Friday, October 5, 2012
Is Ice Right? Let's kick the ice bucket.
Just about everyone knows the acronym RICE (Rest Ice Compress Elevate). This protocol has been used for many years to treat acute injuries. Well now it is time to look at the physiology and realize we were wrong. Recently an interview from Dr. Kelly Starrett (mobilitywod.com) and Gary Reinl made me look differently at using ice. Don’t get me wrong if your goal is to numb an area, ice is great. As Mr. Reinl points out, “Yes, making something numb is good if the short-term goal is pain control and the prevention of the body’s normal cellular and vascular response to injury.”
In his recent article titled “People, We’ve Got to Stop Icing. We Were Wrong, Sooo Wrong” Dr. Starrett quotes Dr. Nick DiNubile, Editor in Chief of The Physician and Sports Medicine Journal “Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?” Our bodies are extremely intelligent, they know what they are doing. Inflammation in response to an acute injury is not a mistake. Inflammation provides the tools necessary to remodel an injured area and rebuild the tissue as strong and functional as possible. When inflammation is hindered pain may diminish but we shut down our natural healing process causing the area to heal with a thick nonfunctional tissue commonly called “scar tissue”.
Scar tissue is similar to a scar on the skin but it is on a muscle or tendon. Scar tissue is thick, adhesive and does not stretch well. Scar tissue can adhere to nearby nerves causing peripheral neuropathies (pinched nerves). It can limit your range of motion making you feel stiff and increasing your risk of future injury due to lack of tissue flexibility. Once scar tissue has settled in it can be a tough challenge to reverse. There are advanced non-surgical therapies such as Active Release Technique (A.R.T.), Graston Technique and Shock Wave Therapy which break up scar tissue by triggering the healing response in an effort to reverse the scar tissue that has formed.
Well what does the research and literature say?
“When ice is applied to a body part for a prolonged period, nearby lymphatic vessels begin to dramatically increase their permeability (lymphatic vessels are ‘dead-end’ tubes which ordinarily help carry excess tissue fluids back into the cardiovascular system). As lymphatic permeability is enhanced, large amounts of fluid begin to pour from the lymphatics ‘in the wrong direction’ (into the injured area), increasing the amount of local swelling and pressure and potentially contributing to greater pain.” The use of Cryotherapy in Sports Injuries,’ Sports Medicine, Vol. 3. pp. 398-414, 1986
“Is Ice Right? Does Cryotherapy Improve Outcome for Acute Soft Tissue Injury?” JEM, 2008; Feb. 25; 65–68.
Conclusion: There is insufficient evidence to suggest that cryotherapy improves clinical outcome in the management of soft tissue injuries.
According to Dr. Starrett the new acronym should be MCE:
• M - Movement
Our lymphatic system relies on muscle contraction to push the swelling into our cardiovascular system. If movement is not advised Electronic Muscle Stimulation (EMS) can push out swelling without you having to move the area. Prolonged rest leads to muscle atrophy and scar tissue formation.
• C- Compression
Compressing the injured site improves circulation and clears congestion. Compression reduces swelling, helps with pain control and facilitates the healing process. Be careful not to compress to tight.
• E – Elevation
Elevation uses gravity to drain swelling out of the area. Elevation and compression are the two parts of the acronym RICE still advised.
Just to be clear, I am not saying that ice has no purpose. Ice is great if your goal is to numb an area and get rid of pain. For example, if I ruptured a muscle, dislocated a shoulder or fractured a rib ice would help minimize my pain. However, if the pain is livable think MCE before RICE because ice stops inflammation which leads to poor healing. The problem is not inflammation, it is the pain of swelling that we need to minimize.