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hrdgain81 · #1 03-14-2007, 11:53 AM

Originally posted by IRON:

Quote:

Originally Posted by Iron

I noticed this thread and thought I would re-post the following that I wrote for IF. I hope it's found helpful although it contradicts a lot of things posted here particularly the first aid pieces on the first couple pages. I would like to point out though that in those articles that still believe in R.I.C.E. and NSAIDS treatments, the references are fairly old. The newest one I noticed were at least 9 years old though most are older, some dating back as far as 1976. The following represents the current thinking on these treatments.--

Iron

I realize this runs contrary to what is popularly believed but taking anti-inflamatories (NSAIDS) such as aspirin, ibuprofen, Naproxen (Aleve), Ketoprofen, advil et al not only doesn't help the healing process but is actually detrimental to it.

Also the time honored use of R.I.C.E. (rest, ice, compression and elevation)is likewise out-dated and detrimental to the healing of muscle, tendon, and ligament injuries. Neither of these treatments should be used as the following will show.

Concerning Anti-inflamatories [NSAIDS (Non Steroidal Anti-Inflammatory Drugs)]

First of all NSAIDS don't heal anything.(1) They inhibit pain and the other immune responses such as redness, swelling, fever, etc. It's this immune response brought on in part by prostaglandins that do the healing. If you hamper the prostaglandins, you hamper the body's way of healing itself. There's a purpose for the redness swelling, pain, fever, etc.

NSAIDS reduce the pain, swelling, fever, etc. by inhibiting the synthesis of prostaglandins. Prostaglandins are responsible for the activation of the inflammatory response, production of pain, swelling, fever, etc. When tissues are damaged from an injury or an illness, white blood cells flood to the site to try to minimize tissue destruction. Prostaglandins are produced as a result.

A couple studies have shown this:

1. NSAIDs have been shown to delay and hamper the healing in all the soft tissues, including muscles, ligaments, tendons, and cartilage. Anti-inflammatories can delay healing and delay it significantly, even in muscles with their tremendous blood supply. In one study on muscle strains, Piroxicam (an NSAID) essentially wiped out the entire inflammatory proliferative phase of healing (days 0-4). At day two there were essentially no macrophages (cells that clean up the area) in the area and by day four after the muscle strain, there was very little muscle regeneration compared to the normal healing process. The muscle strength at this time was only about 40 percent of normal. (2)

2. Another study confirmed the above by showing that at day 28 after injury the muscle regenerative process was still delayed. The muscles of the group treated with Flurbiprofen (NSAID) were significantly weaker. The muscle fibers were shown under the microscope to have incomplete healing because of the medication. (3)

(1) "In spite of the widespread use of NSAIDs there is no convincing evidence as to their effectiveness in the treatment of acute soft tissue injuries." Bruckner, P. Clinical Sports Medicine. New York City, NY: McGraw-Hill Book Company, 2004, pp. 105-109.

(2) Greene, J. Cost-conscious prescribing of nonsteroidal anti-inflammatory drugs for adults with arthritis. Archives of Internal Medicine. 1992; 152:2002.

(3) Almekinders, L. An in vitro investigation into the effects of repetitive motion and nonsteroidal anti-inflammatory medication on human tendon fibroblasts. American Journal of Sports Medicine. 2003; 23:119-123.

NSAIDS carry other risks also.

NSAIDs can cause stomach ulcers and related conditions because — in addition to suppressing the prostaglandins associated with inflammation and pain — they decrease production of a prostaglandin that protects your stomach lining. This allows gastric acid to erode the lining and cause bleeding and ulcers. A type of bacteria called Helicobacter pylori causes almost two-thirds of all ulcers. Most other ulcers are caused by NSAIDs.
The Food and Drug Administration (FDA) is now requiring expanded information about the risk of gastrointestinal bleeding on the labels and package inserts of both nonprescription and prescription NSAIDs.

NSAIDs have anti-clotting effects, so you may notice that you bleed or bruise more easily. Large doses of NSAIDs can also lead to kidney problems and fluid retention. NSAIDs can cause liver function test abnormalities, as well as ringing in the ears, headache, dizziness and drowsiness. Mouth sores and skin rashes also can occur while taking NSAIDs.

The FDA recently called for label changes on all over-the-counter and prescription NSAIDs to include information about potential risks heart attack and stroke, and rare but serious skin reactions from using such drugs.

I use Tylenol (acetaminophen). Tylenol is not an NSAID but it does reduce pain and fever. Unlike NSAIDS though it doesn't inhibit prostaglandins or reduce inflammation.

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)

Do you see the difference between pain relief and healing? The athlete needs healed tissue. Up until the present, too many people were advocating NSAID and ice use when it came to ligament and muscle injuries, because they were such great pain-relievers, when in fact they were and are stopping the healing mechanisms of the body. Any technique or medication that stops the normal inflammatory process that helps heal the body must have a long-term detrimental effect on the body.

In short, the body knows better than we do how to heal itself. Now, if pain is unbearable or if swelling is so bad that it may injure an adjoining organ, you may have no choice but to ice or use NSAIDS. However it is always done at the expense of slower healing and slower muscle growth.

(1) Guyton, A. et al. Textbook of Medical Physiology. Philadelphia, PA: W. B. Saunders, 2006, p. 620.

(2) Ho, S. Comparison of various icing times in decreasing bone metabolism blood flow in the knee. American Journal of Sports Medicine. 2002; 18:376-378.

For further references check out:
http://www.caringmedical.com/sports_injury/nsaids.asp
http://www.findarticles.com/p/articl...20/ai_98464592

I realize this runs contrary to what is popularly believed but taking anti-inflamatories (NSAIDS) such as aspirin, ibuprofen, Naproxen (Aleve), Ketoprofen, advil et al not only doesn't help the healing process but is actually detrimental to it. [/QUOTE]

Very good point Iron, I have read that several times and have since discontinued use of all NSAIDS ... not that i used them all that much in the first place.

As for the R.I.C.E. stuff, I dont know much about it, I always thought the Ice part was to bring down swelling ... I dont know what roll that plays in healing, but I assume (possibly incorrectly) that if swelling is present, it would be important to bring that down before any actually healing can take place.

EricT · #2 03-14-2007, 11:55 AM

Hey I appreciate the posts.

On the NSAIDS I agree. I already posted similar things on that. They are right after the first aid part.

However I don't agree at this time on the RICE regimen. I did extensive reasearch and it is still the most widely excepted method. I am aware of the studies you posted but they are only a first step. The studies are theorizing that this initial decrease in blood flow and it's associated slow down in cell metabolism would point to slower healing in the long run. But the body of evidence does not show this.

The point of icing and immobilization is only an initial step. Pain relief is not really the goal although that is a side effect. Heck heat actually relieves pain also but that would be very detrimental. The idea is to slow down bleeding into the area and reduce swelling. Pain relief is not the purpose of it and in some case ice may cause more pain in which case it should be discontinued. Most of the writers and texts, including my own doctor, are aware of some of the speculation regarding this but they base their recommendations on the widest body of evidence. And for right now RICE seems to lead to much better outcomes.

It could well be that some of this may be proven to be a bad idea in certain cases. But right now, for this thread, I went by the most widely accepted practices. As more research is done and the medical community in general endorses a differnet practice then I would be the first one on board. RICE is only intial first aid, though, and ice certainly shouldn't be used very long. The first page goes into it in detail and there is not need to repeat it here.

The stuff on NSAIDS, as I said, I agree with, but the stuff on RICE I don't think represents current thinking in general. Experience with RICE seems to disagree with those researchers theories about it and recovery times are reduced, not lengthened.

With all that said, the reasearch was on sprains. Although doctors still routinely prescribe ice for sprains I don't think it is a universally good idea. Because ligaments have a very small blood supply compared to muscles. So reducing blood flow even more could very well be a bad idea. But that doesn't mean that RICE is out the window for all injuries. And even with sprains, swelling slows down healing. And ice is very effective at reducing swelling. But things can and will change...its just the prevaling opinion. It means we have to recognize the difference between muscles, tendons, and ligaments. I know there is a knew thing called M.E.A.T. that people are talking about in regards to certain injuries. I will do some more reserch and see if I can find new info on this. Meanwhile if you find more please let us know, IRON.

From what reading I've done on it, including writings about the stuff you just posted, I noticed a certain exxageration about what RICE actually entailed. The authors seem to be implying that ice is used for extensive periods which it defintiely should not be. Also immobilization is exaggerated and you get horror stories about the effects of it. But that is long term mobilization. Read what I have and it should be clear that I am only speaking of INITIAL immobilization following an acute injury to prevent further damage. Walking around in a sling for weaks because you pulled a tendon is a VERY bad idea, no doubt. I see the points about ligament injuries. But RICE is first aid, not long term treatment. It is still standard emergency room procedure and the idea is to reduce incipient damage, only being appropriate for the first 1 to 3 days.

I haven't ventured to far into the meat thing. But the first two letters stand for movement and excercise. Look at the first aid page. Movement and excercise are prominently discussed. But telling someone that if they sprain their ankle they should immediately start excercising it? Of course not. Should they immobilize it and walk with a cane for weeks on end. Heck no! I hope I made that abundantly clear and when people have recommended it or said they were going to do that I have told them in no uncertain terms it is a big no no. But lets not throw out the baby with the bath water

First aid is first aid. Rehab is rehab. One doesn't replace the other.

Iron · #3 03-14-2007, 01:04 PM

Quote:

Originally Posted by hrdgain81

Very good point Bull, I have read that several times and have since discontinued use of all NSAIDS ... not that i used them all that much in the first place.

As for the R.I.C.E. stuff, I dont know much about it, I always thought the Ice part was to bring down swelling ... I dont know what roll that plays in healing, but I assume (possibly incorrectly) that if swelling is present, it would be important to bring that down before any actually healing can take place.

It's the swelling that contributes to the healing. Please go back and read through the whole article. Anything that reduces the inflammatory response slows healing whether it's with ice or NSAID drugs. It's this immune response that does the healing. If you hamper it, you hamper the body's way of healing itself. There's a purpose for the swelling. Swelling also has the effect of immobolizing the particular joint as another way of protecting the healing process.

We've been indoctrinated all our lives into thinking that if we stop the swelling than the injured part must be better because it's no longer swollen. How crazy is that? What's bad about having a swollen part? I mean the swelling itself? Nothing other than it might make it harder to put our shoes or whatever on. See how we've been conditioned to believe something to the point that to even question it seems wrong??

Iron · #4 03-14-2007, 01:05 PM

Quote:

Originally Posted by Iron

It's the swelling that contributes to the healing. Please go back and read through the whole article. Anything that reduces the inflammatory response slows healing whether it's with ice or NSAID drugs. It's this immune response that does the healing. If you hamper it, you hamper the body's way of healing itself. There's a purpose for the swelling. Swelling also has the effect of immobolizing the particular joint as another way of protecting the healing process.

We've been indoctrinated all our lives into thinking that if we stop the swelling than the injured part must be better because it's no longer swollen. How crazy is that? What's bad about having a swollen part? I mean the swelling itself? Nothing other than it might make it harder to put our shoes or whatever on. See how we've been conditioned to believe something to the point that to even question it seems wrong??

By the way, my name's Iron, not Bull.. lol!

EricT · #5 03-14-2007, 01:16 PM

I see what you're saying. And there was a short discussion of inflammation and healing earlier in the thread. And I think it's true what you are saying, up to a point. But there are many things to be considered. For one thing, the initial first aid allows a quicker return to movement and activity which speeds up healing and seems to provide a better long term result. Inflammation is allowed to run it's course but the quicker a person can return to movement the better. Pesonal experience shows this to be the case but can I swear by it? No. Always go by what your doctor says. But since a doctor will likely tell you to use rice (except maybe for compression) who are we to listen to. Researchers? Doctors? Our own instinct?

Inflammation is one piece of the puzzle for sure but the inflammatory process is not a perfect on. Any medical doctor can tell you that inflamation begets inflamation.

What seems to be the case is when the RICE regimen is not employed you have pain and swelling and if the injury is bad enough you have forced immobilization because of the pain and inflammation involved. Then it can seem like the injury is "healed up". But what has happened is scar tissue has been allowed to accumulate. Which makes rehab less effective if it is adhered to. But may people would just assume they are good to go and return to regular activities and end up with a long term recurring problem.

hrdgain81 · #6 03-14-2007, 01:29 PM

^^ sorry about that, its been a long day Iron.

Quote:

Please go back and read through the whole article.

I cant promise that, but I'm sure next time I hurt myself (next sunday perhaps), I will definately come running, or hobbling however the case may be.

And just as an aside on this subject, I find the best way to deal with injury is to stop drop and roll as soon as it happens. Just be careful, sdr in the squat rack can lead to serious head injury ... life sucks wear a helmut

EricT · #7 03-14-2007, 01:35 PM

Well seems I'm talking to myself but as Iron said ice therapy has indeed been questioned. But it is too early to draw conclusions either way. The idea of swelling speeding up healing is interesting. Swelling can be edema and blood. If a tissue is actively bleeding it can't heal. Do we allow ourselves to bleed out unchecked when we get a cut? I don't know but it just doesn't make sense at face value.

I understand skepticism and quesioning. And I join in that. But I think Carl Sagan said it best when it comes to these sciency things. We have to be simultaniously open to all ideas and consistently skeptical (paraphrase).

Does Cryotherapy Improve Outcomes With Soft Tissue Injury?
Tricia J. Hubbard and Craig R. Denegar

Pennsylvania State University, University Park, PA

Corresponding author.

Tricia J. Hubbard, MS, ATC, and Craig R. Denegar, PhD, ATC, PT, contributed to conception and design; acquisition, analysis, and interpretation of the data; and drafting, critical revision, and final approval of the article.

Address correspondence to Tricia J. Hubbard, MS, ATC, Department of Kinesiology, Pennsylvania State University, University Park, PA 16802. Address e-mail to tjh228@psu.edu.

Reference:
Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004; 32:251–261.

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.

Study Selection:
To be included in the review, each study had to fulfill the following conditions: be a randomized, controlled trial of human subjects; be published in English as a full paper; include patients recovering from acute soft tissue or orthopaedic surgical interventions who received cryotherapy in inpatient, outpatient, or home-based treatment, in isolation or in combination with placebo or other therapies; provide comparisons with no treatment, placebo, a different mode or protocol of cryotherapy, or other physiotherapeutic interventions; and have outcome measures that included function (subjective or objective), pain, swelling, or range of motion.

Data Extraction:
The study population, interventions, outcomes, follow-up, and reported results of the assessed trials were extracted and tabulated. The primary outcome measures were pain, swelling, and range of motion. Only 2 groups reported adequate data for return to normal function. All eligible articles were rated for methodologic quality using the PEDro scale. The PEDro scale is a checklist that examines the believability (internal validity) and the interpretability of trial quality. The 11-item checklist yields a maximum score of 10 if all criteria are satisfied. The intraclass correlation coefficient and kappa values are similar to those reported for 3 other frequently used quality scales (Chalmers Scale, Jadad Scale, and Maastricht List). Two reviewers graded the articles, a method that has been reported to be more reliable than one evaluator.

Main Results:
Specific search criteria identified 55 articles for review, of which 22 were eligible randomized, controlled clinical trials. The articles' scores on the PEDro scale were low, ranging from 1 to 5, with an average score of 3.4. Five studies provided adequate information on the subjects' baseline data, and only 3 studies concealed allocation during subject recruitment. No studies blinded their therapist's administration of therapy, and just 1 study blinded subjects. Only 1 study included an intention-to-treat analysis. The average number of subjects in the studies was 66.7; however, only 1 group undertook a power analysis. The types of injuries varied widely (eg, acute or surgical). No authors investigated subjects with muscle contusions or strains, and only 5 groups studied subjects with acute ligament sprains. The remaining 17 groups examined patients recovering from operative procedures (anterior cruciate ligament repair, knee arthroscopy, lateral retinacular release, total knee and hip arthroplasties, and carpal tunnel release). Additionally, the mode of cryotherapy varied widely, as did the duration and frequency of cryotherapy application. The time period when cryotherapy was applied after injury ranged from immediately after injury to 1 to 3 days postinjury. Adequate information on the actual surface temperature of the cooling device was not provided in the selected studies. Most authors recorded outcome variables over short periods (1 week), with the longest reporting follow-ups of pain, swelling, and range of motion recorded at 4 weeks postinjury. Data in that study were insufficient to calculate effect size. Nine studies did not provide data of the key outcome measures, so individual study effect estimates could not be calculated. A total of 12 treatment comparisons were made. Ice submersion with simultaneous exercises was significantly more effective than heat and contrast therapy plus simultaneous exercises at reducing swelling. Ice was reported to be no different from ice and low-frequency or high-frequency electric stimulation in effect on swelling, pain, and range of motion. Ice alone seemed to be more effective than applying no form of cryotherapy after minor knee surgery in terms of pain, but no differences were reported for range of motion and girth. Continuous cryotherapy was associated with a significantly greater decrease in pain and wrist circumference after surgery than intermittent cryotherapy. Evidence was marginal that a single simultaneous treatment with ice and compression is no more effective than no cryotherapy after an ankle sprain. The authors reported ice to be no more effective than rehabilitation only with regard to pain, swelling, and range of motion. Ice and compression seemed to be significantly more effective than ice alone in terms of decreasing pain. Additionally, ice, compression, and a placebo injection reduced pain more than a placebo injection alone. Lastly, in 8 studies, there seemed to be little difference in the effectiveness of ice and compression compared with compression alone. Only 2 of the 8 groups reported significant differences in favor of ice and compression.

Conclusions:
Based on the available evidence, cryotherapy seems to be effective in decreasing pain. 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. These must focus on developing modes, durations, and frequencies of ice application that will optimize outcomes after injury.

The effects of ice have been demonstrated in numerous animal models and human studies. Ice reduces tissue temperature, blood flow, pain, and metabolism. However, and possibly more important, is the question, “Does ice application improve the treatment outcomes?” Does treatment facilitate achievement of goals related to functional limitations and sudden transient disability after injury or surgery? Bleakley et al1 reported that cold seemed to be more effective in limiting swelling and decreasing pain in the short term (immediately after application to 1 week postinjury). However, the long-term effects of cryotherapy and the effect on the tissue repair are not known. Only 1 group examined the effect of cryotherapy at 4 weeks postinjury. Additionally, evidence is limited that cryotherapy hastens return to participation.

Currently, only 4 groups have examined the effect of cryotherapy on return to participation.2–5 The 4 groups addressed return to sport or work after ankle sprain and scored 2–4 on the PEDro scale (maximum = 10 points). Cryotherapy was applied immediately after injury. Two of the four reports suggested that cryotherapy speeds return to full activity. However, the results of the outcome measures were not fully documented. A confounding factor of compression as part of the treatment prevents interpretation of the effects of cryotherapy in one of the articles.4 Therefore, whether cryotherapy facilitates return to participation is still unclear.

Ice does not seem to be more effective than compression after surgery. Only 2 of the 8 groups reported significant differences in favor of ice and compression. However, in all 8 studies, postsurgical dressings or socks were used to separate the injured area of the body and the cooling agent. Such barriers may have mitigated the cooling effect of the cold compress. Further research comparing ice with compression is required in subjects with acute injuries.

Currently, no authors have assessed the efficacy of ice in the treatment of muscle contusions or strains. Considering that most injuries are muscle strains and contusions, this is a large void in the literature. Most cryotherapy studies have focused on postsurgical anterior cruciate ligament repairs and knee and hip replacements. The results of these studies cannot be generalized to muscle strains and contusions.

The Bleakley et al1 study has several limitations. In the 12 treatment comparisons made by Bleakley et al,1 only 1 or 2 articles were examined in some instances. It is difficult to generalize results based on only 1 or 2 studies. Additionally, the authors did not separate cryotherapy for acute immediate care from that for rehabilitation. The goals for each may be different and a potential reason for the lack of efficacy of cryotherapy.

Based on this review by Bleakley et al1 and a similar review by Hubbard et al,6 the methodologic quality of clinical trials of cryotherapy is poor. Most of the studies were conducted years ago. Additionally, with cryotherapy research, it is not possible to blind subjects to the exposure to cold and thus score 10 on the PEDro scale. However, scores higher then 5 should be achieved. Assessing the quality of the randomized, controlled clinical trials is important because of evidence that low-quality studies provide biased estimates of treatment effectiveness.7 Despite the general acceptance of cryotherapy as an effective intervention, evidence on which to base these conclusions is limited. Only with strong randomized, controlled clinical trials will we know the true efficacy of cryotherapy.

1.Bleakley C, McDonough S, MacAuley D. The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials. Am J Sport Med. 2004;32:251–261.
2.Hocutt JE Jr, Jaffe R, Rylander CR, Beebe JK. Cryotherapy in ankle sprains. Am J Sport Med. 1982;10:316–319.
3.Basur RL, Shephard E, Mouzas GL. A cooling method in the treatment of ankle sprains. Practitioner. 1976;216:708–711. [PubMed]
4.Wilkerson GB, Horn-Kingery HM. Treatment of the inversion ankle sprain: comparison of different modes of compression and cryotherapy. J Orthop Sports Phys Ther. 1993;17:240–246. [PubMed]
5.Laba E, Roestenburg M. Clinical evaluation of ice therapy for acute ankle sprain injuries. NZ J Physiother. 1989;17:7–9.
6.Hubbard TJ, Aronson SL, Denegar CR. Does cryotherapy hasten return to participation? A systematic review. J Athl Train. 2004;39:88–94. [PubMed]
7.Maher CG, Sherrington C, Herbert RD, Moseley AM, Elkins M. Reliability of the PEDro scale for rating quality of randomized controlled trials. Phys Ther. 2003;83:713–721. [PubMed]

Iron · #8 03-14-2007, 02:04 PM

Quote:

Originally Posted by Eric3237

Well seems I'm talking to myself

Hang on, I'm putting a response together. I'm doing this at work and trying to do two things at once and it's a rather lengthy reply but I'm not ignoring you bro.

EricT · #9 03-14-2007, 02:07 PM

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.

Iron · #10 03-14-2007, 02:58 PM

Eric3237-

Thanks for the reply Eric. Sorry it took so long. Please take everything I say in the way it's meant. I apologize up front if I come across harsh. I respect your knowledge and value what you say. Also, you're always a gentleman when you say it and I hope I come across the same way..

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. If I hit a wall with my car and watch it happen and report to you that I observed the wall fall down what would you say. That it's a theory or that you disagree? See it's not about disagreeing. We saw it happen, we know what caused it. Would you after seeing a study like my car example be willing to then stand in front of it and let me hit you knowing what you saw happen? Would you let me hit you because you "disagree" with my study??

New discoveries will always put them in the minority til everyone catches on. Wasn't Galileo put to death because he sai he saw that the sun and not the earth was at the middle of the solar system? It wasn't just his opinion, it was what he actually observed. And since no wanted to admit they had been wrong all the years they decided to kill him.

I always get one of two responses to studies I post like this. One is acceptance of the observed fact, the other is an apologetic tenacious clinging to the old ways in spite of it. Interpretations may differ as to why such and such happened but never the facts. What happened, happened. I believe it's human nature to fight anything people see as different. It's disturbing to think you've done something wrong or believed something wrongly all your life. This all applies to myself as well.

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.

We both know that medical practices tend to hang on long after they've been proven to be inadequate practices. It's dangerous to go with the status quo just because that's what "most everyone does." If we did that we'd still be using bleeding techniques to cure cancer. Being the "most widely excepted method" doesn't mean it's the best way of doing anything or even mean that it's correct. Please throw that out. Let's look at real evidence and see what works in practice. Then we can interpret it together but let's never say we disagree with what we witnessed.

This quote of yours says it all--

"Always go by what your doctor says. But since a doctor will likely tell you to use rice (except maybe for compression) who are we to listen to. Researchers? Doctors? Our own instinct?"

Go by what the studies actually have observed happening. Doctors work long days and can't possibly keep up with the latest developments in everything medical. Where do you think they get their knowledge or where any medical knowledge comes from? Research and observations. That's what epidemiology is. Watching and seeing what happens.

If, like my studies show that without ice an injury heals in X time and without ice it heals in X less time, you tell me what should you go with? The one that actually works best in practice of course. If not, then why not?? Because it's the "most widely excepted method" and it's the "most widely accepted practice"?? Tell me why what I know to have happened didn't happen? Come on, don't stick with something for that reason. Heck, let's go back to bleeding and stop using anti-biotics for the same reason. They used to be the "most widely accepted practice" too.

QUOTE: "The studies are theorizing that this initial decrease in blood flow and it's associated slow down in cell metabolism would point to slower healing in the long run."

How is the following theorizing?--

Anti-inflammatories can delay healing and delay it significantly, even in muscles with their tremendous blood supply. In one study on muscle strains, Piroxicam (an NSAID) essentially wiped out the entire inflammatory proliferative phase of healing (days 0-4). At day two there were essentially no macrophages (cells that clean up the area) in the area and by day four after the muscle strain, there was very little muscle regeneration compared to the normal healing process.
by: Greene, J. Cost-conscious prescribing of nonsteroidal anti-inflammatory drugs for adults with arthritis. Archives of Internal Medicine. 1992; 152:2002.

It says "The inflammatory response was wiped out." That's not a theory, that's what actually was observed to happen. It's not a matter of my opinion or your opinion. Neither of them matter. It's right in front of us. it happened. So you tell me which way to go???

QUOTE: Most of the writers and texts, including my own doctor, are aware of some of the speculation regarding this but they base their recommendations on the widest body of evidence.

Why is that wise? and again it's not speculation. It's fact that these things happened in the studies. If you don't believe what has actually been observed to happen in real practice, then tell me, why do you believe the other way and cling to it so tenaciously?? Where is the proof that the other way is correct? And please don't tell me it's "the most widely used practice." At least for me that's not good enough.

Can't you imagine this same debate taking place in the 1930's when they first developed penicillin:
Well I know antibiotics seem to work and it certainly cured that guy but that's not the way we've always done it. So I'll stick to the old way????

QUOTE: Experience with RICE seems to disagree with those researchers theories about it and recovery times are reduced, not lengthened.

Where is this supported by science? My study said:
Another study confirmed the above by showing that at day 28 after injury the muscle regenerative process was still delayed. The muscles of the group treated with Flurbiprofen (NSAID) were significantly weaker. The muscle fibers were shown under the microscope to have incomplete healing because of the medication.
by Almekinders, L. An in vitro investigation into the effects of repetitive motion and nonsteroidal anti-inflammatory medication on human tendon fibroblasts. American Journal of Sports Medicine. 2003; 23:119-123.

Again that's not an opinion but an actuall observation of what actually happened. "experience" as you use it here is purely anectodal and not very reliable. It's just people's opinions once again, and once again, not to be relied upon.

QUOTE: And even with sprains, swelling slows down healing.

Where's the science on this as well? My studies showed that just the opposite happened. How much proof is needed??

In summary if we want to know the truth and be on the cutting edge of what the newest science says (and isn't that what this board is all about?)we have to stop clinging to old ways simply because it's always been done like that. We'd never progress with that attitude.

Iron

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Is Popular Opinion Wrong About Treating Injuries?