athletes, like, is it that big of a, like, if we're looking at non athletes, what that means, what that really looks like, it's not even a downside, it means like somebody that meniscus tear.
And as a regular human, like you and me, and like every, you know, we're fine and then it gets aggravated and then we deal with the aggravation and then we continue on, we have a better chance of healing the tissue on our own and not needing to get surgery. And I can't emphasize enough how powerful it is to not have to get surgery for every little thing because surgeries do not put you back to your previous timeline.
It is a fix. It is not a reverse. Right? There are consequences and risks of surgery. So, um, and, and the new tissue is different tissue. It's not like it's the same thing. Right? So if we can help somebody avoid surgery and like manage things, that's not bad. It's more challenging when you're dealing with high level professional athletes like me.
Because sometimes it's like, oh, we just ate up our off season when, if we would have just, you know, realized this in the first place, we would have had three more months. But, on the flip side, maybe we would have had to end the previous season short, right? So, at the end of the day, that's a timeline problem with the athletes, is like, the off seasons just aren't long enough to, like, fully fix things a lot of the time, so.
Um, This podcast episode is going way longer than I thought, but clearly I'm like very passionate about this, but I did want to like actually read some of the comments from people that I get because um Like I said, I think, I think some of them are valid. So this one was, oh, this person was a new, I always look on people's profile too, like who are you?
Why do you think that you know better? But this person was a new grad and they were like, would love to see the stats on re injury in your athletes. You claimed on the free PDF that you had NFL players with grade two and grade three ankle sprains return to play the next day, question mark. How does your protocol address in.
Heal a ruptured ligament in less than 24 hours. So I never This is a little bit of like well you're reading between the lines because never did I say this protocol was to heal things in 24 hours. I said it was to decrease swelling in 24 hours. Now there is a difference between no swelling and healed tissue healed tissue takes weeks to months and years, depending on the tissue.
I'm not healing the tissue. I'm decreasing swelling. So a little bit of that is people thinking that swelling equals healing. Swelling and healing though kind of are related, not the same thing. A lack of swelling doesn't mean tissues. Right? Because we've got tendinosis and tendinopathies that don't involve any healing but have a lot of tissue damage.
So that doesn't hold up, right? That theory doesn't hold up. So this is somebody not understanding that, you know, that kind of nuance. And then also understanding that our body's amazing and we can function on things that are torn, right? If we tear, you know, if we tear some fibers of our calcaneofibular ligament in an ankle sprain, Can we still walk?
Yeah. Can we still jump? Yeah. Do we have a little less proprioception around our ankle? Absolutely. Um, should that mean that we don't play if we're a multi million dollar athlete in the next game? That's up to the athlete. That's not up to me. As long as they know the risks, it's up to them. But then also we have modalities, we have ways to improve the proprioception as that ligament is healing.
We're not ever going to speed up healing, but we can do a lot of things to slow it down. And is there a risk of re injury? Of course, but you know what makes the risk of re injury even higher? Stagnant swelling. Stagnant swelling that creates arthrogenic inhibition. I can't. exercise my way out of that. I can't kinesiotape my way out of that.
I can't do anything out of that. That is a fundamental nervous system protection pattern, right? So the best way to get over that nervous system protection pattern is decrease the swelling. I would rather an athlete play on an injured joint that was not swollen versus go to play on a swollen joint. I've seen so many athletes be told by their staff.
It's okay to play on a huge swollen knee. It's, it's kind of crazy because I'm like their quad can't even turn on when they have that much swelling. They are going to get really hurt, right? So it's like, I'd rather have the little bit of decreased proprioception, but the muscle control because there's no more arthrogenic inhibition than swelling and arthrogenic inhibition and then playing like, that's crazy.
So, my response to her was, Hey, I did not claim to heal tissue in one day. I said decrease swelling. They're not mutually exclusive. And then I actually looked into it. I said, hey, great question. My NFL athletes collectively in the last 12 years have averaged about 10 years in the league. In case you didn't know, the league average is typically two and a half years.
From a significant non contact injury standpoint, that has resulted in multiple games lost for my athletes in 11 years. So I say, from a significant non contact injury standpoint, um, it's resulted in, oh, that have resulted in multiple games lost for my athletes in the last year, there have been two.
That's it. Two injuries in 11 years. Um, and I said, since you were going to be a new grad, it was in her bio that when she was graduating from DPT school, I said, let me share some insight on how athletes and professional sports operate. They're often playing on swollen joints, which decreases their proprioception, body awareness and mobility quite significantly.
So playing on injured tissue with minimal to no swelling is more ideal. So again, would I do this for Joe Schmo? I mean, I, it wouldn't be as high of a concern, though, when I have swelling in my joints, it doesn't feel good and I would like to feel better as soon as possible, um, so, you know. And then, um, the response was, so it's okay to play on injured tissue or when you say return to play, do you mean modified exercise that it's appropriate for their injury?
And I, my response, which is often my response in this kind of scenario, is their body their choice. I said, yes, the athletes play through minor injuries regularly and it is okay, especially when managing the swelling, which allows to help, which allows, um, to maintain optimal blood flow for healing.
Stagnant swelling impedes tissue healing. That is like, if that's all you get out of this knowledge is like, that's good. Stagnant swelling impedes tissue healing. So let's talk about stagnant swelling as a bad guy just as much as we talk about anti inflammatories and just as much as we talk about ice being the bad guy with healing.
This other thing, this person said, so we just. So are we just ignoring suppressing the millions of years old human inflammatory response now? Is it not a process that provides vital healing components for the injured tissues? And this whole time I've been telling you, like, no, we're actually facilitating this response.
We're allowing this response to be magical like it is by preventing it being clogged up by itself.
That's what I said, I said, Hey, nope, not at all. Actually supporting the body's amazing lymphatic and vascular system to ensure the inflammatory response is optimized and its healing capabilities and not impeded by excessive and stagnant exudate or swelling. It's actually pretty amazing to see how efficient and effective the body is at healing when these systems are supported.
I am constantly surprised how little amount of swelling is actually necessary to support healing. This guy said, you shouldn't be reducing inflammation in 24 hours, the inflammatory process is vital to the natural healing and when you reduce the inflammation in 24 hours rather than gradually over time, over time you interrupt that process.
Just use peace and love protocols, the most current guideline for acute and subacute injury treatment, not to mention it's free and you don't have to attend any seminars or land on an email list to learn about it. Well, you don't have to land on the email list to learn about this either. I provide all this free education in the podcast and on my Instagram.
But again, what he's saying, he's misunderstanding that I'm not stopping the inflammatory response. Decreasing swelling is not stopping the inflammatory response. Decreasing swelling, the way I'm decreasing swelling is by facilitating the vascular and lymphatic system the body's inflammatory response and allowing the body to dictate how much swelling is necessary
So again, how I answered it to him, just for the record, the degree of swelling is not indicative of the quality of inflammatory process for healing. Another practitioner thinking they know better than the body does. When the lymph and vascular systems are free to do their job, the amount of swelling needed for healing is actually often both a small amount and not long lasting.
So again, as I said, the majority of the inflammation response for healing happens in 72 hours and then over weeks. But the big burst of it is those first 72 hours. So why are we okay with joints being excessively swollen for longer than that?
And then the last one was a more recent one, those are a couple, a couple, uh, weeks ago. Let me pull it up. Chronic swelling is problematic, but it isn't the body's reaction of, but isn't Isn't, isn't not, is not the body's reaction of acute swelling beneficial for the injury and part of the normal recovery process?
So again, this is the same question, the same theme people have. Like, isn't them, isn't inflammation and swelling good and part of healing? Yes. Yes. But stagnant swelling, excessive swelling, impedes the healing response. Period. So, I hope you don't feel like going through these is petty, because I'm not trying to be petty, but I'm just trying to like hammer home.
No matter how many different ways people ask it, they're asking the same question, and the same, and it always goes back to the belief that swelling equals healing. Swelling does not equal healing. The inflammatory response equals healing. Swelling, the amount of swelling, is not indicative of the degree of the inflammatory response.
The amount of swelling is indicative of potential entrapments creating stagnant swelling or an ongoing injury to the tissue creating persistent swelling. And this comes down to monitoring the distal pulses. You know the difference between persistent swelling and stagnant swelling based on the distal pulses.
And I have an entire podcast episode all about that that I'll have Joe link in the show notes. But if we have an amount of swelling in a joint in a good pulse, then we can assume that is a new injury or persistent swelling because of something like a meniscus tear or a chondral defect or like something that we've missed, right?
Or a tendonitis or something like that. If we have excessive swelling in a joint in diminished distal point pulses, we can see that as ah, that is maybe an old injury with static, or sorry, stagnant swelling, or that is acute swelling with a clogged up lymphatic and vascular system somewhere, and so we're actually impeding the healing response.
That's all it comes down to. Whew. I have a lot to say about that. I hope this was helpful. So, thank you for being here. If you haven't already, download the free Swelling Reduction Protocol. Take the course or don't take the course. It doesn't hurt my feelings even way. Either way, I have a ton of free information out there if you want to just do the free route.
If you all, if you want it all in one spot, then I have the course. So I'm glad you're here. I'm excited for all the teaching coming up and uh, go wish Joe a happy belated birthday. See you next time.