The anterior cruciate ligament (ACL) tear is the dreaded knee injury that can end professional sports careers and turn the rest of us weekend warriors into permanent couch potatoes.
At Battle Balm, we are pain specialists. We work with ACL injuries both pre- and post-surgery. Our products enhance and increase the rate of successful outcomes and help you sprint back to the sporting activity you love.
How do we know? Our CEO put his money where his mouth was. He rehabilitated his knee after ACL reconstruction (ACLR) surgery using Battle Balm. He modified the physical therapy performance plan to fit his theory, executed it on his own, and used Battle Balm instead of ice from day 2 post-operation. He believed in the Battle Balm line of products before surgery and can now tell his incredible story to others. Dylan's rapid and complete recovery after knee surgery is proof that Battle Balm should be a crucial part of every post-surgery rehabilitation plan. Did we mention that he was 38 years old at the time and recovered as fast as the orthopedic surgeon's 20 year-old pro athletes?
The #1 thing to speed ACLR recovery is to REDUCE SWELLING AS FAST AS POSSIBLE.
Many medical staff focus on encouraging movement and straightening of the knee joint after the operation. When physical therapy starts, the PT's have you begin muscular contractions on the quadriceps along with ROM exercises. The quadriceps muscles are the spotlight of the rehabilitation process, but early on, we disagree with their intense focus. We’re here to establish what you should be doing, when you should be doing it, and most importantly, why you should be doing it.
Whether you get an allograft or autograft, hamstring tendon or patellar tendon, the same first rule applies. You must reduce swelling ASAP. Read below to find out more.
What Does Post-Surgery Swelling Do?
Swelling after trauma (e.g. surgery), does three things:
It prevents damage to the joint by immobilizing it. The excess fluid is physically in the way of normal, natural movement. ROM is purposely limited by the body’s own healing response.
It causes the surrounding musculature to "turn off". In fact, the muscular contraction is impaired by the contents of the excess fluid. This secondary protective mechanism won't allow you to squeeze the quadriceps with 100% power on a damaged joint. (This can be simulated in a lab setting by effusing the joint with saline and measuring the reduction in contraction strength of the quadriceps muscle.) NOTE: There are nervous system safeguards as well, but for the sake of simplicity, they are left out.
It restricts the flow of fluid into and out of the injured area. Swelling provides warmth to the knee but is a major impediment to getting fresh blood and nutrients into the injured area for cellular repair. The only way we physically heal is by transporting nutrients to damaged tissue and transporting debris out of damaged tissue. Any impediment to this process slows healing. (This is a gross simplification of cellular activity, but sometimes high level observation of human function provides the clarity we need.)
To recap, swelling prevents further injury to injured tissue, turns off surrounding muscles to further safeguard the knee, and warms injured region. The major downsides of swelling are that it restricts movement, deactivates muscular contractions, and slows healing.
Why You Should Reduce Swelling As Soon As Possible
Swelling is the primary inhibiting factor in the first 2-3 months of ACLR (anterior cruciate ligament reconstruction) recovery. You cannot increase ROM or improve muscular contraction power without first dealing with the swelling. As the swelling decreases, both muscle strength and ROM increase as a result.
The blood and lymph carry nutrients essential for tissue repair into and out of injured regions of the body. Swelling is a natural blockage of blood and lymph. It keeps a certain amount of fluid trapped to protect and warm the injured area, but it also keeps fresh, nutrient-rich fluid out. We have found that this barrier to fluid circulation is a significant bottleneck to healing.
The more quickly you can reduce swelling, the sooner you will:
- regain muscle fiber recruitment/activation
- reduce degree of quadriceps atrophy
- recover strength
- increase ROM
- lower vascular resistance
- maximize metabolic function
Basically, you will optimize your body's healing processes and quickly accelerate through the physical phases of trauma recovery. In addition, the shortened recovery period will keep you mentally strong and avoid recovery plateaus.
The 5 Options to Reduce Swelling
There are 5 currently used methods to reduce swelling, all of which are useful in certain conditions. Ice. Compression. Elevation. Muscular contraction. Massage.
Do the first 3 look familiar? They are part of the RICE method, which is now defunct since the one who coined the phrase (Dr. Gabe Mirkin) has since retracted his statement about the use of ice in recovery.
Below is a short description of each.
Ice - Reduces swelling. Ice initially dilates the vessels as the body tries to respond to target tissue by trying to warm the tissue back up. But in prolonged use, the body will respond by constricting blood and lymph flow to the area. Swelling gets reduced but at the cost of fluid circulation, the primary healing mechanism for the body. Plus, the application of ice can numb pain, thus tricking the mind and body that the condition is improving. There are benefits to use of ice, but most people overdo it with a resulting impairment of healing rather than acceleration.
Compression - This also reduces swelling. Compression mechanically squeezes the excess fluid out of the compressed area and into the nearby tissues. This is a great short term solution for moving fluid, but if the compression stocking or wrap is removed, the fluid tends to move back into the original location. Long term compression wrap wearing will reduce the blood and lymph flow in the knee area and thus, slow the healing process. (Think of the use of wraps and tourniquets to stop bleeding from lacerations.) We love using compression wraps, but only at certain times during recovery. The proper use of compression wraps will be elaborated upon later.
Elevation - This is a great way to allow gravity to assist in moving excess swelling away from the injured area and reduce strain on both the vascular system and lymphatic system. It is highly recommended whenever possible during rehabilitation.
Muscular Contraction - This is primarily the method used in Western rehabilitation circles to help reduce swelling. Muscles act as a natural pump for all of the vessels and fluid running through them. Therefore, movement is key for every rehabilitation program. The sooner you start moving, the better. Needless to say, we mean safe, controlled movement, not unbridled activity. But this method has limitations, namely muscular fatigue and the fact that most of us do not have the ability to spend all day in the physical therapy clinic.
Massage Therapy – This is the most underestimated and underused of the five treatment options for swelling. Unfortunately, massage continues to get the cold shoulder as any part of a complete Western medical trauma rehabilitation program. Growing evidence, though, has been turning doubters into believers. This is actually the best option of the five above. Massage therapy can have the biggest impact on your ACLR recovery. It cuts the inflammatory phase down, so you can get the knee joint in motion as soon as possible. Properly applied massage can move more fluid through the injured area in one hour than using that same time to elevate your knee or execute an hour’s worth of isometric quad contractions. Massage also generates positive responses in the nervous and immune system, which are both critical to overall functional wellness.
The Clear Solution
Massage. Massage. Massage.
From a physiological standpoint, inflammation starts within 24-48 hours of surgery. It is a natural phase of the entire healing process and should be managed as soon as possible. Proper massage technique will:
- Relax surrounding musculature which may be in spasm after surgery.
- Reduce vascular resistance as a byproduct of relaxing musculature. Blood will flow easier and cardiac output will reduce.
- Deliver fresh, nutrient filled blood into the musculature and knee.
- Warm injured area to open capillaries and vessels to further improve blood flow. Since blood also carries heat, warmth is a natural side effect of increase circulation.
- Drive away cellular waste debris from the repair process out into lymphatic system to be filtered.
- Encourage the reduction of swelling by accelerating through the inflammatory response phase of healing.
Picking the Correct Massage
When we refer to massage, we are not referring to a general massage like you would get in a spa setting. Although helpful and relaxing, general massage doesn’t tend to have specific recovery goals in mind. What you need is therapeutic massage that is focused on moving fluid. Some licensed massage therapists (LMTs) call it therapeutic massage, others will call it manual lymphatic drainage massage. Since there are a vast number of names associated with this type of massage, it’s difficult here to call out one in particular as being optimal. To better assess the type of massage you need, you should learn about the massage therapist’s skillset. Find someone who works with trauma, sports injury, post-surgical rehabilitation and definitely someone who understands anatomy and what the different types of ACL surgery will do to the structure and function of the knee.
We also strongly advise for you to look at doing some of the massage yourself. Since most of us cannot afford the time or costs associated with 3 massage sessions a day, it is highly likely that you, the reader, will want to perform many of the treatments on yourself.
The specific massage program that we encourage will be written in a later segment. Until then, feel free to contact us with any specific needs or questions you may have.
4 Ways Battle Balm Can Help
Battle Balm products were designed for trauma. The brand was originally created to treat professional combat fighters. Our hand-crafted herbal formulation treats pain, inflammation, edema, bruising, and more. As a natural antimicrobial, Battle Balm was independently laboratory tested to kill common skin microbes like staph and strep. Below are the ways Battle Balm can help you recover faster and get healthy again!
1 - Battle Balm is an excellent medium for massage therapy - Battle Balm has the glide you or your professional massage therapist need for the strokes and techniques of many massage modalities. Incorporate rubbing Battle Balm into and around the nearby area of the knee one to three times daily. Avoid massaging directly over the sutures or recent incisions.
2 - Battle Balm can be used for Cupping and Gua sha - If you apply these ancient techniques for pain relief and blood circulation, you can enhance your treatments with Battle Balm.
3 - Battle Balm can replace use of ice - Yes. You heard it correctly. In the first 48-72 hours post-surgery, there will be significant swelling and pain. You will probably be taking pain medications as well. If you need to control the swelling, you can use Battle Balm along with or instead of ice. (We do not advise the use of ice for trauma in most cases, but short, intermittent use of ice is appropriate for certain conditions.) Our recommendation for Battle Balm in the first few days after surgery would be Battle Balm Demon Strength as it was made for acute injury and trauma.
4 - Battle Balm can be added to most rehabilitation programs - Battle Balm is a great adjunct to any massage program. For pain management, Battle Balm is the #1 natural choice. But don't be fooled. Our all-natural products are potent pain relievers. We have a wide range of products to choose from. Our traditional line contains 100% all-natural and USDA-certified organic plant ingredients specifically crafted for pain relief. Our new CBD line incorporates 100% pure CO2-extracted cannabidiol with a proprietary terpene blend targeted for additional pain relief. (For our CBD products, please visit: https://BattleBalmCBD.com)
Our products can be used with most pharmaceutical medications. Please see our usage restrictions at the bottom of this page and discuss our products with your Western medical physician before starting any program.
NOTE: These statements have not been evaluated by the Food and Drug Administration. These products and statements are not intended to diagnose, treat, cure or prevent disease. If you are not familiar with these formulas or concepts please consult a licensed practitioner of Chinese herbal medicine and/or more in-depth reference materials.
Battle Balm® is not recommended for use on pregnant women. Battle Balm® is not recommended for use in those that have a heart condition or history of heart conditions. Battle Balm® is not recommended for use on children or those under 18 years of age. Battle Balm® use is cautioned if one is taking blood-thinning medications. Battle Balm® is not recommended for those with liver conditions.
Allergic reactions may occur if one is allergic to any of the constituents in this product. If one is allergic to aspirin, do not use this product as the Wintergreen contains methyl salicylate. This product contains powerful herbs. If you notice any abnormal skin reaction to Battle Balm®, discontinue use until reaction subsides. Seek professional medical attention if necessary.
For those that like to put things in their mouths, we do not encourage eating Battle Balm® and recommend external use only. Do not use Battle Balm® on open wounds. Needless pain and suffering is possible and likely should you decide to ingest.
The makers of Battle Balm® are not responsible for misuse, abuse, or use of this product outside of recommended applications.