[HN Gopher] Ice not recommended for soft tissue injury treatment...
___________________________________________________________________
Ice not recommended for soft tissue injury treatment (2019)
Author : mhb
Score : 164 points
Date : 2022-12-19 13:38 UTC (9 hours ago)
(HTM) web link (blogs.bmj.com)
(TXT) w3m dump (blogs.bmj.com)
| [deleted]
| jackcviers3 wrote:
| > Selective Science Unbalanced reporting. Cherry-picking the
| literature. All signs of pseudoscience. The anti-ice movement has
| neglected years of research on the mechanism of ice after injury,
| focusing only on a select few studies that support (but in
| reality DON'T support) their argument. Dr. Knight explained that
| ice is not an 'anti-inflammatory' per-say (Knight, 1976); rather,
| it prevents the secondary injury to tissues by dampening the
| negative physiological effects of widespread inflammation. His
| position has been supported by other researchers as well (Ho et
| al. 1994, Merrick et al. 1999). And to top it off, one study
| quoted against icing (Bleakley et al. 2004) even concluded, "The
| sooner after injury cryotherapy is initiated, the more beneficial
| this reduction in metabolism will be." Hmmm...the anti-ice crowd
| must have missed that statement. [1]
|
| > The Benefits of Ice Ice is not wrong or harmful. The theory
| that ice impedes the normal healing response by limiting
| inflammation is not well documented in the literature. If you
| have been swayed by this on the internet, I would urge you to try
| to research this more and scrutinize the literature. Be careful
| of what you see on the internet and ALWAYS seek to validate
| anything yourself.
|
| Ice has plenty of benefits and clinical validation.
|
| Proper application of cryotherapy can reduce secondary injury and
| reduce edema formation if applied within the first 36 to 48 hours
| (remember, ice doesn't reduce swelling after the acute injury
| phase, and may not play a huge role in inflammation or recovery).
| We do know that ice helps reduce pain, spasm, and guarding,
| allowing more mobility (Barber et al. 1998, Raynor et al. 2005).
| More than anything, ice is a convenient and potent pain reliever,
| so it's ok to apply ice to 'chronic' conditions as a safer pain
| reliever at any time. In fact, cryotherapy has been shown to
| decrease the amount of prescription pain medications needed after
| surgery (Barber et al. 1998, Raynor et al. 2005).[1]
|
| 1. https://mikereinold.com/is-icing-really-bad-for-you/ (2018)
|
| Ice has shown benefits in study and practice, and the above
| article has many cited studies and a critique of anti-ice
| articles.
| emptyfile wrote:
| londons_explore wrote:
| I wonder what other things will turn out to have no benefit...?
|
| Maybe rather than washing wounds, it'll turn out it's best to jam
| them with soil to get the immune system revved up...
| unsupp0rted wrote:
| Perhaps licking of wounds?
|
| Which seems to me like a way to introduce mouth bacteria and
| cause an infection, but maybe it's counter-intuitively
| beneficial?
| penteract wrote:
| Saliva has some antisceptic properties and promotes clotting.
|
| https://en.wikipedia.org/wiki/Wound_licking
| purpleflame1257 wrote:
| It actually is beneficial, and is instinctive. There's a
| difference between bites (which introduce bacteria deep into
| punctures where they don't belong) and licking which places
| nitrites, lysozyme, and other antimicrobials onto the skin.
| see here: https://www.thelancet.com/journals/lancet/article/P
| IIS0140-6...
|
| Nevertheless, washing in tap water with soap is probably
| better nowadays.
| jgalt212 wrote:
| My grandfather used to say rub some spit in it--that's what the
| Native Americans did (before Pfizer stole their land).
| JauntyHatAngle wrote:
| I get you are jokingly musing, but let's not open our minds so
| much our brains fall out.
|
| Jamming an open wound into soil is going against the well
| established knowledge we have on how infection works.
| ehnto wrote:
| I guess I was an unwitting trial in this new pathology, when I
| shattered my collarbone (which involves a lot of soft tissue
| damage). The doctors deliberated quite a lot over whether or not
| it needed surgery, traditionally it would have as it was
| shattered and displaced, but they wanted to try the new approach
| of just kindof hoping for the best. They moved it into place in a
| loose sling, and said "Just hold it generally there" and so I
| did. That was the entire health plan. No medication, no anti-
| inflammatories, no suggestions on over-the-counter stuff either.
|
| It can be quite difficult to use pain as a guide for those of us
| lucky enough to have endured chronic pain, as you build up a
| bunch of subconscious coping mechanisms and you are expected to
| experience pain when getting the broken bits moving again. So how
| much is too much? I have no idea. I definitely agree that pain
| management meds and anti-inflammatories are counter-productive
| though.
|
| It's all a bit ambiguous I guess, I'd rather get updates via
| x-rays even if we are doing the "HOPES" and "DREAMS" approach to
| healing. Sorry, I mean PEACE and LOVE. I do believe in this
| approach to healing, I want to make that clear, there's just some
| rough edges in the User Experience of the approach in the doctors
| office I think.
| chis wrote:
| Did that work? I approve of the trend towards letting the body
| heal itself when possible. But I thought displaced bones
| generally need to be set, otherwise they can heal with
| incorrect angles and lose functionality, range of motion, etc.
| skykooler wrote:
| They did the same when I broke my collarbone. The bone healed
| mis-aligned and needed surgery anyway to re-break it so it
| could be aligned properly.
| zdragnar wrote:
| A doctor tried that with my wife's broken arm. It was very much
| the wrong call. She ended up getting surgery anyway, but is
| worse off for having waited a long time before she went to a
| different doctor.
| thefaux wrote:
| Yes, I had a similar experience with a clavicle fracture 15
| years ago. I saw a surgeon but somewhat surprisingly, she
| wanted to let it heal on its own if it could. Today my left
| shoulder is an inch shorter than the right and I have a knob
| where the two halves fused back together but it doesn't hinder
| me in any noticeable way.
| eric_b wrote:
| In my own experience, ice (either the frozen water kind or the
| compression and elevation components) doesn't do a damn thing.
| For soft tissue injury my usual plan is movement movement
| movement. Getting the blood flowing and using the affected area
| (lightly) is the best way to get back in the game I've found.
| thinkharderdev wrote:
| Yeah, I spent years as a competitive endurance athlete and
| always found the best way to heal was to stress the injury
| (lightly as you say) as soon as you can. I suspect part of the
| issue is that elite-level athletes tend to be quite "type A"
| and have a high pain tolerance. So the risk with them is that
| that push too hard too soon and re-injure themselves. But
| "normal" people tend to make the opposite mistake. They don't
| stress the injured tissue at all until all the pain is gone so
| it doesn't get great blood flow and builds up scar tissue.
| londons_explore wrote:
| Ice has only been widely available for the last ~100 years, which
| means presumably ice to treat injuries has only been around for
| 100 years, which in turn means I assume someone must have done a
| modern study to prove it benefitted patients?
|
| So what changed that it is no longer beneficial?
| bena wrote:
| Looking at "PEACE & LOVE", the "A" stands for "Avoid Anti-
| inflammatories" because anti-inflammatories will reduce tissue
| healing.
|
| Ice is used as an anti-inflammatory. Because swelling often
| prevents movement. So since ice reduced the inflammation and
| swelling, it increased movement, which we've translated as
| "being better".
|
| But apparently what you want is to not move and aggravate the
| actual injury.
|
| We've moved from treating the symptoms to treating the cause.
| contravariant wrote:
| Assuming something must have been studied because it became
| more pervasive recently is a dangerous assumption.
|
| Especially with things that seem obvious. Like cooling an
| injury with ice for instance, which seem like a good idea (or
| feels better anyway).
|
| Also people have tried to keep stuff cold for ages, I'm pretty
| sure the folk remedy of using a slab of cold meat to cool an
| injury has been around longer than just the period in time that
| people had free access to ice.
| rascul wrote:
| > I'm pretty sure the folk remedy of using a slab of cold
| meat to cool an injury has been around longer than just the
| period in time that people had free access to ice.
|
| Wouldn't it have been difficult to keep the meat cold?
| noja wrote:
| Probably two presumptions: less swelling is good, cold reduces
| pain.
|
| Now it has been tested.
| bennyelv wrote:
| > which in turn means I assume someone must have done a modern
| study to prove it benefitted patients
|
| I wouldn't assume that :) Ice treatment was about pain relief,
| not overall benefit. I believe it also came from the world of
| sports science, to which a lower bar is applied due to the
| general non-life-or-death consequences.
| AstixAndBelix wrote:
| >I assume someone must have done a modern study to prove it
| benefitted patients?
|
| why assume in the age of the internet? if it's something that
| tickles your curiosity just do a little research
| fsh wrote:
| I wouldn't be surprised if that assumption turns out to be
| wrong. A lot of medical procedures seem to have little or no
| empirical backing. Apparently there are not many incentives to
| do high-quality studies in the field.
| 11235813213455 wrote:
| Inflammation is basically your body turning on repair mode (when
| all goes right, so not in chronic issues), so usually not the
| best idea to counteract it
| Hnrobert42 wrote:
| The accuracy of science aside, can we all agree that the acronym
| PEACE & LOVE is trash?
|
| Rest Ice Compression Elevation may be wrong, but it is at least
| easy to understand, memorize, and explain. When my friend hurts
| their ankle, I want to pass on the latest, vetted wisdom. I don't
| want to sound like a jackass saying, "O is for optimism. But we
| are not done yet. V is for vascularization. You don't have much
| control over it, but we need to the round out the word LOVE. The
| third E is for ..."
| PhileasNietzche wrote:
| Yes. Let us put the scientific accuracy of a scientific
| research paper to the side and focus on the difficulty of a
| nine-letter acronym.
|
| "Couldn't they have come up with something simpler, since the
| healing of soft-tissue injuries is so simple?"
| gretch wrote:
| The comment section is vast and plentiful. It's okay to talk
| about things that aren't limited to scientific accuracy. In
| fact, that's exactly what you did with your comment.
| yshavit wrote:
| "Education" maybe the worst of them. One of the what-to-do
| steps is... learn what to do? Talk about drawing the rest of
| the freaking owl.
| emberfiend wrote:
| These are guidelines for medical practitioners, who are well-
| placed to educate their patients.
| munch117 wrote:
| Read them again. Where the guidelines say "you", they are
| clearly addressing the injured party.
| filesystem wrote:
| Yes this one is comically bad. The description is even worse:
| "Your body knows best. Avoid unnecessary passive treatments
| and medical investigations and let nature play its role."
|
| So really this is preaching anti-education. Do not seek out
| information about your injury.
| emberfiend wrote:
| They certainly worded it poorly, but what they meant was
| "voodoo doesn't work". As in, educate your patient about
| their wacky home remedies, and try to get them to engage
| with realistic recovery outcomes.
|
| From the paper:
|
| > E for educate
|
| > Therapists should educate patients on the benefits of an
| active approach to recovery. Passive modalities, such as
| electrotherapy, manual therapy or acupuncture, early after
| injury have insignificant effects on pain and function
| compared with an active approach, and may even be
| counterproductive in the long term. Indeed, nurturing an
| external locus of control or the 'need to be fixed' can
| lead to therapy- dependent behaviour. Better education on
| the condition and load management will help avoid
| overtreatment. This in turn reduces the likelihood of
| unnecessary injections or surgery, and supports a reduction
| in the cost of healthcare (eg, due to disability
| compensation associated with low back pain). In an era of
| hi- tech therapeutic options, we strongly advocate for
| setting realistic expectations with patients about recovery
| times instead of chasing the 'magic cure' approach.
| emodendroket wrote:
| It seems like a lot of folks have responded to conspiracy
| idiocy by going all-out anti-learning in favor of blind
| deferral to experts. Even if I thought that was wise,
| telling people not to research their injuries is like
| telling the tide not to come in. Better to focus on
| identifying trustworthy information.
| kelipso wrote:
| Seriously. It's a trend I've noticed with a lot of anti-
| misinformation people, including with my friends and
| family, where they skip the learning and critical
| thinking part and just buy straight into whatever is said
| by someone who calls themselves an expert.
| jwally wrote:
| Does "Education" lead to recursion?
| jedmeyers wrote:
| BOBODDY. The first B stands for Biznus.
| Vox_Leone wrote:
| >> Over the years, acronyms guiding their management have
| evolved from ICE to RICE[1], then to PRICE[2] and POLICE (...)
| (PEACE) to subsequent management (LOVE). PEACE & LOVE (...)
|
| Boy, really? I was interested until stumbling on those bits.
| We've certainly reached peak-acronym.
|
| [edit] And now I see it's an old story.
| jvanderbot wrote:
| MEAT. Movement Exercise Analgesiacs Treatment
|
| https://progressiveptandrehab.com/rice-and-meat-physical-the...
|
| TLDR; IRRC: Don't take anti-inflammatory, don't keep it
| stationary, don't fight swelling at all, but do keep it moving
| and teach your body to avoid the motion that caused the injury.
|
| So easy to remember, since, you know, we damaged our meat in
| these types of injury.
| emodendroket wrote:
| If we're supposed to _avoid_ analgesics what are they doing
| in the acronym?
| jvanderbot wrote:
| Analgesics are not anti inflammatory medication, they are
| pain relief meds, if I understand. Analgesics are ok for
| pain relief according to MEAT
| emodendroket wrote:
| Which painkillers are not also anti-inflammatory drugs?
| All the OTC ones are NSAIDs.
| jvanderbot wrote:
| Well, acetaminophen is not NSAID, that's why you can take
| acetaminophen with ibuprofen for really bad headaches.
| That's what Excedrin is.
| emodendroket wrote:
| Well, I'd suggest making "A" stand for acetaminophen
| then.
| jvanderbot wrote:
| Ah, it's not the only one, it's just one? If you want to
| share it that way, that's probably fine by everyone.
| TylerE wrote:
| Not available in the US, but in many countries various
| acetaminophen+codeine preperations are available (at
| limited strength) OTC. "Tylenol 3" is a common one
| hannasm wrote:
| Avoiding the motion that caused the injury is one of the most
| challenging _issues_ to overcome. The body naturally tries to
| stop you from making the same mistakes again but these
| compensation strategies may significantly reduce athletic
| performance and in many cases actually cause new injuries
| because the original motor pattern was the ideal one and the
| compensated motion is just _next best_. Keep adding them up
| over the course of a human lifespan and it 's no wonder our
| bodies break down so much.
|
| In the short term it may be beneficial to avoid a certain
| muscle or area, but eventually you have to get it turned back
| on too.
| TylerE wrote:
| Yep. Been dealing with diabetic foot ulcers for the past
| year+. No fun. Had one on the left that was pretty bad, and
| as that was healing all the offloading I was doing caused
| me to develop another one (less serious, luckily...) on the
| other foot.
| emodendroket wrote:
| Not just for athletes: this is equally applicable to
| keyboard jockeys with repetitive strain injuries. One of
| the reasons braces are actually counterindicated.
| wmeredith wrote:
| Yes, this makes me cringe. It's overly cute and is a stretch.
| gamblor956 wrote:
| I learned it as HELM: Heat, Exercise [the the appendage or body
| part through its range of motion], Lower [the appendage or body
| part] and Massage.
|
| Basically the opposite of RICE, all 4 were focused on
| maximizing blood flow to the soft tissue injury. And
| anecdotally, I can confirm it works way better than RICE or the
| alternatives. I used to be out for 2-3 weeks after running
| issues when I used RICE, etc. After I switched to HELM I was
| back on the pavement the next morning.
|
| The issue with HELM is that it can be significantly more
| painful than RICE, etc., as you must avoid using anti-
| inflammatories and painkillers.
| Mountain_Skies wrote:
| Canada's use of MAID (Medical Assistance In Dying) is a creepy
| one for euthanasia. Seems to imply that dying people are a
| dirty mess to be swept out the door and into the trash bin.
| emodendroket wrote:
| Have you read the stories about ill people being pressured to
| get it because their care is too expensive? Maybe that isn't
| an accident.
| SapporoChris wrote:
| I have not. I would be interested in reading more about
| this. Can you provide links?
| neoecos wrote:
| Intresting article about the topic.
| https://www.thenewatlantis.com/publications/no-other-
| options Also from an HN link.
| https://news.ycombinator.com/item?id=34027753
| emodendroket wrote:
| https://www.ctvnews.ca/health/chronically-ill-man-
| releases-a...
|
| > An Ontario man suffering from an incurable neurological
| disease has provided CTV News with audio recordings that
| he says are proof that hospital staff offered him
| medically assisted death, despite his repeated requests
| to live at home.
|
| > Roger Foley, 42, who earlier this year launched a
| landmark lawsuit against a London hospital, several
| health agencies, the Ontario government and the federal
| government, alleges that health officials will not
| provide him with an assisted home care team of his
| choosing, instead offering, among other things, medically
| assisted death.
| Izkata wrote:
| Not specifically about that part, but another factoid
| that may be interesting:
|
| > In 2021, there were 10,064 MAID provisions reported in
| Canada, accounting for 3.3% of all deaths in Canada.
|
| From an official government report:
| https://archive.ph/xD0wD#selection-3057.0-3057.107
|
| Numbers aren't out yet for 2022, and in 2023 it opens up
| to mental illness as well.
| Traubenfuchs wrote:
| Adding to the other guys story, have a second one!
|
| https://www.catholicnewsagency.com/news/252991/canadian-
| vete...
| saurik wrote:
| Even the actual non-metaphorical parts are Annoying. "A is
| for... I think it was Anti-inflammatories?" "No no, I think it
| was _Avoid_ anti-inflammatories... " "Damn that distinction
| seems important :/."
| optimuspaul wrote:
| I don't think you'd sound like a jackass saying "O is for
| optimism. But we are not done yet. V is for
| vascularization...." but wouldn't you rather sound like a
| jackass than give bad advice? I'd rather hear this than the
| clinical robotic "Rest Ice Compression Elevation", I mean come
| on, I'm a person!
| SamBam wrote:
| I'm not sure how "Rest Ice Compression Elevation" is
| "clinical robotic" and "vascularization" isn't...
| ralusek wrote:
| > than the clinical robotic
|
| > I'm a person [not a robot]!
|
| > optimuspaul
| wirthjason wrote:
| About 5 years ago I tore my ACL and had it repaired a few months
| ago over the the summer. I've done a lot of PT rehab over the
| past few months and my PT mentioned that ice reduces blood flow,
| heat increases blood flow. It wasn't so much an as ice vs heat
| but more about the importance of increasing blood flow to help
| the tissue repair. Other things increase blood flow too, like
| exercise. There isn't really a strict dos-and-donts to treatment.
| egberts1 wrote:
| BJSM: "Provenance and peer review: Not commissions; internally
| peer reviewed."
| scottLobster wrote:
| This fits with my experience, growing up I was taught to
| regularly apply ice to acute sports injuries, however the ice
| always melted pretty quick and slipped off besides, so I got
| tired of effort of keeping a fresh bag of ice on the injury, and
| eventually just stopped.
|
| What I discovered anecdotally is that the swelling was never any
| worse, and there was no discernible difference in the time a
| given category of injury (twisted/sprained ankles for the most
| part) took to heal.
|
| And it makes sense when you think about it, we've evolved for
| millions of years to deal with acute minor injuries without ice.
| Look at the billions of people who live without refrigeration
| today and engage in daily manual labor, are they continually
| hobbled by minor injuries? No. How ice became such a religious
| imperative in injury treatment I have no idea. Granted it
| probably makes sense in cases where the swelling/inflammation is
| so severe it becomes a secondary injury or just continuously
| painful, but for the everyday "rolled my ankle while playing
| house league soccer" injury? Completely unnecessary and
| ineffective IMO.
| denton-scratch wrote:
| "Ice" in the title should be ICE. It's an acronym - it's not
| about the use of cold compresses for pain relief. A lot of the
| comments here are about the use of frozen water. That's not what
| this article's about.
|
| ICE stands for Impact, Confidence, and Ease. I think the acronym
| is rather stretched and awkward.
| elil17 wrote:
| To be clear, though, they say "avoid icing" (i.e. The use of
| cold compresses for pain relief). It isn't what the article is
| primarily about, but it still is not their recommendations.
| elif wrote:
| Here is the part you missed:
|
| "We also question the use of cryotherapy. Despite widespread
| use among clinicians and the population, there is no high-
| quality evidence on the efficacy of ice for treating soft-
| tissue injuries. Even if mostly analgesic, ice could
| potentially disrupt inflammation, angiogenesis and
| revascularisation, delay neutrophil and macrophage infiltration
| as well as increase immature myofibres."
| Izkata wrote:
| My understanding, picked up as a kid sometime in the late
| 90s/early 2000s, was that ice makes injuries feel better
| while impeding healing. So it's a trade-off you had to make
| for yourself.
|
| Reading stuff like this now kinda feels like we lost a bunch
| of knowledge in the past two decades.
| dumbotron wrote:
| nashashmi wrote:
| Yes. The A in PEACE stands for "avoid icing" and anti
| inflammatory .
|
| So more or less, the title may be correct as is.
| dwighttk wrote:
| Huh... you're saying ICE also isn't the end of RICE, or Rest,
| Ice, Compression, Elevation?
|
| All this is confusing.
| [deleted]
| llbeansandrice wrote:
| Doesn't it stand for "ice compress elevate"??
| SamBam wrote:
| Yes, I'm not sure where GP got that other acronym.
|
| And, given that, people talking about ice (frozen water) is
| fine, since that's specifically one of the things the new
| paper seems to be suggesting people stop doing, as well as
| stopping the use of anti-inflammatories.
| denton-scratch wrote:
| I got it here:
|
| https://university.hygger.io/en/articles/3272334-lesson-6-i
| c...
|
| I didn't search beyond the first result; but it seemed
| clear that it was an acronym, and it wasn't expanded in the
| article. So there may be other ways of expanding the
| acronym.
| SamBam wrote:
| People use the same acronyms in different fields to mean
| different things, so it's definitely a good idea to
| double-check that is in the right domain.
|
| "Impact" may have made it look like it's talking about an
| injury, but actually those acronyms you found are about
| prioritizing tasks in product development.
| roperj wrote:
| You don't even need to consider context, you need to use
| the right acronym to start. The current acronym isn't
| even ICE - it's RICE.
| anamexis wrote:
| The correct acronym, which includes ice (frozen water),
| is in the title of the citation in the abstract.
|
| > Rehabilitation of soft tissue injuries can be complex.
| Over the years, acronyms guiding their management have
| evolved from ICE to RICE[1], then to PRICE[2] and
| POLICE[3].
|
| > [1] van den Bekerom MPJ, Struijs PAA, Blankevoort L, et
| al. What is the evidence for rest, ice, compression, and
| elevation therapy in the treatment of ankle sprains in
| adults. J Athl Train2012;47: 435-43.
| astura wrote:
| I usually see it as RICE - rest, ice, compression, elevation
| https://en.wikipedia.org/wiki/RICE_(medicine)
| PuercoPop wrote:
| I knew that as RICE: Rest Ice Compression Elevation. I
| remember seeing in in medwiki which was a wikipedia curated
| my doctors that Standford tried to launch iirc.
| frenchy wrote:
| That's what I remember as well. It seems like the acronym
| has been so successful that it remains popular even though
| no one can agree one what it stands for.
| cobbzilla wrote:
| I was taught RICE which is:
|
| Rest, Immobilization, Cold, Elevation
|
| The article mentions a shift from ICE to RICE (which I'm
| aware of) and then another shift to PRICE, which I'm not
| aware of-- anyone know what the P stands for?
| SamBam wrote:
| Protection. Preventing further injury.
| ComputerGuru wrote:
| Seems... pointless? Obviously protect all of you from
| further injury insomuch as you can.
|
| It seems like someone just wanted to invent another
| acronym.
| mattkrause wrote:
| It's not meant to be general protection, like wearing
| shin guards next time so you don't get hurt at all.
|
| Instead, they mean that you should protect _the injury_
| so that it 's not exacerbated: brace it or put it in a
| sling, have the patient use crutches, etc.
| [deleted]
| bilsbie wrote:
| If inflammation is good then they should remove elevation and
| compression from their acronym.
| guerrilla wrote:
| Yeah I never understood the theory behind why you would ice
| something.. It'd just reduce bloodflow via vasoconstriction which
| seems like the opposite of what you'd want unless you had a
| specific reason to the contrary. Same with anti-inflammatories,
| unless it's completely out of control then both the inflammation
| and the resultant pain are doing a job for you (telling you to
| stay off it and doing repair work.)
|
| I hope this research continues until it's conclusive one way or
| the other and if it's the opposite of what I (and that paper)
| suggest then we should have a good explanation for that.
| ghaff wrote:
| Note that this is focused on chronic treatment. It doesn't seem
| to be saying that if you have an injury you shouldn't ice it at
| the time if only to decrease pain.
| ac2u wrote:
| I apply the same logic even to painkillers which aren't anti-
| inflammatories like paracetamol. I figure that there could be
| lots about healing mechanisms that we don't know yet where
| interrupting the feedback of pain might interfere with healing.
|
| That's not to say I don't take painkillers, but that I think a
| lot about the tradeoffs before I take one. For instance, I
| didn't take any to relieve vaccination symptoms even though
| that was the standard advice by the healthcare provider as I
| figured why would I want to interrupt my bodies response to a
| pathogen at the precise time it's learning to combat it? (There
| are some studies that suggest this is true, although the scale
| of it is a little fuzzy).
|
| What usually tips the balance for me to take a mild painkiller
| is if the pain is bad enough to genuinely stop me sleeping, in
| that case I'm buying the healing mechanism that sleep provides.
| Dylan16807 wrote:
| > why would I want to interrupt my bodies response to a
| pathogen at the precise time it's learning to combat it?
|
| Some of those responses are of the form "hurt the pathogen
| more than it hurts you" and since the vaccine isn't a real
| threat all they do is hurt you.
| SamBam wrote:
| The CDC recommends that antipyretic or analgesic
| medications (ibuprofen, tylenol, etc) should not be taken
| with the Covid vaccine, at least not before or immediately
| after. This is because the fever and inflammation response
| are specifically triggers that recruit your immune system
| into creating the necessary antibodies.
|
| https://www.cdc.gov/vaccines/covid-19/clinical-
| consideration...
| ac2u wrote:
| Good to see this formalised. In my jurisdiction
| paracetamol was more casually recommended.
| nov21b wrote:
| I did some research into the best way to treat a third degree
| ankle sprain (after a mountainbike accident). From what I've
| gathered ice can still be beneficial in the first 8 hours or so.
| But shouldn't be used later on as it may hamper blood flow and
| thereby recovery. Compression, elevation, moderate use of an anti
| inflammatory and exercising just up to inducing more swelling is
| the best way to recover. I found "walking" exercises in a pool to
| be very helpful as the cool water plus pressure reduced pain and
| the buoyancy reduces much of your body weight.
| nonameiguess wrote:
| I'm not sure what to make of this. It's an opinion piece, not
| peer-reviewed, doesn't cite any research, and includes
| "education" and "optimism" seemingly for the sole purpose of
| being able to make the cute acronyms PEACE and LOVE to help us
| remember what injuries need to heal. On a blog where the comments
| are spammers literally advertising the services of magicians who
| will cast healing spells for you.
| OnACoffeeBreak wrote:
| There are 20 citations in the references section. Also,
| clicking on "Please see the full FREE paper in the BJSM here"
| gets to a PDF that has more meat and other references. It also
| has this: "Provenance and peer review: Not commissions;
| internally peer reviewed."
| MontagFTB wrote:
| This blog post is from 2019- should it be noted as such?
| jameal wrote:
| Interestingly no mention of MEAT which is another competing
| recovery paradigm: Movement, Exercise, Analgesics, Treatment
|
| Though it does seem to overlap some with the authors' PEACE &
| LOVE except with regard to analgesics. I've been hearing more and
| more about how NSAIDs may not be as beneficial as they've been
| touted. I wonder what is the current scientific consensus on
| them.
| rubyron wrote:
| NSAIDs are anti-inflammatories. Analgesics are anti-pain.
| Completely different mechanisms.
|
| I had arthroscopic surgery for a torn meniscus in my knee this
| year. My doc (well-respected pro sports ortho in Austin) put me
| on ice and rather long term Naproxen (NSAID). So not every doc
| has gotten with or believes in the new thinking.
| acqbu wrote:
| Check out the comments to that article!
| alin23 wrote:
| _> SAVE YOUR RELATIONSHIP AND GET YOUR BOYFRIEND /GIRLFRIEND
| BACK_
|
| _> HERPES SIMPLEX VIRUS GONE FOREVER... My name is Angela
| foden from Canada, I Can 't believe that I got cured_
|
| _> I still can't thank you enough for DR UWAIFO, My boyfriend
| left me, and went for a younger lady because I was unable to
| give birth_
|
| oh man, what a throwback to 2010 spam emails and blogpost
| comments
| kube-system wrote:
| I know this is not very scientific, but I have always figured
| that my body knows what it's doing when it responds to an injury
| with inflammation.
| akerl_ wrote:
| I think it's worth remembering that your body does what it does
| for a reason, but that it's nearly always working with
| imperfect information. Some notable examples:
|
| When you're in a stressful situation at work, your body can't
| tell the difference between that and "Oh no, we spotted a
| material threat to our life", so it reacts in ways that would
| make fight or flight easier, not in ways that help you handle
| the real situation.
|
| If your liver fails and you get a transplant, your body sees
| "ah, a foreign invader", and will set about the task of
| rejecting the new liver, despite it being very important for
| your wellbeing.
| guerrilla wrote:
| Definitely true, but the way I think of it is that you should
| go with the default _unless_ you have a reason not to. Things
| like fear and depression are useful tools but if they get out
| of control and _only then_ are they mental illness, for
| example. In all of your examples, the person can know better,
| but when we 're talking about the type of injuries from the
| OP then we usually don't unless we've consulted with medical
| professionals (or are one ourselves) so it makes sense to
| start with the default.
| kube-system wrote:
| I'm the type of person who produces their best work when
| they're under pressure, so, maybe my fight response _does_
| help me at work.
| onion2k wrote:
| _I have always figured that my body knows what it's doing when
| it responds to an injury with inflammation._
|
| Applying the logic of "your body knows" is probably not in your
| best long term interest. In purely evolutionary terms, getting
| a bad enough injury that you require medical attention _should_
| mean you just die because you weren 't strong enough to
| survive. Artificially saving your life is "unnatural".
| nh23423fefe wrote:
| This is an often repeated but incorrect interpretation of
| 'survival of the fittest.'
|
| Newborn babies can not survive, yet that says nothing about
| whether they 'should' or 'shouldn't' according to
| 'evolution.'
|
| Evolution isn't goal directed, it isn't picking winners and
| losers.
| todd8 wrote:
| When I started running longer distances to train for marathons, I
| ran into lots of other runners that iced after running say 10
| miles. I did this too, but as time passed I got too lazy to pack
| up some ice to use at the end of long runs because these were
| always scheduled in the very early mornings at sometimes distant
| but interesting locations.
|
| What I discovered was that cold did feel good and did alleviate
| some of the discomfort from running, but for overuse induced
| discomfort it wasn't overall helpful to me.
|
| Now a bit off-topic to explain what did help me with overlong
| runs:
|
| What helped me the most for the wear and tear caused by long runs
| was getting the right shoes: some would make the lateral
| (furthest from the midline of my body) sides of my knees hurt,
| some would make the medial (closest to midline) sides of my knees
| hurt and when I found the right ones my knees didn't hurt. Shoes
| without enough padding under the ball of my foot also ended up
| causing me more pain than shoes with more padding.
|
| I always alternated my runs between shoes from two different
| manufacturers because I found that the slight differences in the
| ways the shoes flexed prevented overuse injuries from running in
| the same shoes each day.
|
| Finally, for some reason I would curl my toes down as I got tired
| and bruise a couple of my toenails. I fixed this with little soft
| silicon toe sleeves that I could pick up at the pharmacy.
| ericmcer wrote:
| This is a good example of how there isn't really a cutesy
| acronym that will fix your injuries. Your body is yours and
| figuring out what works for you is part of the process of
| health. I have been climbing for years and what prevents
| injuries and aids recovery is a constant game with ever
| changing rules, so you have to enjoy the ups and downs.
| sizzle wrote:
| Are you worried about wearing out cartilage in your knees?
| SaberTail wrote:
| I'm also a distance runner and I've never iced after running.
| Foam rolling and massaging seem to work much better for me.
|
| And +1 on the shoes thing. I do the alternating shoes thing, as
| well. And I can tell when a pair is wearing out because I start
| to get little pains that grow until I replace the shoes. Some
| of my full-blown, need-to-take-time-off injuries have been from
| running in worn out shoes. Usually they wear out after 300-500
| miles.
|
| I'll have to check out the toe sleeves. Thanks for the tip.
| isk517 wrote:
| Its funny but the most useful feature that my GPS running
| watch provides me is a warning that my shoes have more than
| 300 miles on them. Known that information and then switching
| out right away helps avoid so much injury.
| theonething wrote:
| > pair is wearing out because I start to get little pains
| that grow until I replace the shoes
|
| I experience this too and wasn't sure if it was my
| imagination or truly indicative that I need to replace them.
| Your comment helps to assure me it's the latter case.
| nashashmi wrote:
| In place of icing, and in place of anti-infammatory, my approach
| to reducing swelling is to increase blood flow with massaging an
| area before and/or after the injured tissue at the time of
| swelling. But do not massage the area that is swelling.
| nashashmi wrote:
| A little info on (my) theory of swelling:
|
| When a part of the body is injured, stressed, or just requiring
| extra nutrition, it swells up. Swelling is a cure. But swelling
| is also painful and can lead to other problems. The most
| important thing to do is to make sure the area that is swelling
| is also getting good circulation. So a simple "pumping"
| approach of the muscles surrounding the swelled area should
| cause good flow. And swelling will be reduced.
|
| For example: You walk a long distance with inappropriate
| footwear. I am talking about 20,000 steps. And this is not
| something you are used to. So When resting, the body floods the
| foot with a whole lot of nutrients. But the blood just stays
| there, because it will slowly and eventually flow out with
| movement. But the body is not moving, so it swells. Massage
| pumping the calves will pump the blood out and new blood will
| flow in. This will reduce the swelling.
| [deleted]
| ls15 wrote:
| So they are replacing _POLICE_ with _PEACE & LOVE_.
| cfeduke wrote:
| This sounds like a bunch of nonsense (PEACE & LOVE? Really?).
|
| That being said I continuously injure myself because I am very
| active - all sports have a risk of injury - and have never iced.
| I had a really bad ankle sprain a few weeks ago where my only
| treatment was compression and I was operating on it and performed
| a 2.25x body weight back squat with no issues within three weeks.
| So, anecdotally, not icing and no anti-inflammatories seems to
| work well for me. Probably a healthy dose of being stubborn and a
| stickler for not missing training helps as well.
|
| (It's not because I'm young and heal quickly - I'll be 44 in two
| weeks.)
| philliphaydon wrote:
| It seems a lot of boxers and MMA fighters use ice. My wife was
| doing boxing and such for exercise at a gym run by an ex MMA
| fighter in Singapore. She hurt her wrist and it hurt alot and the
| gym told her to put ice and water in a jar, and hold her hand in
| it for 15 minutes. The pain subsided and swelling went down and a
| day later she had normal movement in her wrist again.
|
| I have no idea of it's effective but it seems to have helped her.
| fsh wrote:
| You don't know what would have happened without the ice.
| Believing in anecdotes instead of studies leads to bloodletting
| and homeopathy.
| philliphaydon wrote:
| This is true. And I hope my story didn't come across as me
| trying to claim it as anything more than a story.
|
| I'm always skeptical about these sorry of things. But having
| had similar injuries before and having not used ice I was
| surprised that she could move her wrist without pain while
| for me it takes like a week.
| gwd wrote:
| It will certainly reduce swelling and pain; the question is
| whether her wrist would have been back up to 100% more quickly
| without the ice. The claim in the infographic was that the ice
| probably slowed down healing. I haven't looked at the evidence
| (presumably) presented in the paper itself to justify this
| conclusion.
| philliphaydon wrote:
| So having had similar injuries before myself it's taken me
| longer to heal and movement was painful.
|
| In my wife's case she has full movement and no pain. But she
| didn't go back for class for 2 weeks. Make sure it had
| healed. Just was surprising to me that she curls move her
| wrist without pain.
| mhb wrote:
| _I haven 't looked at the evidence (presumably) presented in
| the paper_
|
| Surprisingly, the blog has more references than the paper
| (and the paper mentions that).
| kristiandupont wrote:
| That ice would reduce swelling feels intuitive to me. What is
| less intuitive is whether or not reducing swelling is in fact a
| good thing.
|
| The way I see it, swelling could be one of two things:
|
| 1) a mechanism that the body engages in order to heal or
| alleviate healing, similar to fevers, or
|
| 2) a negative side-effect caused by, say, inflammation or
| something.
|
| There are probably studies that indicate which of the two it
| is, I don't know. But if it is #1, then reducing it is just a
| way to actively work against the body.
| SamBam wrote:
| It's always been curious to me that a number of things we do
| some to be counter to our own bodies' healing mechanisms.
|
| Besides trying to reduce inflammation, the other big one of
| course is antipyretics, or fever reducers. Fever is a big
| trigger for our bodies' innate immune system, both helping to
| denature bacterial and viral enzymes and triggering the
| recruitment of defense cells. Suppressing the fever
| unnecessarily (i.e. when the fever itself isn't causing harm)
| seems to have a significant effect on the body's ability to
| fight pathogens.
|
| > "the use of antipyretic drugs to diminish fever correlates
| with a 5% increase in mortality in human populations infected
| with influenza virus and negatively affects patient outcomes
| in the intensive care unit."
|
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4786079/
| algorias wrote:
| Swelling means that your body is directing more blood than
| usual to this location. More nutrients, more antibodies, etc.
| jonnycomputer wrote:
| Acute inflammation is there for a reason; it helps repair
| tissue damage. At the cost of function in the short-term. My
| bet is that icing means you can use your wrist again sooner,
| but with prolonged or incomplete recovery.
| naasking wrote:
| > Acute inflammation is there for a reason; it helps repair
| tissue damage.
|
| Inflammation is primarily to address _severe trauma_ , like
| having a limb severed or torn apart. That doesn't
| necessarily mean it's good for all tissue damage, but
| evolution often can't make such fine distinctions, so our
| body triggers inflammatory responses even when it's
| counterproductive. The inconvenience a counterproductive
| response is much better than the death that follows from
| not having any response.
|
| A lot of medicine is about controlling the body's
| inappropriate inflammatory responses. We don't always have
| a good handle yet on when the body's inflammatory response
| is good vs. bad in all cases, which is why the debate over
| icing is ongoing, but it is clear that it often isn't
| beneficial. I think it's also clear that icing and NSAIDS
| for _chronic_ inflammation are not good ideas.
| iamthirsty wrote:
| > but evolution often can't make such fine distinctions,
| so our body triggers inflammatory responses even when
| it's counterproductive
|
| This is just not accurate, and I'd love to see your
| source on even the first clause here. because evolution
| does, in fact, make fine distinctions all over the tree
| of life.
| naasking wrote:
| > because evolution does, in fact, make fine distinctions
| all over the tree of life.
|
| I said evolution _often_ can 't make fine distinctions,
| not that it _never can_. The inconvenience of improper
| inflammation was clearly never so great that it impacted
| reproductive fitness, where death resulting from no
| inflammation clearly does.
| Dylan16807 wrote:
| To be clear, given what you quoted, your claim is that
| inflammation is almost never wrong?
| iamthirsty wrote:
| My claim didn't really have to do anything with inflation
| specifically, just that evolution itself can make fine
| distinctions.
| Dylan16807 wrote:
| It looked like you were calling the whole sentiment
| wrong, not just the first half (and ignoring the word
| often). Okay then.
| SiempreViernes wrote:
| I imagine the claim was more that evolution gives systems
| that at the individual level aren't that fussy about the
| details, not that evolution can't produce highly
| specialised organisms.
|
| Or in other words, ducks imprinting on a dog is a thing:
| https://www.youtube.com/watch?v=6qidueuojrc
| abfan1127 wrote:
| source?
| danenania wrote:
| Another factor when it comes to evolution is that it
| doesn't care much what happens to us when we get old. If
| it can trade increased fitness during our reproductive
| primes for a lot of aches and pains in our 40s, it will
| happily accept. You don't hear too many 16-25 year olds
| complaining about inflammation.
| 323 wrote:
| But the body during evolution didn't have access to ice
| (studying polar bears and pinguins might be interesting).
|
| So it could be that ice is a good thing, just like air
| conditioning is a good thing, but nature had no way of
| evolving that.
| orestarod wrote:
| Well ice is there to UNDO some of our body's responses, so
| it does not do something the body could not theoretically
| achieve.
| danenania wrote:
| Overdoing it with one mechanism then compensating for
| that with some other mechanism is so like biology though.
| Biology is like a junior programmer who is rushing to
| meet a deadline. If it can slap a bandaid on somewhere
| instead of refactoring, it will nearly always do that.
| harimau777 wrote:
| An explanation that I was given (note: by a pharmacist, not a
| doctor or sports therapist) was that swelling is your body's
| way of "splinting" the injury so that you can keep moving in
| a survival situation. However, it delays/inhibits healing.
|
| While survival now at the expense of long term healing was
| probably a good tradeoff for our ancestors living in the
| wild, it likely no longer makes sense for modern people
| outside of emergency situations.
|
| I want to emphasize, that this was just an explanation that I
| was told. No actual evidence was given.
| nvrspyx wrote:
| I've never heard the "splinting" explanation before. I've
| been told that it's the body's way of prioritizing the
| routing of plasma and red/white blood cells to the damaged
| area for cell repair and immune response as well as
| clearing out damaged tissue. I've also been told that the
| only bad inflammation is chronic inflammation.
|
| This was from a sports medicine doctor during a
| conversation about our sports trainers. The doctor was also
| against the heavy use of cryotherapy by our trainers
| because, according to her, it prolonged recovery. She
| actually encouraged applying heat instead of cold for non-
| injuries (e.g., post-workout, pre-competition, etc.) where
| your body may not have an inflammatory response to increase
| blood flow to the areas and that applying cold would just
| increase the chance of actual injury.
| kristiandupont wrote:
| That is a fine example of a third explanation which seems
| equally plausible to me.
|
| Of course, the topic is very similar to all the
| conversations about ChatGPT: are eyebrows "made" to protect
| the eyes from dripping sweat? No, because evolution has no
| intention. But it sure was convenient.
| neuralRiot wrote:
| Let's throw anecdotal data since we are at it, for me in my
| over 20 years of bodybuilding experience with plenty of "soft
| tissue" injuries what works best is cold-warm theraphy.
| jackmott42 wrote:
| Yes, athletes have been both icing and heating injuries for
| centuries, and doing many other things that make no sense.
|
| However, it _could_ be the case that icing injuries is a good
| idea if you need to perform the next day (or otherwise soon)
| but a bad idea if you want to heal the best /soonest that you
| can.
|
| Or it could all just be nonsense, no shortage of that, no
| matter how popular.
| grumple wrote:
| This title does not match the article.
|
| This article / "paper" is barely a stub. No study was done and I
| don't think this could be called a meta-analysis, but rather a
| summary citing a few other articles (only 2 relevant to icing in
| the context of avoiding anti-inflammatories). Even if it's true,
| this article does nothing to support the claims and does not
| address reasons why ice would be used.
| [deleted]
| tinglymintyfrsh wrote:
| I'm curious what the tradeoffs are for and against anti-
| inflammatories (and which ones in particular and which kind of
| injuries).
|
| Are there studies proving anti-inflammatories are
| counterproductive?
| AlbertCory wrote:
| There does seem to be some medical evidence given, but you really
| have to work to find it. And yes, the acronyms are cringe.
|
| I have a friend who just had knee replacement. She said the pain
| was excruciating, and that the best advice was ice in the first
| few days (she said two days), followed by heat after that. Since
| she's the type of person who would have access to the best
| medical advice, I tend to believe it.
|
| As for claims that "the body is always right" : look up "auto-
| immune disease."
___________________________________________________________________
(page generated 2022-12-19 23:01 UTC)