12 ms·

Ice not recommended for soft tissue injury treatment (2019)

177 points by mhb 4y ago

emptyfile 4y ago
londons_explore 4y ago
Ice has only been widely available for the last ~100 years, which means presumably ice to treat injuries has only been around for 100 years, which in turn means I assume someone must have done a modern study to prove it benefitted patients? So what changed that it is no longer beneficial?
- bena 4y ago
  Looking at "PEACE & LOVE", the "A" stands for "Avoid Anti-inflammatories" because anti-inflammatories will reduce tissue healing. Ice is used as an anti-inflammatory. Because swelling often prevents movement. So since ice reduced the inflammation and swelling, it increased movement, which we've translated as "being better". But apparently what you want is to not move and aggravate the actual injury. We've moved from treating the symptoms to treating the cause.
- contravariant 4y ago
  Assuming something must have been studied because it became more pervasive recently is a dangerous assumption. Especially with things that seem obvious. Like cooling an injury with ice for instance, which seem like a good idea (or feels better anyway). Also people have tried to keep stuff cold for ages, I'm pretty sure the folk remedy of using a slab of cold meat to cool an injury has been around longer than just the period in time that people had free access to ice.
  - rascul 4y ago
    > I'm pretty sure the folk remedy of using a slab of cold meat to cool an injury has been around longer than just the period in time that people had free access to ice. Wouldn't it have been difficult to keep the meat cold?
- noja 4y ago
  Probably two presumptions: less swelling is good, cold reduces pain. Now it has been tested.
- bennyelv 4y ago
  > which in turn means I assume someone must have done a modern study to prove it benefitted patients I wouldn't assume that :) Ice treatment was about pain relief, not overall benefit. I believe it also came from the world of sports science, to which a lower bar is applied due to the general non-life-or-death consequences.
- AstixAndBelix 4y ago
  >I assume someone must have done a modern study to prove it benefitted patients? why assume in the age of the internet? if it's something that tickles your curiosity just do a little research
- fsh 4y ago
  I wouldn't be surprised if that assumption turns out to be wrong. A lot of medical procedures seem to have little or no empirical backing. Apparently there are not many incentives to do high-quality studies in the field.
guerrilla 4y ago
Yeah I never understood the theory behind why you would ice something.. It'd just reduce bloodflow via vasoconstriction which seems like the opposite of what you'd want unless you had a specific reason to the contrary. Same with anti-inflammatories, unless it's completely out of control then both the inflammation and the resultant pain are doing a job for you (telling you to stay off it and doing repair work.) I hope this research continues until it's conclusive one way or the other and if it's the opposite of what I (and that paper) suggest then we should have a good explanation for that.
- ghaff 4y ago
  Note that this is focused on chronic treatment. It doesn’t seem to be saying that if you have an injury you shouldn’t ice it at the time if only to decrease pain.
- ac2u 4y ago
  I apply the same logic even to painkillers which aren't anti-inflammatories like paracetamol. I figure that there could be lots about healing mechanisms that we don't know yet where interrupting the feedback of pain might interfere with healing. That's not to say I don't take painkillers, but that I think a lot about the tradeoffs before I take one. For instance, I didn't take any to relieve vaccination symptoms even though that was the standard advice by the healthcare provider as I figured why would I want to interrupt my bodies response to a pathogen at the precise time it's learning to combat it? (There are some studies that suggest this is true, although the scale of it is a little fuzzy). What usually tips the balance for me to take a mild painkiller is if the pain is bad enough to genuinely stop me sleeping, in that case I'm buying the healing mechanism that sleep provides.
  - Dylan16807 4y ago
    > why would I want to interrupt my bodies response to a pathogen at the precise time it's learning to combat it? Some of those responses are of the form "hurt the pathogen more than it hurts you" and since the vaccine isn't a real threat all they do is hurt you.
nonameiguess 4y ago
I'm not sure what to make of this. It's an opinion piece, not peer-reviewed, doesn't cite any research, and includes "education" and "optimism" seemingly for the sole purpose of being able to make the cute acronyms PEACE and LOVE to help us remember what injuries need to heal. On a blog where the comments are spammers literally advertising the services of magicians who will cast healing spells for you.
- OnACoffeeBreak 4y ago
  There are 20 citations in the references section. Also, clicking on "Please see the full FREE paper in the BJSM here" gets to a PDF that has more meat and other references. It also has this: "Provenance and peer review: Not commissions; internally peer reviewed."
MontagFTB 4y ago
This blog post is from 2019- should it be noted as such?
jameal 4y ago
Interestingly no mention of MEAT which is another competing recovery paradigm: Movement, Exercise, Analgesics, Treatment Though it does seem to overlap some with the authors' PEACE & LOVE except with regard to analgesics. I've been hearing more and more about how NSAIDs may not be as beneficial as they've been touted. I wonder what is the current scientific consensus on them.
- rubyron 4y ago
  NSAIDs are anti-inflammatories. Analgesics are anti-pain. Completely different mechanisms. I had arthroscopic surgery for a torn meniscus in my knee this year. My doc (well-respected pro sports ortho in Austin) put me on ice and rather long term Naproxen (NSAID). So not every doc has gotten with or believes in the new thinking.
acqbu 4y ago
Check out the comments to that article!
- alin23 4y ago
  > SAVE YOUR RELATIONSHIP AND GET YOUR BOYFRIEND/GIRLFRIEND BACK > HERPES SIMPLEX VIRUS GONE FOREVER... My name is Angela foden from Canada, I Can't believe that I got cured > I still can’t thank you enough for DR UWAIFO, My boyfriend left me, and went for a younger lady because I was unable to give birth oh man, what a throwback to 2010 spam emails and blogpost comments
deleted 4y ago
[deleted]
ls15 4y ago
So they are replacing POLICE with PEACE & LOVE.
cfeduke 4y ago
This sounds like a bunch of nonsense (PEACE & LOVE? Really?). That being said I continuously injure myself because I am very active - all sports have a risk of injury - and have never iced. I had a really bad ankle sprain a few weeks ago where my only treatment was compression and I was operating on it and performed a 2.25x body weight back squat with no issues within three weeks. So, anecdotally, not icing and no anti-inflammatories seems to work well for me. Probably a healthy dose of being stubborn and a stickler for not missing training helps as well. (It's not because I'm young and heal quickly - I'll be 44 in two weeks.)
philliphaydon 4y ago
It seems a lot of boxers and MMA fighters use ice. My wife was doing boxing and such for exercise at a gym run by an ex MMA fighter in Singapore. She hurt her wrist and it hurt alot and the gym told her to put ice and water in a jar, and hold her hand in it for 15 minutes. The pain subsided and swelling went down and a day later she had normal movement in her wrist again. I have no idea of it’s effective but it seems to have helped her.
- fsh 4y ago
  You don't know what would have happened without the ice. Believing in anecdotes instead of studies leads to bloodletting and homeopathy.
  - philliphaydon 4y ago
    This is true. And I hope my story didn’t come across as me trying to claim it as anything more than a story. I’m always skeptical about these sorry of things. But having had similar injuries before and having not used ice I was surprised that she could move her wrist without pain while for me it takes like a week.
- gwd 4y ago
  It will certainly reduce swelling and pain; the question is whether her wrist would have been back up to 100% more quickly without the ice. The claim in the infographic was that the ice probably slowed down healing. I haven't looked at the evidence (presumably) presented in the paper itself to justify this conclusion.
  - philliphaydon 4y ago
    So having had similar injuries before myself it’s taken me longer to heal and movement was painful. In my wife’s case she has full movement and no pain. But she didn’t go back for class for 2 weeks. Make sure it had healed. Just was surprising to me that she curls move her wrist without pain.
  - mhb 4y ago
londons_explore 4y ago
I wonder what other things will turn out to have no benefit...? Maybe rather than washing wounds, it'll turn out it's best to jam them with soil to get the immune system revved up...
- unsupp0rted 4y ago
  Perhaps licking of wounds? Which seems to me like a way to introduce mouth bacteria and cause an infection, but maybe it’s counter-intuitively beneficial?
  - penteract 4y ago
    Saliva has some antisceptic properties and promotes clotting. https://en.wikipedia.org/wiki/Wound_licking https://en.wikipedia.org/wiki/Wound_licking
  - purpleflame1257 4y ago
    It actually is beneficial, and is instinctive. There's a difference between bites (which introduce bacteria deep into punctures where they don't belong) and licking which places nitrites, lysozyme, and other antimicrobials onto the skin. see here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)63002-4/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Nevertheless, washing in tap water with soap is probably better nowadays.
- jgalt212 4y ago
  My grandfather used to say rub some spit in it--that's what the Native Americans did (before Pfizer stole their land).
- JauntyHatAngle 4y ago
  I get you are jokingly musing, but let's not open our minds so much our brains fall out. Jamming an open wound into soil is going against the well established knowledge we have on how infection works.
ehnto 4y ago
I guess I was an unwitting trial in this new pathology, when I shattered my collarbone (which involves a lot of soft tissue damage). The doctors deliberated quite a lot over whether or not it needed surgery, traditionally it would have as it was shattered and displaced, but they wanted to try the new approach of just kindof hoping for the best. They moved it into place in a loose sling, and said "Just hold it generally there" and so I did. That was the entire health plan. No medication, no anti-inflammatories, no suggestions on over-the-counter stuff either. It can be quite difficult to use pain as a guide for those of us lucky enough to have endured chronic pain, as you build up a bunch of subconscious coping mechanisms and you are expected to experience pain when getting the broken bits moving again. So how much is too much? I have no idea. I definitely agree that pain management meds and anti-inflammatories are counter-productive though. It's all a bit ambiguous I guess, I'd rather get updates via x-rays even if we are doing the "HOPES" and "DREAMS" approach to healing. Sorry, I mean PEACE and LOVE. I do believe in this approach to healing, I want to make that clear, there's just some rough edges in the User Experience of the approach in the doctors office I think.
- zdragnar 4y ago
  A doctor tried that with my wife's broken arm. It was very much the wrong call. She ended up getting surgery anyway, but is worse off for having waited a long time before she went to a different doctor.
- chis 4y ago
  Did that work? I approve of the trend towards letting the body heal itself when possible. But I thought displaced bones generally need to be set, otherwise they can heal with incorrect angles and lose functionality, range of motion, etc.
  - skykooler 4y ago
    They did the same when I broke my collarbone. The bone healed mis-aligned and needed surgery anyway to re-break it so it could be aligned properly.
  - ehnto 4y ago
wirthjason 4y ago
About 5 years ago I tore my ACL and had it repaired a few months ago over the the summer. I’ve done a lot of PT rehab over the past few months and my PT mentioned that ice reduces blood flow, heat increases blood flow. It wasn’t so much an as ice vs heat but more about the importance of increasing blood flow to help the tissue repair. Other things increase blood flow too, like exercise. There isn’t really a strict dos-and-donts to treatment.
egberts1 4y ago
BJSM: "Provenance and peer review: Not commissions; internally peer reviewed."
denton-scratch 4y ago
"Ice" in the title should be ICE. It's an acronym - it's not about the use of cold compresses for pain relief. A lot of the comments here are about the use of frozen water. That's not what this article's about. ICE stands for Impact, Confidence, and Ease. I think the acronym is rather stretched and awkward.
- llbeansandrice 4y ago
  Doesn’t it stand for “ice compress elevate”??
  - cobbzilla 4y ago
    I was taught RICE which is: Rest, Immobilization, Cold, Elevation The article mentions a shift from ICE to RICE (which I’m aware of) and then another shift to PRICE, which I’m not aware of— anyone know what the P stands for?
    - SamBam 4y ago
      Protection. Preventing further injury.
      - ComputerGuru 4y ago
        Seems… pointless? Obviously protect all of you from further injury insomuch as you can. It seems like someone just wanted to invent another acronym.
        mattkrause 4y ago
        It's not meant to be general protection, like wearing shin guards next time so you don't get hurt at all. Instead, they mean that you should protect the injury so that it's not exacerbated: brace it or put it in a sling, have the patient use crutches, etc.
  - SamBam 4y ago
nov21b 4y ago
I did some research into the best way to treat a third degree ankle sprain (after a mountainbike accident). From what I've gathered ice can still be beneficial in the first 8 hours or so. But shouldn't be used later on as it may hamper blood flow and thereby recovery. Compression, elevation, moderate use of an anti inflammatory and exercising just up to inducing more swelling is the best way to recover. I found "walking" exercises in a pool to be very helpful as the cool water plus pressure reduced pain and the buoyancy reduces much of your body weight.
grumple 4y ago
This title does not match the article. This article / "paper" is barely a stub. No study was done and I don't think this could be called a meta-analysis, but rather a summary citing a few other articles (only 2 relevant to icing in the context of avoiding anti-inflammatories). Even if it's true, this article does nothing to support the claims and does not address reasons why ice would be used.
- deleted 4y ago
  [deleted]
- tinglymintyfrsh 4y ago
  I'm curious what the tradeoffs are for and against anti-inflammatories (and which ones in particular and which kind of injuries). Are there studies proving anti-inflammatories are counterproductive?
kube-system 4y ago
I know this is not very scientific, but I have always figured that my body knows what it’s doing when it responds to an injury with inflammation.
- akerl_ 4y ago
  I think it's worth remembering that your body does what it does for a reason, but that it's nearly always working with imperfect information. Some notable examples: When you're in a stressful situation at work, your body can't tell the difference between that and "Oh no, we spotted a material threat to our life", so it reacts in ways that would make fight or flight easier, not in ways that help you handle the real situation. If your liver fails and you get a transplant, your body sees "ah, a foreign invader", and will set about the task of rejecting the new liver, despite it being very important for your wellbeing.
  - guerrilla 4y ago
    Definitely true, but the way I think of it is that you should go with the default unless you have a reason not to. Things like fear and depression are useful tools but if they get out of control and only then are they mental illness, for example. In all of your examples, the person can know better, but when we're talking about the type of injuries from the OP then we usually don't unless we've consulted with medical professionals (or are one ourselves) so it makes sense to start with the default.
  - kube-system 4y ago
    I'm the type of person who produces their best work when they're under pressure, so, maybe my fight response does help me at work.
- onion2k 4y ago
  I have always figured that my body knows what it’s doing when it responds to an injury with inflammation. Applying the logic of "your body knows" is probably not in your best long term interest. In purely evolutionary terms, getting a bad enough injury that you require medical attention should mean you just die because you weren't strong enough to survive. Artificially saving your life is "unnatural".
eric_b 4y ago
In my own experience, ice (either the frozen water kind or the compression and elevation components) doesn't do a damn thing. For soft tissue injury my usual plan is movement movement movement. Getting the blood flowing and using the affected area (lightly) is the best way to get back in the game I've found.
- thinkharderdev 4y ago
  Yeah, I spent years as a competitive endurance athlete and always found the best way to heal was to stress the injury (lightly as you say) as soon as you can. I suspect part of the issue is that elite-level athletes tend to be quite "type A" and have a high pain tolerance. So the risk with them is that that push too hard too soon and re-injure themselves. But "normal" people tend to make the opposite mistake. They don't stress the injured tissue at all until all the pain is gone so it doesn't get great blood flow and builds up scar tissue.
Hnrobert42 4y ago
The accuracy of science aside, can we all agree that the acronym PEACE & LOVE is trash? Rest Ice Compression Elevation may be wrong, but it is at least easy to understand, memorize, and explain. When my friend hurts their ankle, I want to pass on the latest, vetted wisdom. I don’t want to sound like a jackass saying, “O is for optimism. But we are not done yet. V is for vascularization. You don’t have much control over it, but we need to the round out the word LOVE. The third E is for …”
- wmeredith 4y ago
  Yes, this makes me cringe. It's overly cute and is a stretch.
- optimuspaul 4y ago
  I don't think you'd sound like a jackass saying "O is for optimism. But we are not done yet. V is for vascularization...." but wouldn't you rather sound like a jackass than give bad advice? I'd rather hear this than the clinical robotic "Rest Ice Compression Elevation", I mean come on, I'm a person!
  - SamBam 4y ago
    I'm not sure how "Rest Ice Compression Elevation" is "clinical robotic" and "vascularization" isn't...
  - ralusek 4y ago
    > than the clinical robotic > I'm a person [not a robot]! > optimuspaul
- yshavit 4y ago
  "Education" maybe the worst of them. One of the what-to-do steps is... learn what to do? Talk about drawing the rest of the freaking owl.
  - filesystem 4y ago
    Yes this one is comically bad. The description is even worse: "Your body knows best. Avoid unnecessary passive treatments and medical investigations and let nature play its role." So really this is preaching anti-education. Do not seek out information about your injury.
nashashmi 4y ago
In place of icing, and in place of anti-infammatory, my approach to reducing swelling is to increase blood flow with massaging an area before and/or after the injured tissue at the time of swelling. But do not massage the area that is swelling.
- nashashmi 4y ago
  A little info on (my) theory of swelling: When a part of the body is injured, stressed, or just requiring extra nutrition, it swells up. Swelling is a cure. But swelling is also painful and can lead to other problems. The most important thing to do is to make sure the area that is swelling is also getting good circulation. So a simple "pumping" approach of the muscles surrounding the swelled area should cause good flow. And swelling will be reduced. For example: You walk a long distance with inappropriate footwear. I am talking about 20,000 steps. And this is not something you are used to. So When resting, the body floods the foot with a whole lot of nutrients. But the blood just stays there, because it will slowly and eventually flow out with movement. But the body is not moving, so it swells. Massage pumping the calves will pump the blood out and new blood will flow in. This will reduce the swelling.
todd8 4y ago
When I started running longer distances to train for marathons, I ran into lots of other runners that iced after running say 10 miles. I did this too, but as time passed I got too lazy to pack up some ice to use at the end of long runs because these were always scheduled in the very early mornings at sometimes distant but interesting locations. What I discovered was that cold did feel good and did alleviate some of the discomfort from running, but for overuse induced discomfort it wasn't overall helpful to me. Now a bit off-topic to explain what did help me with overlong runs: What helped me the most for the wear and tear caused by long runs was getting the right shoes: some would make the lateral (furthest from the midline of my body) sides of my knees hurt, some would make the medial (closest to midline) sides of my knees hurt and when I found the right ones my knees didn't hurt. Shoes without enough padding under the ball of my foot also ended up causing me more pain than shoes with more padding. I always alternated my runs between shoes from two different manufacturers because I found that the slight differences in the ways the shoes flexed prevented overuse injuries from running in the same shoes each day. Finally, for some reason I would curl my toes down as I got tired and bruise a couple of my toenails. I fixed this with little soft silicon toe sleeves that I could pick up at the pharmacy.
- SaberTail 4y ago
  I'm also a distance runner and I've never iced after running. Foam rolling and massaging seem to work much better for me. And +1 on the shoes thing. I do the alternating shoes thing, as well. And I can tell when a pair is wearing out because I start to get little pains that grow until I replace the shoes. Some of my full-blown, need-to-take-time-off injuries have been from running in worn out shoes. Usually they wear out after 300-500 miles. I'll have to check out the toe sleeves. Thanks for the tip.
  - isk517 4y ago
    Its funny but the most useful feature that my GPS running watch provides me is a warning that my shoes have more than 300 miles on them. Known that information and then switching out right away helps avoid so much injury.
  - 4y ago
jackcviers3 4y ago
> Selective Science Unbalanced reporting. Cherry-picking the literature. All signs of pseudoscience. The anti-ice movement has neglected years of research on the mechanism of ice after injury, focusing only on a select few studies that support (but in reality DON’T support) their argument. Dr. Knight explained that ice is not an ‘anti-inflammatory’ per-say (Knight, 1976); rather, it prevents the secondary injury to tissues by dampening the negative physiological effects of widespread inflammation. His position has been supported by other researchers as well (Ho et al. 1994, Merrick et al. 1999). And to top it off, one study quoted against icing (Bleakley et al. 2004) even concluded, “The sooner after injury cryotherapy is initiated, the more beneficial this reduction in metabolism will be.” Hmmm…the anti-ice crowd must have missed that statement. [1] > The Benefits of Ice Ice is not wrong or harmful. The theory that ice impedes the normal healing response by limiting inflammation is not well documented in the literature. If you have been swayed by this on the internet, I would urge you to try to research this more and scrutinize the literature. Be careful of what you see on the internet and ALWAYS seek to validate anything yourself. Ice has plenty of benefits and clinical validation. Proper application of cryotherapy can reduce secondary injury and reduce edema formation if applied within the first 36 to 48 hours (remember, ice doesn’t reduce swelling after the acute injury phase, and may not play a huge role in inflammation or recovery). We do know that ice helps reduce pain, spasm, and guarding, allowing more mobility (Barber et al. 1998, Raynor et al. 2005). More than anything, ice is a convenient and potent pain reliever, so it’s ok to apply ice to ‘chronic’ conditions as a safer pain reliever at any time. In fact, cryotherapy has been shown to decrease the amount of prescription pain medications needed after surgery (Barber et al. 1998, Raynor et al. 2005).[1] 1. https://mikereinold.com/is-icing-really-bad-for-you/ https://mikereinold.com/is-icing-really-bad-for-you/ (2018) Ice has shown benefits in study and practice, and the above article has many cited studies and a critique of anti-ice articles.
AlbertCory 4y ago
There does seem to be some medical evidence given, but you really have to work to find it. And yes, the acronyms are cringe. I have a friend who just had knee replacement. She said the pain was excruciating, and that the best advice was ice in the first few days (she said two days), followed by heat after that. Since she's the type of person who would have access to the best medical advice, I tend to believe it. As for claims that "the body is always right" : look up "auto-immune disease."
bilsbie 4y ago
If inflammation is good then they should remove elevation and compression from their acronym.
scottLobster 4y ago
This fits with my experience, growing up I was taught to regularly apply ice to acute sports injuries, however the ice always melted pretty quick and slipped off besides, so I got tired of effort of keeping a fresh bag of ice on the injury, and eventually just stopped. What I discovered anecdotally is that the swelling was never any worse, and there was no discernible difference in the time a given category of injury (twisted/sprained ankles for the most part) took to heal. And it makes sense when you think about it, we've evolved for millions of years to deal with acute minor injuries without ice. Look at the billions of people who live without refrigeration today and engage in daily manual labor, are they continually hobbled by minor injuries? No. How ice became such a religious imperative in injury treatment I have no idea. Granted it probably makes sense in cases where the swelling/inflammation is so severe it becomes a secondary injury or just continuously painful, but for the everyday "rolled my ankle while playing house league soccer" injury? Completely unnecessary and ineffective IMO.
11235813213455 4y ago
Inflammation is basically your body turning on repair mode (when all goes right, so not in chronic issues), so usually not the best idea to counteract it
deleted 4y ago
[deleted]

177 points by mhb 4y ago

Ice has only been widely available for the last ~100 years, which means presumably ice to treat injuries has only been around for 100 years, which in turn means I assume someone must have done a modern study to prove it benefitted patients? So what changed that it is no longer beneficial?

bena 4y ago
Looking at "PEACE & LOVE", the "A" stands for "Avoid Anti-inflammatories" because anti-inflammatories will reduce tissue healing. Ice is used as an anti-inflammatory. Because swelling often prevents movement. So since ice reduced the inflammation and swelling, it increased movement, which we've translated as "being better". But apparently what you want is to not move and aggravate the actual injury. We've moved from treating the symptoms to treating the cause.
contravariant 4y ago
Assuming something must have been studied because it became more pervasive recently is a dangerous assumption. Especially with things that seem obvious. Like cooling an injury with ice for instance, which seem like a good idea (or feels better anyway). Also people have tried to keep stuff cold for ages, I'm pretty sure the folk remedy of using a slab of cold meat to cool an injury has been around longer than just the period in time that people had free access to ice.
- rascul 4y ago
  > I'm pretty sure the folk remedy of using a slab of cold meat to cool an injury has been around longer than just the period in time that people had free access to ice. Wouldn't it have been difficult to keep the meat cold?
noja 4y ago
Probably two presumptions: less swelling is good, cold reduces pain. Now it has been tested.
bennyelv 4y ago
> which in turn means I assume someone must have done a modern study to prove it benefitted patients I wouldn't assume that :) Ice treatment was about pain relief, not overall benefit. I believe it also came from the world of sports science, to which a lower bar is applied due to the general non-life-or-death consequences.
AstixAndBelix 4y ago
>I assume someone must have done a modern study to prove it benefitted patients? why assume in the age of the internet? if it's something that tickles your curiosity just do a little research
fsh 4y ago
I wouldn't be surprised if that assumption turns out to be wrong. A lot of medical procedures seem to have little or no empirical backing. Apparently there are not many incentives to do high-quality studies in the field.

guerrilla 4y ago

Yeah I never understood the theory behind why you would ice something.. It'd just reduce bloodflow via vasoconstriction which seems like the opposite of what you'd want unless you had a specific reason to the contrary. Same with anti-inflammatories, unless it's completely out of control then both the inflammation and the resultant pain are doing a job for you (telling you to stay off it and doing repair work.) I hope this research continues until it's conclusive one way or the other and if it's the opposite of what I (and that paper) suggest then we should have a good explanation for that.

ghaff 4y ago
Note that this is focused on chronic treatment. It doesn’t seem to be saying that if you have an injury you shouldn’t ice it at the time if only to decrease pain.
ac2u 4y ago
I apply the same logic even to painkillers which aren't anti-inflammatories like paracetamol. I figure that there could be lots about healing mechanisms that we don't know yet where interrupting the feedback of pain might interfere with healing. That's not to say I don't take painkillers, but that I think a lot about the tradeoffs before I take one. For instance, I didn't take any to relieve vaccination symptoms even though that was the standard advice by the healthcare provider as I figured why would I want to interrupt my bodies response to a pathogen at the precise time it's learning to combat it? (There are some studies that suggest this is true, although the scale of it is a little fuzzy). What usually tips the balance for me to take a mild painkiller is if the pain is bad enough to genuinely stop me sleeping, in that case I'm buying the healing mechanism that sleep provides.
- Dylan16807 4y ago
  > why would I want to interrupt my bodies response to a pathogen at the precise time it's learning to combat it? Some of those responses are of the form "hurt the pathogen more than it hurts you" and since the vaccine isn't a real threat all they do is hurt you.

nonameiguess 4y ago

I'm not sure what to make of this. It's an opinion piece, not peer-reviewed, doesn't cite any research, and includes "education" and "optimism" seemingly for the sole purpose of being able to make the cute acronyms PEACE and LOVE to help us remember what injuries need to heal. On a blog where the comments are spammers literally advertising the services of magicians who will cast healing spells for you.

OnACoffeeBreak 4y ago
There are 20 citations in the references section. Also, clicking on "Please see the full FREE paper in the BJSM here" gets to a PDF that has more meat and other references. It also has this: "Provenance and peer review: Not commissions; internally peer reviewed."

MontagFTB 4y ago

This blog post is from 2019- should it be noted as such?

jameal 4y ago

Interestingly no mention of MEAT which is another competing recovery paradigm: Movement, Exercise, Analgesics, Treatment Though it does seem to overlap some with the authors' PEACE & LOVE except with regard to analgesics. I've been hearing more and more about how NSAIDs may not be as beneficial as they've been touted. I wonder what is the current scientific consensus on them.

rubyron 4y ago
NSAIDs are anti-inflammatories. Analgesics are anti-pain. Completely different mechanisms. I had arthroscopic surgery for a torn meniscus in my knee this year. My doc (well-respected pro sports ortho in Austin) put me on ice and rather long term Naproxen (NSAID). So not every doc has gotten with or believes in the new thinking.

acqbu 4y ago

Check out the comments to that article!

alin23 4y ago
> SAVE YOUR RELATIONSHIP AND GET YOUR BOYFRIEND/GIRLFRIEND BACK > HERPES SIMPLEX VIRUS GONE FOREVER... My name is Angela foden from Canada, I Can't believe that I got cured > I still can’t thank you enough for DR UWAIFO, My boyfriend left me, and went for a younger lady because I was unable to give birth oh man, what a throwback to 2010 spam emails and blogpost comments

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ls15 4y ago

So they are replacing POLICE with PEACE & LOVE.

cfeduke 4y ago

This sounds like a bunch of nonsense (PEACE & LOVE? Really?). That being said I continuously injure myself because I am very active - all sports have a risk of injury - and have never iced. I had a really bad ankle sprain a few weeks ago where my only treatment was compression and I was operating on it and performed a 2.25x body weight back squat with no issues within three weeks. So, anecdotally, not icing and no anti-inflammatories seems to work well for me. Probably a healthy dose of being stubborn and a stickler for not missing training helps as well. (It's not because I'm young and heal quickly - I'll be 44 in two weeks.)

philliphaydon 4y ago

It seems a lot of boxers and MMA fighters use ice. My wife was doing boxing and such for exercise at a gym run by an ex MMA fighter in Singapore. She hurt her wrist and it hurt alot and the gym told her to put ice and water in a jar, and hold her hand in it for 15 minutes. The pain subsided and swelling went down and a day later she had normal movement in her wrist again. I have no idea of it’s effective but it seems to have helped her.

fsh 4y ago
You don't know what would have happened without the ice. Believing in anecdotes instead of studies leads to bloodletting and homeopathy.
- philliphaydon 4y ago
  This is true. And I hope my story didn’t come across as me trying to claim it as anything more than a story. I’m always skeptical about these sorry of things. But having had similar injuries before and having not used ice I was surprised that she could move her wrist without pain while for me it takes like a week.
gwd 4y ago
It will certainly reduce swelling and pain; the question is whether her wrist would have been back up to 100% more quickly without the ice. The claim in the infographic was that the ice probably slowed down healing. I haven't looked at the evidence (presumably) presented in the paper itself to justify this conclusion.
- philliphaydon 4y ago
  So having had similar injuries before myself it’s taken me longer to heal and movement was painful. In my wife’s case she has full movement and no pain. But she didn’t go back for class for 2 weeks. Make sure it had healed. Just was surprising to me that she curls move her wrist without pain.
- mhb 4y ago

londons_explore 4y ago

I wonder what other things will turn out to have no benefit...? Maybe rather than washing wounds, it'll turn out it's best to jam them with soil to get the immune system revved up...

unsupp0rted 4y ago
Perhaps licking of wounds? Which seems to me like a way to introduce mouth bacteria and cause an infection, but maybe it’s counter-intuitively beneficial?
- penteract 4y ago
  Saliva has some antisceptic properties and promotes clotting. https://en.wikipedia.org/wiki/Wound_licking https://en.wikipedia.org/wiki/Wound_licking
- purpleflame1257 4y ago
  It actually is beneficial, and is instinctive. There's a difference between bites (which introduce bacteria deep into punctures where they don't belong) and licking which places nitrites, lysozyme, and other antimicrobials onto the skin. see here: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)63002-4/fulltext https://www.thelancet.com/journals/lancet/article/PIIS0140-6... Nevertheless, washing in tap water with soap is probably better nowadays.
jgalt212 4y ago
My grandfather used to say rub some spit in it--that's what the Native Americans did (before Pfizer stole their land).
JauntyHatAngle 4y ago
I get you are jokingly musing, but let's not open our minds so much our brains fall out. Jamming an open wound into soil is going against the well established knowledge we have on how infection works.

ehnto 4y ago

I guess I was an unwitting trial in this new pathology, when I shattered my collarbone (which involves a lot of soft tissue damage). The doctors deliberated quite a lot over whether or not it needed surgery, traditionally it would have as it was shattered and displaced, but they wanted to try the new approach of just kindof hoping for the best. They moved it into place in a loose sling, and said "Just hold it generally there" and so I did. That was the entire health plan. No medication, no anti-inflammatories, no suggestions on over-the-counter stuff either. It can be quite difficult to use pain as a guide for those of us lucky enough to have endured chronic pain, as you build up a bunch of subconscious coping mechanisms and you are expected to experience pain when getting the broken bits moving again. So how much is too much? I have no idea. I definitely agree that pain management meds and anti-inflammatories are counter-productive though. It's all a bit ambiguous I guess, I'd rather get updates via x-rays even if we are doing the "HOPES" and "DREAMS" approach to healing. Sorry, I mean PEACE and LOVE. I do believe in this approach to healing, I want to make that clear, there's just some rough edges in the User Experience of the approach in the doctors office I think.

zdragnar 4y ago
A doctor tried that with my wife's broken arm. It was very much the wrong call. She ended up getting surgery anyway, but is worse off for having waited a long time before she went to a different doctor.
chis 4y ago
Did that work? I approve of the trend towards letting the body heal itself when possible. But I thought displaced bones generally need to be set, otherwise they can heal with incorrect angles and lose functionality, range of motion, etc.
- skykooler 4y ago
  They did the same when I broke my collarbone. The bone healed mis-aligned and needed surgery anyway to re-break it so it could be aligned properly.
- ehnto 4y ago

wirthjason 4y ago

About 5 years ago I tore my ACL and had it repaired a few months ago over the the summer. I’ve done a lot of PT rehab over the past few months and my PT mentioned that ice reduces blood flow, heat increases blood flow. It wasn’t so much an as ice vs heat but more about the importance of increasing blood flow to help the tissue repair. Other things increase blood flow too, like exercise. There isn’t really a strict dos-and-donts to treatment.

egberts1 4y ago

BJSM: "Provenance and peer review: Not commissions; internally peer reviewed."

denton-scratch 4y ago

"Ice" in the title should be ICE. It's an acronym - it's not about the use of cold compresses for pain relief. A lot of the comments here are about the use of frozen water. That's not what this article's about. ICE stands for Impact, Confidence, and Ease. I think the acronym is rather stretched and awkward.

llbeansandrice 4y ago
Doesn’t it stand for “ice compress elevate”??
- cobbzilla 4y ago
  I was taught RICE which is: Rest, Immobilization, Cold, Elevation The article mentions a shift from ICE to RICE (which I’m aware of) and then another shift to PRICE, which I’m not aware of— anyone know what the P stands for?
  - SamBam 4y ago
    Protection. Preventing further injury.
    - ComputerGuru 4y ago
      Seems… pointless? Obviously protect all of you from further injury insomuch as you can. It seems like someone just wanted to invent another acronym.
      - mattkrause 4y ago
        It's not meant to be general protection, like wearing shin guards next time so you don't get hurt at all. Instead, they mean that you should protect the injury so that it's not exacerbated: brace it or put it in a sling, have the patient use crutches, etc.
- SamBam 4y ago

nov21b 4y ago

I did some research into the best way to treat a third degree ankle sprain (after a mountainbike accident). From what I've gathered ice can still be beneficial in the first 8 hours or so. But shouldn't be used later on as it may hamper blood flow and thereby recovery. Compression, elevation, moderate use of an anti inflammatory and exercising just up to inducing more swelling is the best way to recover. I found "walking" exercises in a pool to be very helpful as the cool water plus pressure reduced pain and the buoyancy reduces much of your body weight.

grumple 4y ago

This title does not match the article. This article / "paper" is barely a stub. No study was done and I don't think this could be called a meta-analysis, but rather a summary citing a few other articles (only 2 relevant to icing in the context of avoiding anti-inflammatories). Even if it's true, this article does nothing to support the claims and does not address reasons why ice would be used.

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tinglymintyfrsh 4y ago
I'm curious what the tradeoffs are for and against anti-inflammatories (and which ones in particular and which kind of injuries). Are there studies proving anti-inflammatories are counterproductive?

kube-system 4y ago

I know this is not very scientific, but I have always figured that my body knows what it’s doing when it responds to an injury with inflammation.

akerl_ 4y ago
I think it's worth remembering that your body does what it does for a reason, but that it's nearly always working with imperfect information. Some notable examples: When you're in a stressful situation at work, your body can't tell the difference between that and "Oh no, we spotted a material threat to our life", so it reacts in ways that would make fight or flight easier, not in ways that help you handle the real situation. If your liver fails and you get a transplant, your body sees "ah, a foreign invader", and will set about the task of rejecting the new liver, despite it being very important for your wellbeing.
- guerrilla 4y ago
  Definitely true, but the way I think of it is that you should go with the default unless you have a reason not to. Things like fear and depression are useful tools but if they get out of control and only then are they mental illness, for example. In all of your examples, the person can know better, but when we're talking about the type of injuries from the OP then we usually don't unless we've consulted with medical professionals (or are one ourselves) so it makes sense to start with the default.
- kube-system 4y ago
  I'm the type of person who produces their best work when they're under pressure, so, maybe my fight response does help me at work.
onion2k 4y ago
I have always figured that my body knows what it’s doing when it responds to an injury with inflammation. Applying the logic of "your body knows" is probably not in your best long term interest. In purely evolutionary terms, getting a bad enough injury that you require medical attention should mean you just die because you weren't strong enough to survive. Artificially saving your life is "unnatural".

eric_b 4y ago

In my own experience, ice (either the frozen water kind or the compression and elevation components) doesn't do a damn thing. For soft tissue injury my usual plan is movement movement movement. Getting the blood flowing and using the affected area (lightly) is the best way to get back in the game I've found.

thinkharderdev 4y ago
Yeah, I spent years as a competitive endurance athlete and always found the best way to heal was to stress the injury (lightly as you say) as soon as you can. I suspect part of the issue is that elite-level athletes tend to be quite "type A" and have a high pain tolerance. So the risk with them is that that push too hard too soon and re-injure themselves. But "normal" people tend to make the opposite mistake. They don't stress the injured tissue at all until all the pain is gone so it doesn't get great blood flow and builds up scar tissue.

Hnrobert42 4y ago

The accuracy of science aside, can we all agree that the acronym PEACE & LOVE is trash? Rest Ice Compression Elevation may be wrong, but it is at least easy to understand, memorize, and explain. When my friend hurts their ankle, I want to pass on the latest, vetted wisdom. I don’t want to sound like a jackass saying, “O is for optimism. But we are not done yet. V is for vascularization. You don’t have much control over it, but we need to the round out the word LOVE. The third E is for …”

wmeredith 4y ago
Yes, this makes me cringe. It's overly cute and is a stretch.
optimuspaul 4y ago
I don't think you'd sound like a jackass saying "O is for optimism. But we are not done yet. V is for vascularization...." but wouldn't you rather sound like a jackass than give bad advice? I'd rather hear this than the clinical robotic "Rest Ice Compression Elevation", I mean come on, I'm a person!
- SamBam 4y ago
  I'm not sure how "Rest Ice Compression Elevation" is "clinical robotic" and "vascularization" isn't...
- ralusek 4y ago
  > than the clinical robotic > I'm a person [not a robot]! > optimuspaul
yshavit 4y ago
"Education" maybe the worst of them. One of the what-to-do steps is... learn what to do? Talk about drawing the rest of the freaking owl.
- filesystem 4y ago
  Yes this one is comically bad. The description is even worse: "Your body knows best. Avoid unnecessary passive treatments and medical investigations and let nature play its role." So really this is preaching anti-education. Do not seek out information about your injury.

nashashmi 4y ago

In place of icing, and in place of anti-infammatory, my approach to reducing swelling is to increase blood flow with massaging an area before and/or after the injured tissue at the time of swelling. But do not massage the area that is swelling.

nashashmi 4y ago
A little info on (my) theory of swelling: When a part of the body is injured, stressed, or just requiring extra nutrition, it swells up. Swelling is a cure. But swelling is also painful and can lead to other problems. The most important thing to do is to make sure the area that is swelling is also getting good circulation. So a simple "pumping" approach of the muscles surrounding the swelled area should cause good flow. And swelling will be reduced. For example: You walk a long distance with inappropriate footwear. I am talking about 20,000 steps. And this is not something you are used to. So When resting, the body floods the foot with a whole lot of nutrients. But the blood just stays there, because it will slowly and eventually flow out with movement. But the body is not moving, so it swells. Massage pumping the calves will pump the blood out and new blood will flow in. This will reduce the swelling.

todd8 4y ago

When I started running longer distances to train for marathons, I ran into lots of other runners that iced after running say 10 miles. I did this too, but as time passed I got too lazy to pack up some ice to use at the end of long runs because these were always scheduled in the very early mornings at sometimes distant but interesting locations. What I discovered was that cold did feel good and did alleviate some of the discomfort from running, but for overuse induced discomfort it wasn't overall helpful to me. Now a bit off-topic to explain what did help me with overlong runs: What helped me the most for the wear and tear caused by long runs was getting the right shoes: some would make the lateral (furthest from the midline of my body) sides of my knees hurt, some would make the medial (closest to midline) sides of my knees hurt and when I found the right ones my knees didn't hurt. Shoes without enough padding under the ball of my foot also ended up causing me more pain than shoes with more padding. I always alternated my runs between shoes from two different manufacturers because I found that the slight differences in the ways the shoes flexed prevented overuse injuries from running in the same shoes each day. Finally, for some reason I would curl my toes down as I got tired and bruise a couple of my toenails. I fixed this with little soft silicon toe sleeves that I could pick up at the pharmacy.

SaberTail 4y ago
I'm also a distance runner and I've never iced after running. Foam rolling and massaging seem to work much better for me. And +1 on the shoes thing. I do the alternating shoes thing, as well. And I can tell when a pair is wearing out because I start to get little pains that grow until I replace the shoes. Some of my full-blown, need-to-take-time-off injuries have been from running in worn out shoes. Usually they wear out after 300-500 miles. I'll have to check out the toe sleeves. Thanks for the tip.
- isk517 4y ago
  Its funny but the most useful feature that my GPS running watch provides me is a warning that my shoes have more than 300 miles on them. Known that information and then switching out right away helps avoid so much injury.
- 4y ago

jackcviers3 4y ago

> Selective Science Unbalanced reporting. Cherry-picking the literature. All signs of pseudoscience. The anti-ice movement has neglected years of research on the mechanism of ice after injury, focusing only on a select few studies that support (but in reality DON’T support) their argument. Dr. Knight explained that ice is not an ‘anti-inflammatory’ per-say (Knight, 1976); rather, it prevents the secondary injury to tissues by dampening the negative physiological effects of widespread inflammation. His position has been supported by other researchers as well (Ho et al. 1994, Merrick et al. 1999). And to top it off, one study quoted against icing (Bleakley et al. 2004) even concluded, “The sooner after injury cryotherapy is initiated, the more beneficial this reduction in metabolism will be.” Hmmm…the anti-ice crowd must have missed that statement. [1] > The Benefits of Ice Ice is not wrong or harmful. The theory that ice impedes the normal healing response by limiting inflammation is not well documented in the literature. If you have been swayed by this on the internet, I would urge you to try to research this more and scrutinize the literature. Be careful of what you see on the internet and ALWAYS seek to validate anything yourself. Ice has plenty of benefits and clinical validation. Proper application of cryotherapy can reduce secondary injury and reduce edema formation if applied within the first 36 to 48 hours (remember, ice doesn’t reduce swelling after the acute injury phase, and may not play a huge role in inflammation or recovery). We do know that ice helps reduce pain, spasm, and guarding, allowing more mobility (Barber et al. 1998, Raynor et al. 2005). More than anything, ice is a convenient and potent pain reliever, so it’s ok to apply ice to ‘chronic’ conditions as a safer pain reliever at any time. In fact, cryotherapy has been shown to decrease the amount of prescription pain medications needed after surgery (Barber et al. 1998, Raynor et al. 2005).[1] 1. https://mikereinold.com/is-icing-really-bad-for-you/ https://mikereinold.com/is-icing-really-bad-for-you/ (2018) Ice has shown benefits in study and practice, and the above article has many cited studies and a critique of anti-ice articles.

AlbertCory 4y ago

There does seem to be some medical evidence given, but you really have to work to find it. And yes, the acronyms are cringe. I have a friend who just had knee replacement. She said the pain was excruciating, and that the best advice was ice in the first few days (she said two days), followed by heat after that. Since she's the type of person who would have access to the best medical advice, I tend to believe it. As for claims that "the body is always right" : look up "auto-immune disease."

bilsbie 4y ago

If inflammation is good then they should remove elevation and compression from their acronym.

scottLobster 4y ago

This fits with my experience, growing up I was taught to regularly apply ice to acute sports injuries, however the ice always melted pretty quick and slipped off besides, so I got tired of effort of keeping a fresh bag of ice on the injury, and eventually just stopped. What I discovered anecdotally is that the swelling was never any worse, and there was no discernible difference in the time a given category of injury (twisted/sprained ankles for the most part) took to heal. And it makes sense when you think about it, we've evolved for millions of years to deal with acute minor injuries without ice. Look at the billions of people who live without refrigeration today and engage in daily manual labor, are they continually hobbled by minor injuries? No. How ice became such a religious imperative in injury treatment I have no idea. Granted it probably makes sense in cases where the swelling/inflammation is so severe it becomes a secondary injury or just continuously painful, but for the everyday "rolled my ankle while playing house league soccer" injury? Completely unnecessary and ineffective IMO.

11235813213455 4y ago

Inflammation is basically your body turning on repair mode (when all goes right, so not in chronic issues), so usually not the best idea to counteract it

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