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 …”
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.
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.
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.
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.
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 :/."
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.
> 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.
>> 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.
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.
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.
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.
Not just for athletes: this is equally applicable to keyboard jockeys with repetitive strain injuries. One of the reasons braces are actually counterindicated.
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.
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
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.
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!
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.
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.
> 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.
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.
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.
The advice about rotating shoes to prevent overuse injuries, paying attention to stress bottlenecks is general.
Bodies differ in certain ways, but I've heard the same story as the shoes from many intensive exercisers. That I've never heard from a physician.
Listen to your body.
If it hurts, and it's not muscle burn, it's tendon/ligament/worse.
Muscle burn is very obviously different to actual pain.
Just stop. Change your posture so that part of your body isn't stressed, and the actual pain goes away.
If you can't make actual pain stop hurting, take an extended break by cross training.
Don't go home for the day. Always keep your exercise routine constant, but absolutely vary it to include "low stress" fallback options for tendon/ligament strain (pushups or own bodyweight, exercise bike, swimming).
If the same part hurts again next time, you likely have a "weak" point. You will need to gradually increase intensity until the "weak" point isn't a bottleneck.
Gradually means 10% intensity growth per weak maximum, and not pushing through actual pain.
All of the above is really simple.
The question is, why isn't what "actually works" the cutesy acronym?
"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.
"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."
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.
Doctors here give out anti-inflammatory packs like candy, and I did a dive since it seemed crazy to me. If your body is increasing blood flow to the area there's got to be a reason for it?
All I could find though was statements that it doesn't serve a role/gets in the way of healing, something about maybe being mainly to prevent infection at a wound site?
What you said seems reasonable, but can you point to any sources? I'd like to confirm for myself.
This mirrors my experience. All I've really been able to say is ice on a pulled muscle dulls the pain. I also researched it and never found good evidence supporting it. I also haven't great evidence supporting foam rolling or stretching to relieve muscle pain.
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.
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.
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.
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.
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?
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.
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.
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.
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.
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.
It did work, the doctor said he would have had a similar outcome from surgery. You van definitely feel where it fused, there is a bump there. I think because it was specifically the collarbone, they were able to set it with the surrounding musculature by just moving the arm and shoulder into place until it all lined up again.
I was a pretty model patient though, I was terrified of moving the arm and so it likely did sit where it needed to the whole time. I imagine others may struggle with such a direction.
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.
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.
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.
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.
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.
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."
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.
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.
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.
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.
> 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.
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.
> 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.
> 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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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."
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.
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.
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".
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.
> 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]
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."
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/PIIS0140-6...
Nevertheless, washing in tap water with soap is probably better nowadays.
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.
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.
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.
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.
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.
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.
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?
> 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.
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.
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.
> 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?
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.
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.
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.
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
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.)
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 …”