Is Popular Opinion Wrong About Treating Injuries?

[Iron]

Originally Posted by Eric3237

Oh, bro, I was kidding around. I actually figured that was the case. Sorry! I'm not feeling well so I guess my feeble attempts at humour are even more feeble than usual

I welcome and appreciate the discussion. This kind of thing is the dirty work that most people don't want to touch.

Exactly and thank you.. I welcome and appreciate your views [even if they are wrong ;)] sorry! just kidding! we're even now!! LOL

[Kane]

I just wanted to throw in my bit of experience with ice therapy. I severely strained my quad not to long ago and when I was doing physio I would go through the usual ultrasound, massage and stretching/rehab routine followed by ice.

It was explained to me that the ice was used to effectively shrink the heated/loosened muscle back to its original size to prevent re-occuring damage that may occur from using a weakend elongated muscle. Essentially reducing the strain in the muscle to make it more difficult to strain the muscle further than the original strain.

I don't know how this fits into any theory or study and I don't know if there would have been a better approach. BUT my recovery time, from the time of the strain back to 100%, was about a month and a half. And to me the explanation I was given makes sense, it could be bullshit or it could be true, I don't know.

[Iron]

Originally Posted by Kane

I just wanted to throw in my bit of experience with ice therapy. I severely strained my quad not to long ago and when I was doing physio I would go through the usual ultrasound, massage and stretching/rehab routine followed by ice.

It was explained to me that the ice was used to effectively shrink the heated/loosened muscle back to its original size to prevent re-occuring damage that may occur from using a weakend elongated muscle. Essentially reducing the strain in the muscle to make it more difficult to strain the muscle further than the original strain.

I don't know how this fits into any theory or study and I don't know if there would have been a better approach. BUT my recovery time, from the time of the strain back to 100%, was about a month and a half. And to me the explanation I was given makes sense, it could be bullshit or it could be true, I don't know.

I'll look into that. Have to think if a Dr. told you that then I would hope he would have a good reason. On the other hand an injured muscle doesn't spontaneously stretch out and lengthen just because it's injured. On the contrary, muscles spasm and contract to act as a splint to keep it from being moved to protect it while it's healing. Anyone that's ever had a bad back can attest to that.

Ice may play a role after the inflamation has done it's job and gone away. (I'm thinking out loud.) I don't know that to be a fact and it really doesn't make sense to me though. Once all the inflamation is gone then healing is complete but the muscle may need to regain fitness and strength depending how long it's been out of commision...still doesn't make sense.

Eric, any ideas?

[Kane]

Originally Posted by Iron

. On the other hand an injured muscle doesn't spontaneously stretch out and lengthen just because it's injured.

I think he was getting at something more along the lines of...if you use the muscle when its heated up and loose, and injured, then even walking or climbing stairs could cause elongation significant enough to hinder repair or cause damage. I'm not saying that walking or stairs would do it, I'm just using those as examples of common things you might do.

[EricT]

Here is my quick response and I'll post longer later.

As I've said, it may be that what your are saying bears out. But, and I mean no disrespect when I say this, one or two studies is not enough to change medical practices and I think you are putting too much stock into studies themselves. Evidence from studies must be examined and built upon. While it is true that some doctors stubbornly cling to dogmatic practices is is also true that they don't base their medical decisions on just one piece of evidense that suggests areas of research but comes far from proving or disproving anything. Each study of this nature is wrought with problems. It takes more. That is what I mean when I say "widely accepted". Being on the cutting edge is all fine and good but we can't blindly follow every new idea that comes along until it has stood up to scrutiny and is backed up by other research, ideas, experience, etc. I'm sorry if it is frustrating but this is really how science works. What is in the first aid part is not about my views. I'm just reporting the majority opinion. It is not meant to replace a doctor's opinion and for that matter, a study someone sees should never do so either.

What Kane is talking about, however the doctor explained it to him, represents why doctor's recommend it and it is just what I said: to reduce the chances of further injury to the vulneralble area. Could this be wrong? Sure, but do we KNOW it is wrong based on enough studies? NO. The last time I had an injury the orthopedist said ice in his experience led to better outcomes. Same thing with my wife. She's hurt both her knee and ankle recently. Ice on both. Was the doctor stubbornly clinging to outdated views? I don't really think so.

About ice and inflamation, ice is not thought to play any role at all after the initial period of injury and instead is thought to be counterproductive.

Some of this stuff is a little confusing. On one had you get people saying inflamation is natural, swelling is natural, don't interfere with the body's natural healing process. All well and good up to a point. Then you get the same people ignoring the body's signal. Namely pain. Pain is your body's way of telling you something is wrong. You apply heat to an early injury it can and will increase bleeding and swelling. The result will be increased pain. Your body's way of telling you something is wrong...get my drift?

BTW, on the NSAIDS I agree. I am only talking about RICE. NSAIDS are not part of RICE. I think you are taking the thing about inflamtion, putting cold therapy's role in that and tacking it on to the anti-imflammatory studies. But the only real way to study the effectiveness of cold-therapy is to study cold therapy. You can talk about inflammation and it's role in healing but it is not clear whether reducing inflamation is mechanism in cold therapy. It is one possible mechanism. What I am trying to say, in a nutshell, is the jury is still out, but the court is still leaning toward RICE (for initial first aid).

I understand how it's frustrating to have me questioning studies, but on the other hand, consider that I researched all this very very hard, and came accross all these things and more before I decided what to put in. I won't you to know that I didn't just throw this together based on the first thing I googled. That thing I posted above is just one of many things I have saved. So you can see why I might be a little frustrated too, lol, but instead instead I welcome the discussion because I think it is good to question.

I kept my mind open and my mind is still open. But we are not scientists. At least I am not. Taking every new study, wrought with it's limitations, and going with it in the interest of being cutting edge without looking at what the scientific medical community is saying is not, imho, going to serve us well in these medical subjects.

I think we have to be a little sober in our attitudes. But let me be clear that the last thing I want is for the first part of this thread to be incorrect or damaging. I certainly would like to do away with old outdated ideas. But just because something is old doesn't mean we should close our minds to it in the interest of being, I dont know, modern I guess. Galileo was one guy. If he were living today his ideas would still have to be examined and scrutinized by other scientists. And there would always be guys studying his work and trying either to prove it right or wrong. And he was kind of exceptional wasn't he? Not everyone's ideas should be looked at like that of a Galileo, Newton, Einstein, or Doogie Howser. If you look at the review of cryotherapy research I posted you'll see that they concluded only that there wasn't enough research.

Originally Posted by Iron

It's frustrating to post an actual study showing and proving that when X was done then we saw X happen and have someone say they disagree. Disagree with what? It's not a matter of opinions, they're worthless.

Well I'm going on and on aren't I? When I said I disagree about RICE I wasn't disagreeing with the particular study showing a particular thing. I simply disagree that that is enough to abandon RICE. There's a difference in there, I think.

Again, on the NSAIDs thing I posted some really good reviews on that. But that is not about RICE. It's two different subjects.

[EricT]

Originally Posted by iron

Concerning R.I.C.E. treatment:

Ice slows the ambient cellular metabolism and blood circulation significantly, thus adding to the slowing of healing.

The cells that make up ligaments, tendons, and organs are extremely temperature-sensitive. The metabolic rate at which these cells function is directly proportional to the temperature in their environment.

For each 10 degree drop in temperature, there is a more than two-fold decrease in the cell metabolism. Conversely, in order to increase cell metabolic rate the temperature of the tissue must increase.(1) That's why warming up is effective.
On the other hand, cooling tissue will decrease that cell's metabolism, slowing blood circulation and slowing healing.

In fact, Dr. Sherwin Ho and associates of the University of Hawaii in a landmark study showed that icing a knee for 25 minutes decreases blood flow and skeletal metabolism another 400 percent!(2)

The same study showed that the average decrease in arterial blood flow was 38 percent, 26 percent in soft tissue blood flow (ligaments), and 19 percent in bone uptake (which is a reflection of changes in both the bone blood flow and metabolic rate.) The net effect would be impaired or at best, delayed, soft tissue healing.(2)

You have to see that this shows an effect of ice. The researchers assert that the results would be delayed, soft tissue healing. They haven't shown delayed healing they have surmised it. Others think that these very effects are a desirable thing in the initial stages of injury. Do you see how this is still questionable? The healing process is poorly understood. Only studies showing whether ice delays are speeds favorable healing outcomes really show anything and they are very hard to do.

I'll try to adress the business of the inflammatory response and swelling as head on as possible. As I said, I'm not a doctor, I'm just reporting. First we need to know why we get swelling when we get a strain or sprain. When tissues get torn so do the blood vessels within them. So you get bleeding into the injured area. The blood needs room so there can be some swelling from that. Then you get the inflammatory response and special repair cells are sent to the area. The local blood vessels are expanded to get extra blood to the area in order to deliver as many as possible. This causes fluid to leak out of the vessels into the area and so more swelling.

So yes swelling is natural thing. But a guy in a lab coat who wants to say swelling is always good must never have had a really bad injury. Just as we know people get brain damage from fevers (a natural defensive response) we know that the body can tend to over-react. If you sprain you ankle and get a little swelling is that a big deal? No. But too much swelling is not really a good thing. First of all too much swelling and pressure impedes blood flow to that area and thus things can not get out. Waste products cannot be carried away efficiently and healing can be hampered by this.

Secondly swelling puts pressure on nerves and vessels and can damage them. It can stretch the soft tissure of the area and further stretch the damaged tissue. Again, not good. The body's defensive responses can get a little out of control. Trust me, I know, I have an auto-immune disease to prove it.

I'll relate the story of my really bad ankle sprain. It was a grade three off the chart with all sorts of soft tissue damage. The pain was unbearable. The swelling was so bad my toes disappeared and my entire foot turned black. My ENTIRE foot. I had to go to an army post about 40 miles away from where I was at the time to get treatment. The FIRST thing they did was to get swelling down. Why? Because my toes weren't getting any blood. True this was a bad case but it serves to illustrate my point. Yes, I think we should try to assess the severity of our injuries and for very mild things measures against swelling may not always be necessary....which is why I say see a doctor when in doubt.

But at this point probably 95 percent of the sources are going to say what I'm saying. That's why I'm saying it. I don't think it resposible of me to say differently just because it represents new thinking.

Originally Posted by Iron

When you post stuff like, "most widely excepted method" and "base their recommendations on the widest body of evidence" and "I went by the most widely accepted practices" it doesn't exactly put you on the cutting edge of medical discoveries.

If I didn't know better I'd think you would rather me have posted a single study for the thread. It's not my intention to be on the cutting edge of medcal science. I don't want to make guinea pigs of anyone who may accept what the post says. But there are no cutting edge medical discoveries on this. A study that takes an effect and then concludes that this effect has such and such impact on healing is not a medical discovery. You can say ice causes this or that but you must prove the effect that has in the long term. Just saying it doesn't make it true.

As I said, I'm just being the reporter and at this time there are too many qualified people saying RICE is still the best way. Hopefully there will be more evidence coming in and this will be cleared up. But I'm afraid it will take a while for us to know for sure. Myself, I'm sticking with RICE, then stretch and heat, and rehab.

I agree that new ideas are what it's all about. But new ideas are put forth and discarded everyday. It is not about change for changes sake. We must challenge dogma but at the same time we have to be careful not to create a sort of "cult of ideas" where the new and the modern become a sort of dogma for their own sake.

[Iron]

Thanks for the replies Eric. Sorry I'm so slow in responding. I was off yesterday and away from a computer. My wife doesn't let me "play" on the computer much when I'm home! Thanks also for keeping this civil. So many board discussions downgrade quickly into a brawl. You're an asset here and I enjoy our debates. I did notice your little jabs(jk!) in the shoutbox but too late to respond!

Enough sucking up, now down to business!

Swelling can be bad when it's extreme per the example you gave. I agree in cases like that but for less serious cases I think it's clear that ice is a hindrance. By the same token, if you're bleeding enough inside that it actually adds to the swelling than you've got a hematoma and the proper treatment is not to ice but to surgically stop the bleeding. Again we're talking about average cases.

I agree it can be dangerous to make decisions on your own when it comes to treatment but it can be just as dangerous to listen sometimes. Good Doctors will tell you that your health is ultimately in your own hands. They make incompetent decisions all the time as we all do. To most of them it's a job. You get a guy with a sprain then you spout out the same treatment you've been spouting for 20 years. Most I'm afraid don't care enough to keep themselves educated as they should so ultimately it's up to you to use your own common sense.

About the Doctor you mentioned that said he had always gotten the best results from using ice. This is an example. Do you think he's ever tried any other treatments? Did he perhaps at one time not use ice and compare it to the others he treated where he did use ice? Of course not, that's what researchers do. How long do you think it takes to get to be mainstream?

It's scary to make your own decisions but I think it's wise. That's what's great about the internet, we're now privy to the same info that Doctors have. I've heard it said that up until about 1940 or 1950 that you had about a 50%-50% chance that the treatment you receive from your Doctor would be helpful or harmful. It's your life..

***********

I ran a lot of searches trying to find things that either support RICE or not. In all honesty I couldn't find anything that said conclusively that icing helps. Most of it seems to be just what we've always used for whatever reason. Nothing definitive which actually surprised me. Here's what I did find. For the sake of brevity, I'll only post a sentence or two from each article along with the website if you want to research it further.--

The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials.
Bleakley C, McDonough S, MacAuley D. Rehabilitation Science Research Group, University of Ulster at Jordanstown, Antrim, Ireland.
http://www.ncbi.nlm.nih.gov/entrez/q..._uids=14754753

There are wide variations in the clinical use of cryotherapy, and guidelines continue to be made on an empirical(from experience not from studies) basis.There was little evidence to suggest that the addition of ice to compression had any significant effect. Few studies assessed the effectiveness of ice on closed soft-tissue injury, and there was no evidence of an optimal mode or duration of treatment. CONCLUSION: Many more high-quality trials are needed to provide evidence-based guidelines in the treatment of acute soft-tissue injuries.

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Cold therapy of athletic injuries. Current literature review
Thorsson O.Kliniskt fysiologiska laboratoriet, Universitessjukhuset MAS, Malmo.
http://www.ncbi.nlm.nih.gov/entrez/q...=pubmed_docsum

Cryotherapy reduces the metabolic rate in injured muscle and is often used several days after a soft tissue injury to reduce secondary hypoxic injury. Experimental studies, however, show no effect of cryotherapy on muscle regeneration, and no controlled clinical study has shown a significant effect in emergency treatment of soft tissue sports injuries.

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Acute ankle sprain: an update.Ivins D.Department of Family Medicine, University of Oklahoma College of Medicine-Tulsa, Tulsa, Oklahoma 74102, USA. douglas-ivins@ouhsc.edu

RICE ( Rest, Ice, Compression, and Elevation) is a well-established protocol for the treatment of ankle injury. There is some evidence* that applying ice and using nonsteroidal antiinflammatory drugs improves healing and speeds recovery.

*This was the closest I could find of anything saying that there is evidence for icing being effective and all it says is that there is only some evidence.

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Do textbooks agree on their advice on ice? MacAuley D.
Institute of Postgraduate Medicine and Health Science, University of Ulster, Newtownabbey, UK. dc.macauley@ulst.ac.uk

CONCLUSION: There was little guidance in the standard textbooks on ice application, and the advice varied greatly. There is a need for evidence-based sport and exercise medicine with a consensus on the appropriate use of ice in acute soft tissue injury.***

*** Apparently no one even knows how to properly use ice therapy as it's noe been studied enough

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Does Cryotherapy Improve Outcomes With Soft Tissue injury ?Hubbard TJ, Denegar CR. Pennsylvania State University, University Park, PA.

CLINICAL QUESTION: What is the clinical evidence base for cryotherapy use?
DATA SOURCES: Studies were identified by using a computer-based literature search on a total of 8 databases: MEDLINE, Proquest, ISI Web of Science, Cumulative Index to Nursing and Allied Health (CINAHL) on Ovid, Allied and Complementary Medicine Database (AMED) on Ovid, Cochrane Database of Systematic Reviews, Cochrane Database of Abstracts of Reviews of Effectiveness, and Cochrane Controlled Trials Register (Central). This was supplemented with citation tracking of relevant primary and review articles. Search terms included surgery,orthopaedics,sports injury,soft tissue injury,sprains and strains,contusions,athletic injury,acute,compression, cryotherapy,ice,RICE, andcold.

CONCLUSIONS: Only 2 of the 8 groups reported significant differences in favor of ice and compression. In comparison with other rehabilitation techniques, the efficacy of cryotherapy has been questioned. The exact effect of cryotherapy on more frequently treated acute injuries (eg, muscle strains and contusions) has not been fully elucidated. Additionally, the low methodologic quality of the available evidence is of concern. Many more high-quality studies are required to create evidence-based guidelines on the use of cryotherapy.***

*** I thought this particular study was the most damning to ice therapy beacuse it is actually a search to find if there is any evidence for it. As you can see they did a very extensive search of every possible data-base and couldn't find much at all.

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Lakartidningen. 1983 Mar 2;80(9):779. Links
[Harmful effect of ice packs used in the treatment of athletic injuries--warning against cold injuries]
[Article in Swedish]Andren-Sandberg A.PMID: 6865588 [PubMed - indexed for MEDLINE]*

*This article was in Swedish so there's no text, but the title I think is interesting

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As you can see, there seems to be a lack of any evidence/studies/research in favor of ice therapy. I think I'm safe in concluding that it's never been seriously studied. I couldn't find anything and neither could Hubbard TJ, Denegar CR. Pennsylvania State University, University Park, PA. They actually attempted in their study to see if they could find any evidence and were unable to. I believe it one of those things that' s used simply because that's what everybody's always used and no one's ever thought to question it...

Time to change the first part of the thread??? ;)

[Iron]

Hello? Earth to Eric?? I'm talking to my self here!! ;) LOL

[EricT]

Sorry I was out of town and my monitor was busted on top of it.

I'll respond to some of the specific things you said first

By the same token, if you're bleeding enough inside that it actually adds to the swelling than you've got a hematoma and the proper treatment is not to ice but to surgically stop the bleeding.

A hemotoma is simply a generic term for internal bleeding within a confined space or compartment. It is usually associated with some clotting. If you get hit on the head with a rock the resulting lump is a hemotoma. I don't think they need to open you up for that, necessarily. Trust me, I know all about knots on the head .

It is not clear at all that ice is a hindrance. It is not clear by the reasearh we have seen that ice is a benefit but that doesn't show it to be a hindrance. We KNOW the effect of ice metabolically. Nobody is saying differently. It is it's ability to slow down the metabolism of the tissue that is one of the very reasons it is used. I.E. for the prevention of damage to the tissues from ischemia among the other things I have mentioned.

Whether ice negative effect on long term outcome is the question, not it's immediate effect. Keep in mind that we are only talking about ice for 1 to 3 days AT MOST. Anything longer than that probalbly would be a hindrance.

One of the comments about ice and rehab makes no sense since no active rehab should be started in about the first 48 to 72 hours. Just gentle movement 3 or 4 times a day. By the time someone starts rehabing an injury they should be done with ice. This is what I was talking about in terms of the mischaracterisations of how ice therapy is used. But Ive said all this.

The literature studies are not saying anything we don't already know which is that it hasn't been researched thouroughly. I'd be interested in the specific studies that show harmful effects. I'll look into changing up the first post to reflect some of the questions. One of the biggest is joint versus muscle injuries. I still do not think it is warranted for me to make broad changes based on the reasons I've already stated. I will look into it for the sake of inclusiveness. I wan't to have info as complete as possible.

It's scary to make your own decisions but I think it's wise. That's what's great about the internet, we're now privy to the same info that Doctors have. I've heard it said that up until about 1940 or 1950 that you had about a 50%-50% chance that the treatment you receive from your Doctor would be helpful or harmful. It's your life..

We're getting into a very broad philisophical discussion here. I'll say again that we are not doctors. Having access to info is not the same as having the education and broader understanding necessary to interpret that info.

I'd say that making your own decisions should be based on multiple medical opinions backed up by a general understanding gained from personal research. I certainly don't think people should make medical decisions based on internet searches. Even with pubmed searches the average person is going to have no idea how to properly interpret the data. You have to have a broader understanding of the picture. Like the kind of understanding you'd gain from medical school. No offense to anyone but most people, including myself, are not really qualified to do this. It's getting into territory where people could be MUCH more easily victimized than they could be the not so interested intern. Good research should help you learn what questions to ask. What information is relevant. And how to advocate for your medical care.

I'm not sure that you are hearing what I'm saying about the relevancy of studies to a person's medical decisions. Scientific info needs a context to be properly understood and utilyzed. Many long standing medical practices that have little initial clinical backing turn out to be very sound in the long run. What tends to happen is 1. they know it works but they don't know why 2. they notice benefits and then extend the practice, expecting to see these same benefits in a general context. Hell we now know that leeching has actual benefits. But it was used as a cure-all. It would stand to reason that there was a kernal of truth to the practice.

Ice therapy has been around since the time of Hippocrates. I am not saying that makes it effective. What I am saying is just because something is old and not based on clincial research does not mean it is incorrect.

Again, this is really too broad a discussion for here. I'll just say that every man for himself is not a good way to go when it comes to medicine

What to do about icing? I'm not sure. I still believe in it myself but this is not about my opinion. And it doesn't matter whether my opinion is based on a pubmed search or not because it is not a qualified opinion. That is the quandary here. We are not talking about the benefits of glutamine or something that won't hurt anyone, we are talking about medical information. When more research is done and orthopedists and start talking about it is wil be easier. As for right now you are asking me to base an medical informational post on what is essentially a lack of info. Because whether you like doctors or not, when the majority of them favor a certain practice, then, to me, that is more concrete than some studies that don't show one way or another. And again, let me stress that unrelated studies are exactly that...unrelated. To get somewhere each studie must build on the work of the last and follow specific protocols based on that. Otherwise they don't show much.

So I just don't know....

I think there is enough to say the following things:

1. Ice therapy is broadly excepted for initial treatment of acute injury.

2. There is not very much clinical research showing the long term benefit (or harm) with ice therapy.

P.S. the phrase "whether you like doctors or not" is the closest I ever go to saying "you don't like doctors

[Iron]

Originally Posted by Eric3237

Sorry I was out of town and my monitor was busted on top of it.

That's no excuse! ;)

QUOTE:I'll respond to some of the specific things you said first

QUOTE:A hemotoma is simply a generic term for internal bleeding within a confined space or compartment. It is usually associated with some clotting. If you get hit on the head with a rock the resulting lump is a hemotoma. I don't think they need to open you up for that, necessarily. Trust me, I know all about knots on the head

We're arguing semantics here..my point is that if you're bleeding internally to whatever degree, that ice isn't the answer and doesn't help that particular problem as you stated..

QUOTE:It is not clear at all that ice is a hindrance. It is not clear by the reasearh we have seen that ice is a benefit but that doesn't show it to be a hindrance.

I gotcha here! You're saying it's not clear whether ice is a hindrance and it's not clear that it's beneficial. Then why cling to it so tenaciously? Shouldn't that statement be part of your post??

No evidence? Come on now..I just posted 6 studies showing NO evidence whatsoever for icing being beneficial, on the contrary some show potential harm. One study was even actually a study serching every imaginable database trying to find evidence and none could be found..of course these were all a search for scientific evidence.

To be fair I did exclude all anecdotal evidence that you put so much stock in such as, "'Little Joey's Mom ALWAYS uses ice when he sprains his ankle and it REALLY works" and "'BigAssMuscles123" from the "BigMuscle.com" forum always ices and it works really awesome for him." just kidding..sorta!

QUOTE:The literature studies are not saying anything we don't already know which is that it hasn't been researched thouroughly.

Then why use it or at least why believe in it so religiously?

QUOTE:I'd be interested in the specific studies that show harmful effects.

Those are in my 1st post..

QUOTE: I'll look into changing up the first post to reflect some of the questions. One of the biggest is joint versus muscle injuries. I still do not think it is warranted for me to make broad changes based on the reasons I've already stated. I will look into it for the sake of inclusiveness. I wan't to have info as complete as possible.

Fair enough, especially when your position has no basis other than the fact that that's whats always been done. Am I not right here?

QUOTE:We're getting into a very broad philisophical discussion here. I'll say again that we are not doctors. Having access to info is not the same as having the education and broader understanding necessary to interpret that info.

True to a degree..you're assuming that Dr's keep themselves up-dated which isn't always or even usually the case. Dr's aren't God's or magicians, remember it's a business. They try to see as many patients in as little time to make the most money. Don't buy into the Health CARE providor thing..a lot are too un-caring and frankly too busy to read PubMed articles about ice. Your own health is ultimately up to you. I've questioned my Dr and my familly's Dr's advice often and have had them change their advice quite frequently. Doesn't mean I'm smarter I just have more time to research the particular condition. They can't for every patient, although I do know and see a Dr who does just that before she gives treatment advice.

QUOTE: I'd say that making your own decisions should be based on multiple medical opinions backed up by a general understanding gained from personal research.

Amen..

QUOTE:I certainly don't think people should make medical decisions based on internet searches. Even with pubmed searches the average person is going to have no idea how to properly interpret the data. You have to have a broader understanding of the picture. Like the kind of understanding you'd gain from medical school. No offense to anyone but most people, including myself, are not really qualified to do this. It's getting into territory where people could be MUCH more easily victimized than they could be the not so interested intern. Good research should help you learn what questions to ask. What information is relevant. And how to advocate for your medical care.

I think we're on the same page here.

QUOTE:I'm not sure that you are hearing what I'm saying about the relevancy of studies to a person's medical decisions. Scientific info needs a context to be properly understood and utilyzed. Many long standing medical practices that have little initial clinical backing turn out to be very sound in the long run.

True but only by luck.

QUOTE:What tends to happen is 1. they know it works but they don't know why 2. they notice benefits and then extend the practice, expecting to see these same benefits in a general context.

This was true through the centuries before the scientific method. No one forms medical procedural protocol in this way anymore. The FDA won't approve a procedure or a medication that HASN"T had epidemiological studies done so it's not possible anymore to develop a proceduer this way. Not since the 19th century anyway.

QUOTE:Ice therapy has been around since the time of Hippocrates. I am not saying that makes it effective. What I am saying is just because something is old and not based on clincial research does not mean it is incorrect.

Agreed, but, once again no procedure can be approved and used anymore unless the FDA approves it and they only go by studies. They absolutely never take simple opinions as to how something works in their journey to allowing a procedure to become practice. Don't you see new procedures develop from ideas like you're saying, then they're tested and studied TO BE SURE they work. Like it or not that's how it works and shouldn't old ways be checked out under suspicion and run tests and studies? So many old standard procedures were kickedThat's what actually is being done in the medical community

QUOTE:What to do about icing? I'm not sure. I still believe in it myself but this is not about my opinion.

Exactly..mine either

QUOTE:Because whether you like doctors or not, when the majority of them favor a certain practice, then, to me, that is more concrete than some studies that don't show one way or another.

I'll refer you once again to the ancient practice of bleeding. How long would you have waited to change your mind when countless studies were showing it didn't help but Dr's still used it???

QUOTE:So I just don't know....

at least you're thinking..;)

QUOTE:I think there is enough to say the following things:

QUOTE:1. Ice therapy is broadly excepted for initial treatment of acute injury.

Addendum: ...in spite of the lack of any evidence whatsoever.

QUOTE:2. There is not very much clinical research showing the long term benefit (or harm) with ice therapy.

Addendum: Other than the 12-15 studies I, as a simple layman, were easily able to find without any effort including the study that studyed to find even one study (without success) that supported icing by searching every imaginable database known to man.

QUOTE: And it doesn't matter whether my opinion is based on a pubmed search or not because it is not a qualified opinion. That is the quandary here. When more research is done and orthopedists and start talking about it is wil be easier. As for right now you are asking me to base an medical informational post on what is essentially a lack of info.

We at least seem to agree that there's not enough evidence to support icing and I've posted plenty that show NO support. Let me just say this: this is a fact: [u]There is absolutly NO support in the medical literature supporting icing that I or you have been able to find. That much is fact..[/U]

Ergo, why not just publish the facts and let the readers form their own opinions?

Iron

P.S. thanks for the intellectually stimulating discourse. You're one of the few I've found that can express themselves with a little more than simply saying, "bullshit!" ;)