Monday 4 March 2013

The analgesic properties of tubular elastic bandages


I have previously mentioned that I am somewhat plagued by osteoarthritis (mostly) in the knees - and the main problem is pain; and the main problem with this pain is that due to side effects (and side effects of the drugs used to combat these side effects) I cannot take any of the effective analgesics (NSAIDs or Aspirin).

The only effective and tolerable analgesic that I have so far discovered is to wear 'tubigrip' - tubular elasticated bandages - around the knee joints...

(and extending down to the ankle, to reduce the risk of deep vein thrombosis if I was to have only knee bandages constricting blood supply above the calf).


These tubigrip bandages offer substantial analgesic benefits (i.e. they significantly reduce pain both at rest and when walking), and do so instantly (as soon as the bandages are applied) - which implies that, to be so rapid, the analgesic effect must be via nerves and not (for example) by reducing-swelling or providing support to the joint.


The likely mechanism by which tubigrip bandages work is by counter-irritation, or the Gate Theory - in other words the tubular bandages stimulate superficial touch receptors in the skin (which have rapid-conducting, myelinated nerve fibres); and these skin sensations then block (or gate) the more slowly-conducting (unmyelinated fibres) pain stimuli from within the knee joint.

The principle is the same as rubbing a limb - quickly and lightly - which you have just bumped and which you know will start to hurt in a couple of seconds time. But if you can start rubbing the skin over the injury immediately, then the touch sensation will travel faster to the central nervous system than the pain sensation (because the myelinated touch fibres beat the unmyelinated pain fibres); and therefore the pain is, to some extent, blocked and reduced. 


I have in fact been using tubular bandages on sore joints, including elbows, wrists and ankles, for many years - but used to suppose that they worked by giving support and reducing swelling.

If bandages worked by increasing joint-support and reducing swelling, this would predict that stronger and more compressive bandages would be more effective that lighter and less compressive bandages.

However, I have found the lighter and less-compressive bandages to be more effective (as well as more comfortable). Thus my assumption that the counter-irritation Gate Theory is most likely.


If I am correct about the analgesic mechanism of tubigrip bandages, then the principle could be applied to devise other methods of touch receptor stimulation as an analgesic manoeuvre to treat joint pain; from topical agents (creams) that produce some kind of 'irritation'/ stimulation, perhaps temperature change, perhaps transcutaneous electric stimulation?


Chris C. said...

Sorry to hear.

Everyone has advice I know.

But... If I were you I would completely eliminate Omega 6 (pro inflammatory foods) from your diet for 30 days and see if this helps.

I suffered from terrible aches in my neck, back and knees. When I eliminated all (non cold-pressed) vegetable oil containing foods from my diet the pain went away.

Best, Chris

Steve said...

I have run across the following treatment for tendonitis in weightlifters. I have never had the chance to try it myself

This seems similar to what you are doing. I wonder if it is somehow related?

Steve said...

The previous compression method appears to come from this guy:

Samson J. said...

You know, sometimes I genuinely look forward to getting old - and then I contemplate the near-certainty of osteoarthritis...

Bruce Charlton said...

@CC - I've tried several of the the essential fatty acid stuffs. No use.

@S - That sounds like a different mechanism of action altogether.

@SJ - not near certainty - it's pretty uncommon at my age. My age has manyfold compensations contrasted with the slough of my early adulthood.

Samson J. said...

The high probability of chronic constipation, then. Anyway, I know you're not that old, Bruce. ;)

Steve said...

I would agree with your Melzak and Wall theory. Many other neurological feedbacks, modulations, etc. in play. Sounds like some good chiropractic would definitely help.

Steve said...

Sorry to impose, but, of course, the neurology is much more complex than the simple "gate" at the spinal internuncial pool. Many analgesic creams have capsacian which works via "the gate" as does a TENS unit. Unfortunately, these gate pain methods tend to lose their effectiveness over time. Plain and simple, pain is an important sensation -- probably the most -- and it will not be "fooled" for long. The tubular compression actually works on a longer and better time frame because it increases proprioception enabling better joint functioning and less aberrant nerve firing. Chiropractic -- and acupuncture though less functionally -- work via the gate, by producing after-discharge among deep joint mechanoreceptors, by elevating noxious thresholds, and decreasing denervation supersensitivity (see Cannon's Law and C. Chan Gunn). This cannot only improve pain syndromes, but reduce noxious somatovisceral reflexes and improve general wellness.

Sorry for the mini-lecture. It's my bailiwick.

Anonymous said...


I had wondered if the body might not compensate for the stimulation over time and if the pain might not return, as Steve suggests.

Maybe some sort of multi-mode electronically modulated unit that can subtly shift the type, duration and intensity of the stimulation so that acclimatization is retarded?

I got the idea from the Star Trek episode Mirror Mirror where they have a torture device based on similar principles.

Happybod said...

Sea salt baths, Epsom salt baths or Dead Sea baths.
Very highly recommended from fellow arthritis sufferer.
Best to try & soak for at least 30 mins.
It really helps! (Holland & Barratt sell some decent quality sea salt).

Bruce Charlton said...

Might be worth a try...