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why ice & cold therapy could be counterproductive for recovery & injuries

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Why RICE (rest, ice, compression, elevation), should be replaced by meth (haha - movement, elevation, traction, heat)

Very bold statement, & usually spikes the ears of most medical professionals, athletes & therapists immediately (mine included when I started looking into this a few years back) as this is what we have all known & have been taught since around the 1970’s, it was & is predominately still an extremely popular form of practice. 

For years through my sporting career of weight lifting, rugby & national level water polo, I used ice religiously for recovery, minor & major injuries. This was what I was told, taught & believed, we all were. Moving into my professional career as a Podiatrist & sports rehabilitation & recovery specialist for elite athletes, it was also a tool I brought forward into clinical practice for many of my patients & athletes. First point of contact for acute injuries was the prescription of RICE. It is still within the Podiatry syllabus at university, so why wouldn’t we believe it? We were told that ice reduced inflammation, reduced pain & sped up the recovery process. But what if current literature & evidence has proven this to be wrong? That’s a hard pill to swallow for anyone (myself included as it’s essentially telling me I’ve been doing the wrong thing for years!), & that what we have done on ourselves, family, friends & clients was not the best option, & even, counterproductive to what we were trying to achieve. 

Before everyone gets their knickers in a knot & loses their shit, please head over to www.squatuniversity.com & have a read of a great article by Dr Aaron Horschig

Dr Aaron Horschig deep dives into every concept that has been a primary interest of mine for the past few years when it comes to optimising recovery & injuries around RICE. 

In short, what I’ve always preached, getting the beneficial stuff into the area (oxygen, white blood cells etc) & the bad stuff out (swelling & cellular debris). This concept goes for recovery as well as injuries. Nutrient & oxygen rich blood carries all necessary components for recovery & injury repair. 

Yes, hearing that what we have been doing may not be best, or even wrong is hard at first, no one likes being told they’re wrong haha, it’s normal. Though ignoring CURRENT updated literature is naive & ignorant on our behalf if we choose to neglect evolving proven evidence. It is our DUTY to remain updated so we can provide the BEST treatment options for our clients & athletes. People are wrong all the time, that is a fact, things change, models are disproven, treatment options advance, that is the beauty of the healthcare & medical fields. If they didn’t continually explore, conduct studies & search for new answers or better ways of doing things, we would not get anywhere & zero advancements would be made, & doing nothing is just as bad as going backwards. This is good for our field, this is why we have leading researchers & educators paving the way & leaving complacency behind. 

 

Though when the Harvard physician himself Dr Gabe Mirkin, whom termed RICE in 1978 , retracts his initial statement in 2013 stating 

“Subsequent research shows that ice can actually delay recovery. Mild movement helps tissue to heal faster, and the application of cold suppresses the immune responses that start and hasten recovery. Icing does help suppress pain, but athletes are usually far more interested in returning as quickly as possible to the playing field. So, today, RICE is not the preferred treatment for an acute athletic injury.” (1) It is definitely now our obligation to explore the “why” after knowing this. 

Another reason why we are seeing a huge pivotal shift & adoption toward medical device technology within the medical, healthcare & professional sporting fields that utilises intuitive software driven movement based equipment, light therapy, heat induced & magnetic field treatments that improve our ability to move & work in synergy with our bodies natural response & process of healing, enhancing these cellular mechanisms of repair the way it is designed. 

 

The article written by Dr Aaron Horschig explores the “why” VERY much in depth, so if any of the statements about NOT icing injuries struck a nerve or made you think or questioned your current beliefs & treatment plans (which it should!) please, take the time to read this article, it is your duty. 

The shift WILL take place, the elite stay updated & make decisions quickly about best practice, early adopters will reap the benefits faster & open minded professionals will change the way they approach injuries for the greatest outcomes possible. We have seen this happen in the past, & this will inevitably happen with ice… 

We believed Dr Gabe Mirkin about RICE 40 odd years ago & utilised his prescription methods, so why wouldn’t we believe his updated views from 8 years ago with the many years of studies & evidence drawn between the two dates? 

Move as soon as possible & use energy to heal, because this is where we will see the move in coming years. 

 

  1. Reinl G. Iced! The illusionary treatment option. 2nd Edition. Gary Reinl. 2014.

 

Further informative reads;

 

Cooling an acute muscle injury: can basic scientific theory translate into the clinical setting?

C M Bleakley, P Glasgow, M J Webb

 

Topical Cooling (Icing) Delays Recovery From Eccentric Exercise–Induced Muscle Damage

Tseng, Ching-Yu, Lee, Jo-Ping, Tsai, Yung-Shen et al. 2013

 

Effects of icing or heat stress on the induction of fibrosis and/or regeneration of injured rat soleus muscle

Tsubasa ShibaguchiTakao SugiuraTakanori Fujitsu 2016.

 

The use of ice in the treatment of acute soft-tissue injury: a systematic review of randomized controlled trials

Chris BleakleySuzanne McDonoughDomhnall MacAuley 2004.

 

Does Cryotherapy Improve Outcomes With Soft Tissue Injury?

Tricia J Hubbard Craig R Denegar 2004.

 

https://www.macleans.ca/society/the-end-of-the-ice-age/

 

https://www.news18.com/news/lifestyle/ice-baths-not-helpful-for-repairing-and-building-muscle-2410733.html

 

https://www.chicagotribune.com/lifestyles/health/sc-hlth-icing-injuries-0320-20190319-story.html

 

https://www.washingtonpost.com/lifestyle/wellness/why-icing-a-sprain-doesnt-help-and-could-make-the-injury-worse/2019/03/04/25a6caa0-3ae4-11e9-a2cd-307b06d0257b_story.html

 

https://www.ausdoc.com.au/news/researchers-pour-cold-water-ice-bath-theory

 

https://trainright.com/true-or-false-ice-baths-antioxidants-great-for-recovery/

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