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Hey Eric, I'm very very sorry about that last short smart-ass post of mine. I posted it before I finished it so it's out of context. I got busy (I'm at work) and couldn't finish my post till now. I didn't know it was even there till I refreshed the thread. They're trying to block internet access here at work and I have to get around that constantly so please don't be mad with me ok??

Here's what the post should read:


What's in us that we can't let this thing go?! Actually it's what I like about you Eric! (I know that was borderline "gay" to say so that's why I said "like" instead of "love"!!)

I understand where you're coming from. However, let's be fair about the info you have posted. We've been debating this for a couple weeks and this is the first referenced info you've posted.

With all due respect and in all honesty Eric, I don't see where your article shows any prove of how and why ice therapy works. In fact according to this quote from it, they're actually saying that if we keep studying we may be able to determine if cryotherapy is efficacious. They're directly saying that they don't know if it's effective or not..

"If we directly examine secondary mechanisms for cell death in future research, we may be able to specifically determine the efficacy of treatments, such as cryotherapy, on these secondary mechanisms."

The self described Objective of the study had nothing to do with showing that icing works anyway. The point according to the article is to revisit and incorporate theories and show the need for more research into the secondary injury model.--

Objectives: To revisit the secondary injury model, to incorporate several current pathophysiologic theories into the model, and to show the need for more direct research examining the model.

Nothing frankly about icing other than to show that icing is used extensively. To quote the article.--

"Of these modalities, none is more commonly used for this purpose than cryotherapy."

That we already know.

The following quote from the article states that two previously thought reasons why they thought ice worked have been discredited. It basically concludes by saying that the current reason the researchers in this article think ice is effective is because it reduces secondary injury-further injury to the area caused by the swelling--which is usually NOT the case in most injuries.

though the acute and rehabilitative rationales for using cryotherapy differ and have changed throughout the years,6 the clinical efficacy of this modality has not. One of the most widely accepted theories regarding the rehabilitative use of cryotherapy, that it produced therapeutic cold-induced vasodilation,9 was discredited 20 years ago.6,10 A few years earlier, the rationale that short-term cryotherapy was effective because it limited edema formation through vasoconstriction began to be replaced by the currently accepted theory involving retarding secondary injury.6,11 This secondary injury model was a significant improvement over previous models because it strongly incorporated an understanding of immunology and cell pathology into acute injury management.

In summary we all agree that if swelling is bad enough to be a threat itself then yes, by all means, use it to reduce the damaging swelling. That, of course is the secondary injury thing that we want to avoid. But most swelling doesn't get that bad.

I've posted numerous studies showing zero effectiveness including a study that studied every imaginable database trying to find a good reason for icing. None of these showed ANY effectiveness and a few showed where icing actually hinders healing.

On the other hand I've not seen anything showing a direct relation between icing and better healing. I challenge anyone if I've missed it to show a study plain and simple that directly shows a cause and effect that icing helps (other than limiting further damage by the swelling itself.)



Iron

__________________
There are in fact, two things: science, and opinion; the former begets knowledge, the latter ignorance. -Hippocrates of Cos
"New opinions are always suspected, and usually opposed, without any other reason but because they are not already common." —John Locke
"And you shall know the truth, and the truth shall make you free.” - Jesus Christ

"Perago Validus"

Are we still cool? Did you read my apology and explanation?

I DO consider and acknowledge everything you post and we've found common ground on some of this. Most of it I don't agree with or interpret the same way you do ok? That's why we're debating. It's no problem, I could say the same for you. Please don't let it aggravate you.

Besides I though the reason we were debating was for fun ;)


Iron

Oh, I didn't mean any of that to sound like annoyance. Just responding to what you said. I feel that I have responded to the specific things you have brought up and most of them more than once .

However, I do have a hard time following some of your posts with all the underlining and such (not meaning to criticize) so if I'm missing stuff I didn't mean to. Use the quote function more and it will be easier to tell what you are saying and what you're quoting. It could be that you've acknowledged things and I've misunderstood.

Iron, bro, please read more carefully the specific statement I make. You said there is no "reason" to use ice and have posted things debating whether the metabolic effects of ice are good or bad. So my purpose is to show the "theory" behind it, i.e. the reasoning. As I said, info. And this suggests the specific areas of further research which goes much more in depth than just one study saying the metabolic effect of ice is bad.

Go back and read what I said. This article clearly delineates the reasoning behind ice and that is all I wanted to show. The reason I wanted to show it is because what has been posted so far could lead people to believe that there is no reasoning at all behind it, and, that is not a fair assumption. I never said it proved anything. But I repeat myself again!

We haven't seen those studies. And the reviews both of us have posted didn't find enough info to go either way.

If someone can acknowledge that ice can limit further damage, and not just from swelling but from ischemic effects and others, then how is that not going to affect the ultimate outcome? My main point is that nobody has given valid reason why not either. And since we are supposed to make our own decision I like to consider those reasons. Now you know that I will continue to use ice, but I DON'T KNOW. My mind is not made up one way or another. I'll admit I have personal reasons to use ice since I've had lots of joint injuries. Including three bad ankle injuries, a knee ligament injury, and shoulder injuries. The times I didn't use ice when I was younger, I had to walk on cruthches for a week and a half to two weeks. The times I used ice I was on my feet sooner and return to activity definitely affects long term outcome. So yes I believe in ice.

BTW, no article is perfect and no author is completly unbiased. In the quotes you used above from the artcle, it said that the efficacy needs to be verified AND that it was efficacious. They were saying that the theory behind the modalitly of it's effectiveness has changed but that doesn't change the fact that it works. So clearly the author seems to think it IS efficacious despite his statement that more research is needed to prove it's effectiveness. And he sound's smarter than me so I'm pretty comfortable in using it j/k

But again, I'm not trying to prove anything. Just showing what's out there, as you are.

At this point, neither one of us can prove or disprove it. I cetainly can see that.

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If you act sanctimonious I will just list out your logical fallacies until you get pissed off and spew blasphemous remarks.

What?? You don't like my underlining, highlighting and stuff? I do that to show you the important parts so you don't have to do it yourself! You can trust me not to be biased!!

No, seriously I had hoped it helps people pick out the main points of an article that may look to long and tedious to read through the whole thing. And it helps me point out the parts that I want to emphasize. I promise I'll read the instructions you gave me on the quoting thing and start using it. It is a little neater.

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I think we may agree on more than we disagree on..

If I may though I want to take exception to one thing you said and then we can move on.

I disagree with what you keep repeating about there being no evidence of icing being detrimental to the healing process. I posted the following in the very first post showing that it clearly is.--


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)

Thus, to whatever degree and whatever length of time, icing clearly has a detrimental effect on healing. No way around it..

So, to put it in more scientific words: Nyaaaaaaaaa!!! j/k!

LOL, I give! I spoke at length on that subject. IT DOES NOT PROVE THE LONGTERM OUTCOME.

The very things that it states as the effects of ice on cellular metabolism are the VERY reasons that ice is advocated. They have stated their theory that the long term effect would be delayed healing. Most people see it differently. I've mentioned this particular study you brought up several times and I keep referring to it because it is the only technical info you've given to support a REASON behind ice being bad. Again those reasons are opinion not proof. Everything in that article I posted about second injury have to do with the effects of ice on metabolism and it is seen as a positive thing by many researchers and doctors.

There simply is not other way to interpret that. It simply isn't proof that ice doesn't work. They are stating the obvious when they bring up it's effects on metabolism. As I said before that is not in debate. Stating a short term effect and proving the long term outcome IS NOT THE SAME THING.

I agree wholeheartedly that a person can say that ice slowing metabolism may slow down healing. They can also say, as you've read above, that by preventing secondary injury and protecting the tissue from VARIOUS kinds of damage, that it improves longterm healing. NEITHER has been proven. But there is more theory as to why it would help than that studies simple and statement of "it would slow down healing longterm".

There is no way you can say that is clear. Not if you consider both sides of the issue. Man, I've posted tons of reasons why it could have a positive effect and every one of them has to do with metabolic processes. Nothing has been proven. I understand you choose to interpret the data in a different way, I just don't see why I have to keep answering to the same info.

Another article showing the detrimental effects of ice--

by S.F. Nadler et.el. who is the Director of Sports Medicine at New Jersey Medical School.--


The physiologic basis and clinical applications of cryotherapy
Nadler SF, Weingand K, Kruse RJ. Director of Sports Medicine, New Jersey Medical School, 90 Bergen Street, Suite 3100, Newark, New Jersey 07102.

Clinicians treating these conditions should be aware of current research findings regarding these modalities, because their choice of modality may affect the ultimate outcome of the patient being treated. Although cold and hot treatment modalities both decrease pain and muscle spasm, they have opposite effects on tissue metabolism, blood flow, inflammation, edema, and connective tissue extensibility. Cryotherapy decreases these effects while thermotherapy increases them. Complications of cryotherapy include nerve damage, frostbite, Raynaud's phenomenon, cold-induced urticaria, and slowed wound healing.

LOL, why did you leave out the first line of it?

"Cryotherapy and thermotherapy are useful adjuncts for the treatment of musculo-skeletal injuries"

Here's the full abstract for everyone's viewing pleasure:

Nadler SF, Weingand K, Kruse RJ. Director of Sports Medicine, New Jersey Medical School, 90 Bergen Street, Suite 3100, Newark, New Jersey 07102.

Cryotherapy and thermotherapy are useful adjuncts for the treatment of musculoskeletal injuries. Clinicians treating these conditions should be aware of current research findings regarding these modalities, because their choice of modality may affect the ultimate outcome of the patient being treated. Through a better understanding of these modalities, clinicians can optimize their present treatment strategies. Although cold and hot treatment modalities both decrease pain and muscle spasm, they have opposite effects on tissue metabolism, blood flow, inflammation, edema, and connective tissue extensibility. Cryotherapy decreases these effects while thermotherapy increases them. Continuous low-level cryotherapy and thermotherapy are newer concepts in therapeutic modalities. Both modalities provide significant pain relief with a low side-effect profile. Contrast therapy, which alternates between hot and cold treatment modalities, provides no additional therapeutic benefits compared with cryotherapy or thermotherapy alone. Complications of cryotherapy include nerve damage, frostbite, Raynaud's phenomenon, cold-induced urticaria, and slowed wound healing. With thermotherapy, skin burns may occur, especially in patients with diabetes mellitus, multiple sclerosis, poor circulation, and spinal cord injuries. In individuals with rheumatoid arthritis, deep-heating modalities should be used with caution because increased inflammation may occur. Whirlpool and other types of hydrotherapy have caused infections of the skin, urogenital, and pulmonary systems. Additionally, ultrasound should not be used in patients with joint prostheses.

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It's an article discussing the modalities of ice and heat. It isn't seeking to disprove them it's talking about different and proper ways of using them. I have the full text and I'll post it later if I can get if formatted properly. For some reason I'm having trouble with PDFfiles.

It's not fair to isolate comments out of context from articles when the articles don't really show what your saying they do

That's a cheap shot. ;) I edit most all of them actually. You said yourself that they get too complicated and that you may not have read all of them. Then you said my highlighting makes it even more difficult to read so that by your own admission you may have missed some of what the articles said! So I edit them to just show the points since you don't like highlighting. If you want me to post the full abstracts I can. What's a guy to do?? What evidence did the article give BTW that shows icing is effective? None actually..

I guess you so proudly jumped all over that article because it's the closest thing you've presented that shows icing has any benefits.

But even this article only says "Cryotherapy and thermotherapy are useful adjuncts" but gives no evidence. What does that show? How does any of the article present evidence that icing is effective? Please point that out. (it's ok to highlight BTW !!) The point of that article says that there are serious inherent dangers to using ice that I did highlight in bold. That should take care of the evidence for "long-term" detrimental problems with icing. It states that "Complications of cryotherapy include nerve damage, frostbite, Raynaud's phenomenon, cold-induced urticaria, and slowed wound healing." Why risk that if icing is ineffective anyway??

I see your point in trying to discredit me because I left out an invalid and useless (to our discussion) sentence. I'm afraid that your eagerness to re-post the entire article in an attempt to shame me only re-exposes the points that further validate my position. Discredit the writer and you discredit his point. I frankly see it as a desperate attempt to salvage your position. Especially when the overiding theme of the article is that ice may do considerable irreversible damage. I wouldn't be to proud of using that article to defend icing because it doesn't do that. That being the case then I can only assume that your intention was to discredit myself personally. (I'm not pissed BTW, I considered it fair play actually.)

The overiding message is that you haven't been able to show any evidence that ice is efficacious other than in serious over-swelling injuries so that the swelling itself doesn't cause further injury. I agree with that. For that matter none of this is a matter of agree or not agree, all anyone has to do is see what happens in the studies.

I don't like however, that the theme of our debate has become discrediting me. (I'm not mad though, on the contrary I think it adds spice to the debate so bring it on! )

I do take it though as a last ditch desperate attempt to salvage your position. That change in how you defend your view is actually an admission of you having lost the debate. There's no evidence of any beneficial effects of ice (secondary injury aside) so why not try and discredit the writer?? Re-focus off the issue and on to the opponent! Very good BTW!!

As far as proof what would you consider proof? I've presented many articles showing the detrimental effects even if some are short-term (which I don't believe is the case BTW). I've seen nothing conclusive that shows icing is beneficial (other than the secondary injury thing.)

I may not be able to present tons and tons of evidence but I have posted a substantial amount. I've not seen nor have other professional (not saying that I am one) researchers who have tried as well to find anything concrete that says emphatically that "yes" icing works and it works by such and such.. Even if I haven't "proved " it to your satisfaction with the overwhelming evidence that you apparently require my friend, I've at least shown many studies that at least show "initially" evidence that icing is detrimental.

My question is, "why cling so tenaciously to it???"

Bottom line:

1. There's been no evidence or studies presented showing cause and effect studies of icing being helpful, other than in secondary injury position which doesn't apply to our discussion as that is only in injuries bad enough to cause overwhelming swelling that is rare. This applies to my reserach as well as research done by professionals to find anything they could.

2. I've presented plenty of evidence that icing is detrimental to healing (by your own admission, you agreed that IT IS detrimental but that I haven't shown that it has LONG-TERM detrimental consequences). Why use it BTW if icing shows ANY detrimental effects??

3. I've presented evidence that icing actually CAN be long-term and seriously dangerous (remember "Complications of cryotherapy include nerve damage, frostbite, Raynaud's phenomenon?? Those are long term consequences).

4. This debate has consistently refocused off the topic to other peripheral topics such as my personal credibility, my purported discourtesies, my lack of "knowing a newbies place", my lack of disrespect to well-established members, the frustration I supposedly cause by not interpreting things the way my opponent does, my writing style, the good-natured jabs that I use to keep things light interpreted as insults, my lack of use of "smilies" so that I don't offend, my use of highlights and underlining that make it difficult to read what I post, etc., etc., ad infinitum, ad nauseum.


I'm still not mad BTW. It's actually beginning to become a lot of fun now!!! We're debating like men...


Iron

Ok now, I didn't say I had a problem with highligting I said that underlining makes it hard to read. Certain formats are just hard to view on a screen. As far as highlighting the things you feel are pertinent and reinforce you point, I'm all for that. In fact I appreciate it and do the same thing myself. But I only highlight the parts of a paragraph that I want to stand out...I don't leave out other things that may be detrimental to my point.

Of course you should post entire abstracts. They're not that long and I didn't say anything against posting it all and can't imagine why I would.

For some reason you keep misconstruing things I say and I'm sorry for that. I'm not saying your posts are too complicated I'm just saying the formatting may have mixed me up a bit.

And you haven't seen the full article actually which I was going to talk to you about, since there is a TON of useful info in there and quite frankly it's a lot of new stuff for me and I'm going to go over it with a fine tooth comb and hopefully refine the sticky. In fact I was just getting ready to thank your for bringing it to my attention. It turns out to be a fantastic article and provide a whole lot of updated inforamation. It will take a while for me to digest but hopefully it should significantly improve the sticky.

Didn't I say I would post the whole thing once I get it formatted? I jumped all over it because it had so much info in it. Again if you take the side effects it mentions out of the context of all the rest you don't get the point. There is more info in there and it ellucidates a lot of new stuff.

My intent is to look at everything the abstract says. You are only seeing the parts you want to see. It is not saying that you shouldn't use ice because it is dangerous it is saying that it wants to present information as to the modalities of ice and heat in order to prevent some of the side effects and dangerous things it mentioned. I don't want to discredit you I'm simply calling you on the fact that you used ONLY the parts that supported you and ignored the other parts.


See, I highlight too. The article states plainly that there are are possible complications and then makes it plainly clear that it wishes to provide modalities to limit these complications.

I don't know why you only mention the swelling when I posted that whole article on the SUPPOSED beneficial effects of ice which are clearly not all swelling.

As far as those things listed in number 4 I thought we got past our problems. I am not asking you to walk on egg shells and I didn't think your were asking me to do that. I called you on the one little thing of leaving out the first sentence and I meant it jokingly. I'm sorry you didn't take it that way. What has frustrated me is that you seem to misunderstand and misconstrue the things I am trying to say continually. I don't know what is causing that but perhaps it is what is leading to some of what you see as attacks on your credibility. That was not my intention.

There was another statement in number 2 where you say I said something that I clearly did not say. It's like no matter how much I write I have to keep re-explaining myself. It must be something about the way I write. I know you said your weren't mad but you clearly think I am trying to do things I'm not.

I want to go ahead and post that full article so I can refer to it and hopefully update some stuff.

Wev'e agreed on certain things and disagreed on others. Let's leave it at that as far as continued debate between us. If you post more stuff and I don't respond, please know that I am not ignoring it.

It was never my intention to personally discredit you. In fact I was trying to apologize if I left anything out and only brought up that I was having a hard time following some of your formatting so that you would know I didn't do it on purpose.

I have tried to show you the continued respect of speaking as best I can to the things you have brought up. Despite my best intentions you continue to misunderstand me and for me I'd rather avoid any further misunderstanding. I don't really enjoy arguing for arguings sake.