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
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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.
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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
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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.
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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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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
