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- Hi folks, Brad Heineck, Physical Therapist.
- Hey, I'm Chris the Pharmacist.
- And today we're gonna give you a video on:
Are you injured?
Heal faster while you sleep.
Simple inflammation management is the key.
This is science-based, we got Chris the Pharmacist here,
he's gonna fill us in on all the science
so we can understand it
and go through the whole three pronged approach
to get this goal completed.
But, before we go any further...
- We got this!
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Now, the giveaway!
Look at this!
We have a whole set of large loop bands, here.
With a nice box.
We've got a real nice handles,
Bob and Brad stretch out strands.
It comes in a box.
They're beautiful bands.
This is a nice hip exercise device,
so that you can stretch the hips out.
They were much more comfortable than the latex ones.
And the suspension straps.
I love these, these are one of my favorite things
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And the grip strengthener right there.
We invented that, actually a mountain climber invented that.
It's a great deal.
All right, let's go to work. - All right.
That was tough.
- Yeah, yeah. - Cornucopia of stuff.
- Yeah, absolutely.
Look at this baby little, I don't know.
- Baby straps.
- Yeah. (chuckles)
Just kidding, it's a rubber band.
All right, so Chris, heal faster while you sleep.
That's a pretty cool thing, but is it true?
And if it is true, can you explain what the key is, to us?
- Yeah, well, it's kinda interesting.
We do seem to heal faster when we sleep.
And there was a pretty cool study that came out
this last January.
The study specifically is called,
"Chronotherapy of NSAIDs
"May Enhance Post Operative Recovery."
So a group kinda looked... what?
- That means I don't know what the heck
you're talking about!
- All right, all right.
- Can you shorten that up to something that...
- Basically what it's saying is timing is everything.
And so the key is, when you take an anti-inflammatory drug.
- Like? - Ibuprofen.
- Okay, across the counter?
- We'll use that as our example.
And that's what the study used, was Ibuprofen.
Just plain old Ibuprofen like you get, Advil, Motrin,
Ibuprofen at any local pharmacy or online source.
- So you look on the box, it says,
"Main ingredient: Ibuprofen 200mg"?
- 200mg, yup. - Okay.
- So you betcha, so always check with your doctor
make sure it's right for you.
Those of us that have kidney problems, heart problems,
we have to be real careful with it.
- Sure.
- But for the purposes of this study,
and making sure that we're gonna get
the best possible healing, this was some interesting stuff.
Basically, the subjects were divided into
an active group and resting group.
And they all had an injury that they had to study.
And so basically what happened was,
we know a lot of things about anti-inflammatories.
Since the 70's we have known that anti-inflammatories,
like Ibuprofen, actually can delay healing.
Particularly from a post-operative standpoint.
So if we have surgery...
- Actually delay, slow healing down?
- Slow healing down.
- We know that, but everyone takes it?
- Everyone takes it.
So it's kind of a conundrum.
So we've gotten a lot more advanced in our understanding
of how our bodies work.
And so what the authors of this particular study
looked at very clearly, is they noticed we have genes
that govern our circadian rhythm.
That's kind of cycle that tells us when to sleep,
and when to get up, and what we do throughout our day.
- Yeah, that is kinda been, not a buzzword,
but something people are more familiar with.
- Yeah, so they found that we have these clock genes
that kinda govern that, and it seems to work
hand in hand with the inflammatory process.
So it was really interesting.
Like I said, we know that NSAIDs may delay healing,
but at the same time we know that they help
with pain relief, they help reduce inflammation,
so we feel better.
So it creates kind of a conundrum.
- So the inflammation, you're saying the swelling is good?
It actually helps us heal?
- Swelling is actually a good thing.
It's our body's natural way of getting all those little
chemotactic factors into, let's say you hurt your elbow.
- You want me to throw the flag, again?
(laughter)
- All right, all these healing factors that come in
to try and help us to kinda calm things down,
and allow things, new tissue growth,
whether it's a broken bone, a torn ligament,
a strained muscle tears.
So our body has a unique way of understanding
what injury it is, and how to heal it.
- So it inflames, it swells up, and all of the fluid,
the inflammation, is actually full of good things
to help it heal faster?
- Correct.
- So we take Ibuprofen to... ?
- Reduce the inflammation, so it's kind of a...
- See, I always kinda thought that, you do it,
there's that good stuff in there,
but it gets to be too much, and it swells up,
and it actually pressure it creates pain,
so the Ibuprofen actually just releases it enough
so it doesn't, like it takes the air out
of the ballon, a little.
- It takes the edge off.
And for most of us, for comfort, humane use,
that's kinda what we use it for.
But Ibuprofen not only is an anti-inflammatory,
it's also analgesic, so it helps with pain relief.
- Okay, all right.
- So we'll kinda touch on that, to a degree,
with the example in the study, as well.
So what they did with the subjects is
they kinda grouped 'em up.
'Cause we know that our cycles, again the circadian rhythm,
so we're trying to figure out:
When's the best time to take Ibuprofen,
so we can get the best possible healing?
- Sure.
- Because we don't want to inhibit it.
So what they've kinda postulated is that
when we're asleep at night,
that's when our best tissue recovery occurs.
- So it's healing the best while you sleep.
And I think that's pretty easy to accept.
- Yup, exactly.
And so, but during the day,
that's when your pain is highest,
because our body's are active. - Sure.
- So let's say you sprained ankle.
You're gonna kinda guard that joint,
or you're gonna limp a little bit,
or you're gonna keep pressure off of it.
- Crutches?
- You're not gonna necessarily have
your full range of motion.
So with respect to that,
they found that these painful mediators go up
and same with some of the tissue tear-down factors also
go up during the day, in our active phase.
So what they postulated was,
we're gonna give Ibuprofen to this group of subjects
in their active period,
and we're gonna give Ibuprofen to this group of subjects
in their resting period.
And what they found was pretty interesting.
So when they compared 'em, across the board they found,
exclusively, that the active group that was taking Ibuprofen
healed much better.
Their bone volume was better, 'cause it was on broken bones,
was what the study was. - Sure.
- And so the bone volume was better,
they had better union, where the bones come together.
- Yup.
- So they had less guarding during the day
with pain relief, so meaning that they had a more,
I guess better gait.
- Oh, quality of walk?
Right, mmhmm.
- Yeah, so when they noticed those,
and then they compared it to the resting.
So the subjects slept really well,
and they were much more comfortable.
And they also see that rest is healing.
But when they actually examined the bones
at the end point of the study,
they showed less healing.
Delayed and even very diminished healing.
- So the bottom line is, if you take the Ibuprofen
before you go to bed, with the idea "I will sleep better,
"I'm gonna have less pain, less pain when I get up."
That may be true, but the healing is actually slowed down
as a result.
So you want to take the Ibuprofen
two hours before you go to bed, six hours?
- You know, they didn't really identify that.
Basically what they did, they equated to a 500mg dose
of Ibuprofen for the subject matter.
So from that standpoint, they didn't actually,
like how people take it, it's two tablets
every four to six hours apart.
- Right.
- So they didn't really examine that.
They gave it as a dose, equivalent to the subjects.
- Sure.
- And so, what we know is that if you take Ibuprofen
through the day, you'll take it a couple times,
two-three times during the day.
- Yup.
- We probably wouldn't want you to, based on this study,
it almost seems like you probably wouldn't want to take it
past 6:00 at night.
So that if you're going to bed around 10:00.
- Sure.
- But they also showed, with the gene expression,
that our pain factors actually are,
probably from let's say you were a typical person
gets up at 6:00 in the morning.
- Sure.
- And kind of the evening they kind of rest,
relax, wind down.
- Yup.
- By bed time, the pain's not so bad,
simply because they've begun to relax.
- Right.
- And then sleep is when all these other factors
kind of come into play.
There's other inflammatory factors that come in.
The fluids that we're having.
- Sure.
- What they find is that if you cut that supply off
using the anti-inflammatory,
you're prolonging the healing stage.
So it's gonna take longer to get better.
And maybe inhibit some of the healing.
- Sure.
So, the bottom line is, if you're gonna do a three...
- Three times a day.
- Three times a day, maybe in the morning when you get up,
between 6:00 and 8:00.
- Yeah, lunchtime and dinnertime.
- Lunchtime, dinnertime,
but don't take it before you go to bed.
- Yeah, it seems like if you need something
for pain relief, you might want to go
Acetaminophen or something like that.
But not an anti-inflammatory.
- Sure, okay.
So if you're gonna take the ibuprofen,
take it those times, take it with some food,
at least some milk.
Is that correct?
- Definitely want to take it with some food.
But, you know, the big thing too, to take away on this,
is this is a theoretical study, and it's not done on people.
It was done on animals.
- Sure.
- So we want to be real careful with that.
Talk with your doctor to make sure of it.
But I mean, the logic and science is really sound.
- Yep.
- And so I think it might unlock a lot of possibilities.
Because the problem is, with pain relief,
rest is healing, and if we got pain we don't rest well.
And if we're not resting well, we're not healing well.
- Sure.
- So we've got to come up with a way
that's gonna do a better job.
And we know that anti-inflammatories are a good pain killer.
We know that opioids are a good pain killer.
And so probably the combination is something that,
at least post-surgically,
that most doctors will always do.
- Sure.
- But they don't want to put people on opioids too long,
because obviously there's addiction
and other side effects that occur.
- Sure.
- But the same thing with NSAIDs.
If we take NSAIDs all the time,
we run the risk with our kidneys
having some trouble with that.
People that have bad hearts...
- NSAIDs?
- Non-Steroidals, like Ibuprofen.
So Naproxen, and then there's several prescriptions as well.
- Sure.
- So we want to make sure that our doctors are aware,
the doctors are going to be acutely aware,
but talk it over with your doctor
if you've got kind of a game plan.
Like, "Hey I heard this study,
"It said that maybe it's better to take this
"during the day time,
"and lay off the anti-inflammatories at night."
- Right.
- Just see if it's right for you.
You know, we don't want to steer you in the wrong direction.
But the study seems pretty overwhelmingly positive
that daytime use does a better job for you.
- Sure.
- Better healing while you sleep.
- Then we did say three-pronged,
so you go onto the next phase
and this is more where a therapist comes in.
- Yup.
- And it's basic information.
Elevate.
If you got a swollen ankle, elevate it.
Don't leave it hang down where you're sitting,
get it up in a chair in front of you.
Or on a couch, above the level of your heart.
Get gravity working with it.
You can wrap it with a Ace wrap.
Not too tight!
That's the biggest mistake people make,
is they wrap too right.
You should be able to easily slip two to three fingers
underneath the Ace wrap and easily pull 'em out.
It should not be too tight,
otherwise it acts like a tourniquet, things do not flow.
- Ahh.
- And then cold packs.
I'm a big fan of cold packs.
Not for everyone, they only use 'em if they feel good
and you get good results while you use 'em
and afterwards, the next two to three hours.
But there's some studies comin' out
that are showing cold packs may not be the way to go.
But, I tell ya what, I'm gonna have to really...
I'm gonna look into that.
- Examine that very closely.
- Yeah, examine those, because I've had
really good luck, personally, as well as with patients
over the last 20 years.
So I think you're pretty safe using a cold pack.
So those are the three points.
Ibuprofen, don't take it right before bed.
Take the proper amounts.
Compression, elevate, and cold packs.
So, wow, I'd say Chris you gave a full and detailed
explanation of the study, the recent studies,
and I don't know what else to say.
But one thing's for sure,
I don't think it's gonna help with a broken heart.
- Nope, we can't figure out how to fix that, yet.
- And we're workin' on that, so...
Very good.
Take care until the next episode.
- Thanks guys.