Ice to treat soft-tissue injuries contraindicated by creator of protocol(en.wikipedia.org) |
Ice to treat soft-tissue injuries contraindicated by creator of protocol(en.wikipedia.org) |
But, absolutely, after this has settled a bit, you're supposed to apply warmth, not heat, to encourage increased perfusion to the area and promote healing.
So, apples/oranges. There's nothing in the statement above to say that RICE is contraindicated as an initial management, and the implication that RICE was meant to be applied past initial management simply isn't true in the first place (afaik).
I could be wrong as to how others used it, however. I wouldn't put it past a hospital to mindlessly make it a protocol that would then be followed blindly, I guess...
So I think it's good that the Wikipedia article emphasizes that the protocol is outdated.
Having said that, the RICE acronym is often extended to PRICE, to indicate that the typical treatment also involves a "Plaster of Paris". So in the presence of a plaster, the confinement is even more strict, so you would want to control the swelling response inside the tightly-fitting plaster anyway.
But, again, disclaimer, haven't practiced in years, and even then I was not specifically an orthopedic doctor. :)
I'm no physician, but as a child I did spend many Saturday afternoons watching Dad prepare lecture materials for the med school classes he occasionally taught, so I think that I am probably as qualified as a non-physician can be to massively overestimate my own competence. And I certainly don't know anything about soft tissue injury and inflammation beyond what my physical therapist has told me. But in the classes on research methods that I took in grad school, we loved to pick on the mid-to-late 20th century medical literature and standards of care, and one of the common themes that cropped up was a tendency to over-extrapolate.[1] That might be part of what happened with RICE? A strong acute histamine response might be associated with some secondary cellular damage at the injury site, but that's not necessarily a bad thing for long-term outcomes.
[1]: This tendency was deliciously satirized in https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001541/
Isn’t it possible that promotes healing? The body should know how to heal.
How does this all relate to sauna to ice bath hot-cold style treatment? Is that a totally different kettle of fish?
Therefore by artificially causing them to open slightly less, you control the swelling, and stop it from pooling so much that it then blocks blood flow completely.
The extreme scenario of this is called compartment syndrome, where the blood flow is completely blocked, leading to necrosis of the affected area; this is an orthopedic emergency, where 'fasciectomy' needs to be performed; effectively slicing open the compartments to allow the expansion to occur without compromising blood flow.
The current research supports the role of ice in temporary pain relief, but there is little evidence supporting the use of ice to aid in healing, or even swelling reduction.[7] Further research is needed to further understand how ice should be applied. At this time, due to the lack of evidence, there is no consensus on the ideal temperature ranges, time frames, application methods, or patient populations when using ice on a soft tissue injury.[16] Most studies use icing protocols of intermittent 10-20 minute applications, several times a day for the first few days following an injury.[7]
and
Currently, the RICE protocol is no longer recommended and has given way to other protocols for treating soft tissue injuries. Most recently, in 2019 the mnemonic "PEACE & LOVE" was coined by Blaise Dubois. The PEACE component stands for protection, elevation, avoid anti-inflammatories, compression, and education. It guides the treatment of acute soft tissue injuries. The LOVE component stands for load, optimism, vascularization, and exercise. It guides the treatment for the sub-chronic and chronic management of soft tissue injuries.
[1] https://en.wikipedia.org/wiki/Ronald_A._Malt#First_Successfu...
ice to preserve a detached structure? sure. quelling the inflammation of organs or the brain? yeah, those types of inflammation can turn into a cascading collection of responses, often (but not always) having distinct non-traumatic root causes.
but disrupting increased (life)blood flow to the site of acute, traumatic soft-tissue injury? seems like some otherwise logical lines crossed there, not to mention just a bad idea on its face.
I've dislocated my kneecap a few times and the near-immediate swelling was much worse than the actual injury. Recovery took a few weeks anyway so easing my discomfort for a couple of hours made no difference.
Our sinuses have shrunk and or airways collapsed far too quickly for evolution to adapt, leaving us highly susceptible to allergies and inflammation. This makes the likelihood of catching a cold or flu much worse. It also makes the healing process longer.
I very much recommend you read Breath by James Nestor if you suffer from allergies. Or at the very least, let chafgpt summarize it for you.
Of course, for detached limbs, ice is really good to conserve them until they can be reattached. But that's not the majority of injuries fortunately. Also, compression is really good for wounds that are bleeding profusely. For soft tissue injuries, maybe not so much?
Heat vs Ice for injuries
Fats vs Sugars vs Proteins (and everything else diet-related)
Leeches went out of favor, but now see limited use again (for very specific things, not blanket "release the bad humours!" quackery.
While that's important in order for someone to get back to work or a sport, the most important parameter should be quality of recovery, in my opinion.
I feel a bit like Woody Allen in Sleeper...
> This article examines how faith in science led physicians and patients to embrace the low-fat diet for heart disease prevention and weight loss. Scientific studies dating from the late 1940s showed a correlation between high-fat diets and high-cholesterol levels, suggesting that a low-fat diet might prevent heart disease in high-risk patients. By the 1960s, the low-fat diet began to be touted not just for high-risk heart patients, but as good for the whole nation. After 1980, the low-fat approach became an overarching ideology, promoted by physicians, the federal government, the food industry, and the popular health media. Many Americans subscribed to the ideology of low fat, even though there was no clear evidence that it prevented heart disease or promoted weight loss. Ironically, in the same decades that the low-fat approach assumed ideological status, Americans in the aggregate were getting fatter, leading to what many called an obesity epidemic. Nevertheless, the low-fat ideology had such a hold on Americans that skeptics were dismissed. Only recently has evidence of a paradigm shift begun to surface, first with the challenge of the low-carbohydrate diet and then, with a more moderate approach, reflecting recent scientific knowledge about fats.
I can only summarize it as an ingrained feeling of "Fat is what fat people have". It meant they avoided it like the plague while completely overdoing it on other bad stuff.
Both of those ideas may not necessarily have been 100% abandoned but are at the very least now viewed with a lot more nuance.
Lots of junk science. Lots of marketing fluff. But, also lots of recommendations that were assumed correct but didn't stand up to deeper scrutiny.
Note, I'm not saying any of this is bad, or that scientists are stupid and wrong all the time. Just always amazed about how much our understanding of the human body has changed in the last ~50 years.
The point is that evolved responses don't always properly account for nuance or proportion. If inflammation evolved for large traumatic injury, it may still be triggered for limited soft tissue injuries but then the response could be disproportionate.
(But aren't joint injuries usually soft-tissue as well? It's the ligaments that get the short shaft.)
Unless you are talking to a physician or reading a medical journal, anyone should assume that someone claiming to talk about what the medical community believes is probably wrong and possibly lying.
In the context of the current conversation, reducing saturated fats and bad cholesteral was a reactions to this epidemic https://pubmed.ncbi.nlm.nih.gov/24811552/
After peaking in the mid-1960s, the number of heart disease deaths began a marked decline that has persisted to the present. The increase in heart disease deaths from the early 20th century until the 1960s was due to an increase in the prevalence of coronary atherosclerosis with resultant coronary heart disease, as documented by autopsy studies. This increase was associated with an increase in smoking and dietary changes leading to an increase in serum cholesterol levels
Nutrition is definitely a minefield, I'm with you there!
https://cdn.statcdn.com/Infographic/images/normal/11497.jpeg
> Many Americans subscribed to the ideology of low fat
The "low-fat guidelines made people fat" nonsense would carry more weight if people actually followed the guidelines, but they didn't.
Re caloric density: it's true that fat has more cal/g than carbs or protein. But, people do not eat a fixed mass of food per day -- the satiety of the food they consume influences this. Insulin response also affects weight gain and satiety.
Strenuous here means lifting your one rep max, running 20 miles, breaking a personal best sprint time, that sort of thing.
I can attest from personal experience that ice bath right after exercise works in these cases. I’ve even tested it by icing just one leg and not the other. There is a marked difference in recovery by next day.
Ideally you ice the muscles right after workout then put them in a compression clothing so they’re extra warm for the next several hours.
Imagine you could perfectly recover with some intervention. Then weight lifting no longer works!
For examples like the ones you listed, peak performances where you’re not concerned about gainz and maybe even have to perform again soon after, it makes a lot of sense to do anything to recover quickly.
- hypertrophy to actually gain strength and muscle (ie. longer recovery time)
- maximum recovery to heal from a strenuous exercise and be ready for more the next day (ie. shortest possible recovery time)
In the second scenario, I don't care about gaining strength at all, and the recovery is the only important aspect.
The stress response is literally the point of working out, you won’t get adaptation without stress.
Sometimes that’s undesirable, ie if you’re in the middle of a competitive league and need to reduce stress post-game. In which case, ice away.
For running specifically I’m not trying to make my legs stronger, I’m improving cardio. I need the legs to be in good shape for tomorrow’s hard run :)
If you’re icing after you run you’re missing out on the benefits of the run.
