Monday, May 12, 2014

Follow-Up To "Is R.I.C.E. Paleo?"

Drat. It's tough being a rebel when the authorities come around to your point of view (link to original post).
"Since 1978 when Dr. Gabe Mirkin coined the term RICE, Rest, Ice, Compression, and Elevation have been the gold standard for treating athletic injuries. But now the ice age is melting, and a series of studies that show that injury treatment with cold therapy and total rest may actually delay healing has even Dr. Mirkin changing his mind.

"...A study published in The Journal of Strength and Conditioning Research examined the influence of icing on muscle damage. Data from the study did show that icing delays recovery and should not be the first choice of treatment for injuries. After icing there was an immediate increase in swelling. Indicators of muscle damage increased after application of ice.

"...And research published in The American Journal of Sports Medicine in June, 2013, said that although icing an injury relieved swelling it did not make recovery from muscle damage quicker. If the treatment reduces inflammation it delays healing. This includes the use of anti-inflammatory pain relievers like ibuprofen."

I said I my prior post:
"Now, you might find this hard to believe, but devising a treatment and then never bothering to test it in a scientific fashion is par for the course in the medical profession, as is continuing to use the treatment after it's been shown to have no supporting science behind it and to be of questionable efficacy. People would rather "do something", than do nothing, even if doing nothing is the correct course of action."
Dr. Mirkin obliges to confirm that part of my post as well:
"Mirkin says it is okay to apply ice for pain relief immediately after the injury occurs, but for short periods only. He suggests icing for 10 minutes, removing the ice for 20 minutes, and repeating the process once or twice, but stresses that there is no reason to continue icing more than six hours after injury...."
So it worsens the injury, but you should do it for up to six hours? Ridiculous.

P.S. Dr. Mirkin has a post on his blog that has enough in common with the news article linked to above that I suspect the article is simply a re-purposing of his post. (If you wonder where reporters get their news ideas...) The first comment on that news story is, "Well written and well done. Gabe Mirkin"

But at any rate, he has a nice additional comment that's not included in the news article, and with which I fully agree:

Anything That Reduces Inflammation Also Delays Healing
Anything that reduces your immune response will also delay muscle healing. Thus, healing is delayed by:
  • cortisone-type drugs,
  • almost all pain-relieving medicines, such as non-steroidal anti-inflammatory drugs like ibuprofen (Pharmaceuticals, 2010;3(5)),
  • immune suppressants that are often used to treat arthritis, cancer or psoriasis,
  • applying cold packs or ice, and
  • anything else that blocks the immune response to injury.
What's even worse is that they can lead to further damage, as some of these drugs can lead to fun things like tendon ruptures.