A quick thought on how we spend our time…
Building on last week’s sentiment of the finitude of time, here’s a little extra motivation to steward it wisely.
Our time with our kids peaks in our 30s and then rapidly decreases.
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It’s a sobering reality, but an important reminder to do our best to make the most of the moments we do have with them.
A great article on this topic by Sahil Bloom can be found here.
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A deep dive. To ice or not to ice?
“Don’t put that junk on there.”
I was a bit startled and mumbled back, “what are you talking about?”
“The ice” one of my strength coaches clarified. “It’s going to slow down your recovery.”
I had just strained my hip flexor the day before and had a bag of ice on it given to me by my athletic trainer.
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Is ice… bad?
In true Shaksperean spirit, there’s a big debate here that is worthy of an entire play.
But, I’m going to give you the Sparknotes version.
Ice has been promoted as a healing agent since the dawn of mankind, or at least since 1978 when Dr. Gabe Markin coined the term RICE (rest, ice, compression, elevation).
More recently, however, experts have called this into question and suggested that ice slows down the healing process. Dr. Markin even recanted and said ice should be removed from his protocol.
Why?
Well, the argument against ice is that it slows inflammation.
Contrary to its reputation, inflammation is actually a good thing. The inflammation process is what brings all the good stuff into the area to begin healing the injury and takes away the bad stuff.
Ice constricts your blood vessels, which slows down the blood flow, which, supposedly, slows down the inflammatory process.
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So, we should ban ice from the rehab process, right?
Not quite. I’m holding out on the ice ban fad at the moment.
I have yet to see a single study that directly compares icing to not icing and shows delayed healing rates.
The studies that anti-icers hang their hats on simply extrapolate third-party variables (like constricting blood vessels) to slower healing rates.
There’s even evidence showing that topical ice (like putting an ice bag on your knee) has no effect on muscle tissue temperature. This means that it makes zero difference on what happens at the muscle, so how could it delay muscle healing?
What is well documented in research, is that ice is a fantastic pain reliever. Ice makes the pain feel less painful. This is a temporary reduction in pain, but at least for a short time it helps you feel less pain.
However, this reduction in pain does not mean that ice helps healing. Pain is not a 1:1 correlation with injury status, so we cannot confuse less pain with the injury healing.
Furthermore, there is such a thing as too much swelling/inflammation. Excessive swelling will slow down the healing process. If icing does reduce inflammation, then it seems logical that this would be a beneficial use-case for icing.
Is your head spinning yet? Yeah, mine too.
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What do I do with all of this?
When there are gaps in the research, we use common sense.
If something hurts a lot, there seems to be no issue with using ice to reduce pain temporarily. Other pain management modalities (like a TENS unit) can be used alternatively if desired.
Icing or not icing early on probably doesn’t actually delay nor accelerate healing time. Chasing temporary pain relief can be a noble endeavor in and of itself. Not everything done in the rehab process has to have long-term healing benefits (though, it absolutely shouldn’t be counter-productive to the healing process).
I just wouldn’t suggest becoming reliant on ice. After the initial stage of the injury when pain is mostly managed, it’s probably a good idea to move on from ice.
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An extra note on soft tissue acronyms
If there’s one thing our healthcare system loves, it’s a good acronym.
With soft tissue injuries, we started with RICE.
- Rest
- Ice
- Compression
- Elevation
Then we moved on to PRICE, where the “P” emphasized that we should also “Protect” the injury.
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Turns out, “rest” is not great for recovery. So, we pivoted to POLICE.
- Protection
- Optimal Loading
- Ice
- Compression
- Elevation
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Still, that wasn’t good enough. Our current standard is now an extravagant PEACE & LOVE.
PEACE is designed for immediate management.
- Protection
- Elevation
- Avoid anti-inflammatories (and ice)
- Compression
- Education
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LOVE is designed for subsequent care.
- Load
- Optimism
- Vascularisation
- Exercise
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Outside of the thoughts about ice discussed in this article, I think the newest acronym holds water and can help us navigate the healing process.
I just hope they find a way to tack on LITTLE DONUTS to the end.
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Be >,
Zach
Dr. Zach Guiser, PT, DPT, CSCS