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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)
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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.
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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.
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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.