RICE No More

[erugs]

Interesting news from Dr. Gabe Mirkin:

"Ice Delays Recovery from Injuries

More than 30 years ago I [Dr. Gabe Mirkin] coined the term RICE (Rest, Ice, Compression, Elevation) for the acute treatment of athletic injuries. Now a study from the Cleveland Clinic shows that one of these recommendations, applying ice to reduce swelling, actually delays healing by preventing the body from releasing IGF-1 (Insulin-like Growth Factor-1), a hormone that helps heal damaged tissue (Federation of American Societies for Experimental Biology, November 2010)
When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing.
The response to both infection and tissue damage is the same.
Certain cells called macrophages rush to the damaged tissue to release IGF-1 which helps heal muscles.
Healing is delayed by cortisone-type drugs, nonsteroidal anti inflammatory drugs such as ibuprofen, applying cold packs or ice, and anything else that blocks the immune response to injury.
Now the treatments for an acute injury include Rest (stop exercising), Compression and Elevation (to reduce swelling), but no ice."

 

[leaf]

interesting. after major soft tissue damage from an ankle injury i sustained that fateful day on may 13th.. my ankle is still swollen, a bit stiff and i still don't have full range of motion. (%&^#$@!) i never found ice to help.. i found elevation the best thing. and i actually found the heat treatments made my ankle feel better after.

 

[Kevin Rooney]

Healing is delayed by cortisone-type drugs, nonsteroidal anti inflammatory drugs such as ibuprofen, applying cold packs or ice, and anything else that blocks the immune response to injury.

Thanks for posting this, Ellen. Recently I'd read an article which outlined the info in the quote, but didn't know that ice was found to delay healing as well.

Am now a bit suspicious of compression as an aid to healing. If the body needs to release IGF-1 in the affected areas, then it follows that anything which impedes blood flow (like compression) would slow the release of IGF-1.

My hunch is that in time compression will be "dis-recommended" as well.

 

[WhiteMTHike]

Reading this it all sounds very logical. I wonder how long it'll take to spread through the medical and athletic training community. Most people are still fairly entrenched in the "RICE" theory.

 

[griffin]

Reading this it all sounds very logical.

True, but then so did RICE. I'd be interested to look at actual studies for both ice and non-ice.

 

[DougPaul]

My hunch is that in time compression will be "dis-recommended" as well.

Swelling can cause as much or more damage than the original injury and three of the four components of RICE act to reduce the swelling.

Erugs: do you have a reference or an original source? All I can find is two other sites reporting the same text verbatim.

FWIW, the search http://www.google.com/search?q=Ice+delayed+recovery+from+injuries does bring up a study showing the benefits of icing following exercise (which causes micro injuries): http://sportsmedicine.about.com/od/sampleworkouts/a/Ice-Bath.htm


Many research groups these days seem to rush to their PR departments before presenting their results in peer-reviewed media or waiting for corroborative results. I don't know if this is the case here, but one should be careful about believing such announcements until other groups have had a chance to confirm them.

Doug

 

[daxs]

About two years ago i stopped recommending NSAIDS to my patients for acute injuries for that reason. I still have been saying ice for the first 24-48 hours. May need to rethink that

 

[erugs]

Doug - maybe this will lead to an answer to your question.

explained researcher Lan Zhou from the Neuroinflammation Research Centre at the Cleveland Clinic in Ohio.

The team led by Prof Zhou found that inflamed cells generate a high level of a hormone known as insulin like growth factor-1 (IGF-1) which considerably raises the rate of muscle regeneration. The detection could also alter how much patient observation is required when powerful anti-inflammatory medicines are prescribed over a long period.

In a lab study researchers studied two groups of mice. The first group was altered genetically so they could not form an inflammatory reaction to an injury. The second group was normal. All mice were then injected with barium chloride to cause muscle injury.

It was found that the first group of mice did not heal, but the bodies of the second group repaired the injury. When their muscle tissues were studied it was revealed that healthy mice created greater levels of IGF-1 in their swollen tissue. Muscle inflammation after acute injury is necessary to repair, reported he study published in the Federation of American Societies for Experimental Biology journal.


Kevin - Compression may not be as important as some stabilization, then gentle exercise. Just guessing on that one...

 

[DougPaul]

Doug - maybe this will lead to an answer to your question.

Yes that is interesting info, but is an isolated quote with no context. Is this an isolated result? Has it be replicated elsewhere?

I asked for a (primary) reference because it is likely to give me to context to determine if such info is somebody's preliminary result or whether it is well supported. Until such background is available, such info can only be considered interesting but not reliable.

I repeat: Do you have a reference?

Doug

 

[Aviarome]

I did a search, and I think this is the article. I haven't read it yet, but figured I would post it first.

http://www.ncbi.nlm.nih.gov/pubmed/20889618

Edit: If anyone is interested in the full text article and do not have access to it, just PM me with your email address and I can send it to you.

 

[chipc]

Yes that is interesting info, but is an isolated quote with no context. Is this an isolated result? Has it be replicated elsewhere?

I asked for a (primary) reference because it is likely to give me to context to determine if such info is somebody's preliminary result or whether it is well supported. Until such background is available, such info can only be considered interesting but not reliable.

I repeat: Do you have a reference?

Doug

I believe this is the ref that's getting the hype:
http://www.ncbi.nlm.nih.gov/pubmed?term=Macrophages recruited via CCR2 produce insulin-like growth factor-1 to repair acute skeletal muscle injury

From a quick read, this paper demonstrates that the ability to mount an inflammation response is needed to heal damaged muscle in a mouse model system. I think then PR has taken over to speculate on what may pan out from this down the road. FWIW the journal this appears in is well-respected.

this is the same article in the post above - didn't see it until I posted

 

[DougPaul]

Chipc, Aviarome: thanks--that appears to cover the text bite in post #8.

I still haven't seen a primary reference for the text bite in post #1 (ice slows healing). (I've been doing some searching--everything so far just repeats the basic text bite without useful attribution.

Doug

 

[chipc]

Chipc, Aviarome: thanks--that appears to cover the text bite in post #8.

I still haven't seen a primary reference for the text bite in post #1 (ice slows healing). (I've been doing some searching--everything so far just repeats the basic text bite without useful attribution.

Doug

Doug - the first quotation appears to be from Dr. Mirkin's own site:
http://www.drmirkin.com/public/ezine111410.html

I am guessing he is just speculating based on what's in The FASEB Journal article. I have a feeling that an actual study on ice slowing healing in this context has not been published yet.

 

[DougPaul]

Doug - the first quotation appears to be from Dr. Mirkin's own site:
http://www.drmirkin.com/public/ezine111410.html

Thanks--I googled the title and this didn't come up... ? (Still doesn't.)

I am guess he is just speculating based on what's in The FASEB Journal article. I have a feeling that an actual study on ice slowing healing in this context has not been published yet.

He presents this conclusion as if it is well established. If he is indeed presenting a speculation (or an unverified experiment) as if it is a well established conclusion then he is being irresponsible, IMO.

There is nothing wrong with expressing a speculation as long as you identify it as such. Lots of ultimately good research begins with speculation...

Doug

 

[kaseri]

interesting. after major soft tissue damage from an ankle injury i sustained that fateful day on may 13th.. my ankle is still swollen, a bit stiff and i still don't have full range of motion. (%&^#$@!) i never found ice to help.. i found elevation the best thing. and i actually found the heat treatments made my ankle feel better after.

Try ultrasound therapy on your ankle. It can work wonders.

 

[leaf]

Try ultrasound therapy on your ankle. It can work wonders.

tried that in a bad shoulder injury. didn't see good results, unfortunately.

 

[SAR-EMT40]

He presents this conclusion as if it is well established. If he is indeed presenting a speculation (or an unverified experiment) as if it is a well established conclusion then he is being irresponsible, IMO.

I agree. There is valid scientific reasoning behind RICE and its red headed stepchild HIRICE. One study, or speculation of a study doesn't undue previous protocols. Personally I have used RICE and HIRICE very successfully not just on patients but even on myself. I will likely wait until I hear specific changes to the established protocols and the reasoning behind them.


Keith

 

[Maddy]

Interesting news from Dr. Gabe Mirkin:

"Ice Delays Recovery from Injuries

More than 30 years ago I [Dr. Gabe Mirkin] coined the term RICE (Rest, Ice, Compression, Elevation) for the acute treatment of athletic injuries. Now a study from the Cleveland Clinic shows that one of these recommendations, applying ice to reduce swelling, actually delays healing by preventing the body from releasing IGF-1 (Insulin-like Growth Factor-1), a hormone that helps heal damaged tissue (Federation of American Societies for Experimental Biology, November 2010)
When germs get into your body, your immunity sends cells and proteins into the infected area to kill the germs. When muscles and other tissues are damaged, your immunity sends the same inflammatory cells to the damaged tissue to promote healing.
The response to both infection and tissue damage is the same.
Certain cells called macrophages rush to the damaged tissue to release IGF-1 which helps heal muscles.
Healing is delayed by cortisone-type drugs, nonsteroidal anti inflammatory drugs such as ibuprofen, applying cold packs or ice, and anything else that blocks the immune response to injury.
Now the treatments for an acute injury include Rest (stop exercising), Compression and Elevation (to reduce swelling), but no ice."

If this is true they had best start getting out their narcotic RX pads for the strong stuff. Ice and non steroidals are the only thing that made a difference when I sustained serious injuries to knees, back, and hip. Serious enough that I had to retire from my nursing position. Eventually I was able to do some PT which also helped but my right knee has never fully recovered. There are still days when I use my knee support, ice, and, Naprosyn of I would be perpetually layed out on the couch developing blood clots.Elevation was also included in this regime.

You cannot tolerate that amount of pain and just lie around all day because you can't walk. If you go the narcotics route, they can open up more rehab facilities to get people off their drugs. They already have a huge RX drug problem in this country. Tylenol certainly did not work. I have a high pain threshold and this pain was intolerable.

I think whoever printed this great documentation should take their own turbo flight down 14 steps and see how h/her does with elevation and some "exercises". I am willing to bet h/she would have the old OXYCONTIN bottle right there at h/her beck and woof. I was walking with two hiking poles in the house for months.

I think this regime might be fine if you have some petty little injury that's going to heal in 2 weeks regardless of what you do.

IMHO...long live DR Gabe!! My motto...KEEP IT !!!

 

[DougPaul]

In practice, there are all sorts of issues: for instance long-term vs short-term.

If the short-term issues (eg pain, loss of strength, loss of flexibility) are intolerable, then a treatment which reduces the short-term issues at the cost of increasing the long-term issues (eg healing time) might be useful.

Surgery certainly involves such a trade-off: increased short-term pain, disability, and risk to fix a condition which would have bad long-term consequences (eg premature death or disability).

Whether icing falls into this category remains to be seen. It is clear that in the short-term it reduces pain and swelling for certain injuries/conditions. The long-term issues (effect on healing time) are the subject of the original conjecture. The answer may also depend on the specific injury/condition, its severity, or even the individual being treated.

Doug

 

[kaseri]

tried that in a bad shoulder injury. didn't see good results, unfortunately.

If I may ask... how many session did you have? Were they daily or weekly? There is a big difference between having one treatment per week and one per day. The proper way to administer ultrasound therapy is with daily treatments. Most people don't get this level of treatment and it's generally reserved for professional athletes but if you push your therapist you may be able to get it as well. Or you could just buy your own unit for home use.