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..
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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??? ;)