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If anyone's heard of RICE (Rest, Ice, Compression, Elevation) for healing joints, the new guidance is called POLICE: Protect, Optimal Load, Ice, Compression, an

If anyone's heard of RICE (Rest, Ice, Compression, Elevation) for healing joints, the new guidance is called POLICE: Protect, Optimal Load, Ice, Compression, and Elevation. The key differences being Protect and Optimal Load, meaning don't re-injure it and expose it to some level of weight-bearing or usage.

dfxm12 2y ago
Anyone can RICE their joints. It's foolproof, more or less objective and requires no monitoring from a professional. What defines optimal load? It sounds impossible to gauge, unless maybe if you're working with a physical therapist. Then, what happens if load more than the optimal level? Is the outcome worse than if you just stuck to RICE? I think these are things that have to be considered for medical protocols.
- miketery 2y ago
  Optimal load is right before it starts hurting. You progressively load, and when it starts hurting you unload. Your body will send pain before there is damage to be done. Edit: in fact some discomfort or right kind of pain is good. Else you give to atrophy.
  - shermantanktop 2y ago
    That’s not how pain works. Pain is a noisy and error-prone signal that gives you a good approximation for “stop doing that.” But the edge of pain sensation doesn’t indicate what is or isn’t a good idea during recovery. It’s not a bad place to start, but everyone has different pain tolerances, some injuries are in nerve-poor areas, and repetitive stress or tendinitis are definitely not going to appreciate getting lit up right away.
    - jacksnipe 2y ago
      I’m in PT and dealing with orthos right now, and according to them, that IS how pain works for the vast majority of ortho injuries
      - potamic 2y ago
        Sorry, which comment are you affirming?
        jacksnipe 2y ago
        Go until just before it hurts, which is a moving target that you will have to calibrate carefully
        shermantanktop 2y ago
        Would you give the same advice to someone with a chronic pain condition?
        jacksnipe 2y ago
        I don't know, I'm not a doctor and I'm not giving advice to anybody!
  - layer8 2y ago
    Your edit shows that there is no good rule for the threshold where pain would indicate too much load vs. still being in the beneficial range. We don’t even have a good way to assess subjective pain (one’s 3 is another one’s 7, etc.). “Optimal load” is really just a tautology.
    - pessimizer 2y ago
      "As soon as it starts to hurt" is not some hopelessly complex and useless standard that involves delving into philosophies of subjective pain sensation. It is actually obvious and easy to follow. Use it, but when it hurts, stop.
      - devilbunny 2y ago
        Yeah, but given the huge variations in pain tolerance, some will reinjure it while others will never use it again.
        theultdev 2y ago
        tolerating it doesn't mean you can't detect it. no amount of pain tolerance will help you if something is broken. you WILL feel it. simply stop when you do. it's not a hard thing to grasp.
        devilbunny 2y ago
        Clearly, you have never worked in healthcare. Sleeve tattoos but needs an IV? “Oh, I’m not good with needles, you need to sedate me first.”
        theultdev 2y ago
        How is that relevant?
        devilbunny 2y ago
- paulcole 2y ago
  > I think these are things that have to be considered for medical protocols What makes you think those things haven't been considered? The comment you replied to said, "the new guidance is..." I took that to mean those things have been considered.
  - dfxm12 2y ago
    I mean considered per patient. Pro wrestler Kerry von Erich had to get his broken foot amputated because he thought it felt good enough to walk across the room to get a cheeseburger. Not everyone can gauge these things on their own, especially considering people with broken bones may be taking pain killers. Not everyone can have professionals, or even loved ones, around them to monitor it.
    - darrenf 2y ago
      > Pro wrestler Kerry von Erich had to get his broken foot amputated because he thought it felt good enough to walk across the room to get a cheeseburger. Honestly, I don't think wrestlers -- certainly those from the von Erich era -- are beacons of authority when it comes to sensible recuperation/rehabilitation from injury. Kevin von Erich said it was due to his brother trying to get some food but there are other accounts: > Moody says Kerry turned up on crutches and was feeling too much pain, so the doctors injected a liquid-type numbing painkiller on his injured foot so he could go on. The match went under 6 minutes with Kerry beating Adias, but according to Moody, even with his foot under a painkiller influence, Kerry still felt a lot of pain, which led to the amputation of his foot.
      - dfxm12 2y ago
        Maybe they aren't, but they also aren't unique in this regard. Obstinate tough guy types are obstinate no matter what their job is. I have neighbors and family members who had similar issues where the doctor says something like "you can walk, but take it easy" but they misjudge what "taking it easy" really means.
    - paulcole 2y ago
- lwarfield 2y ago
  When I broke a joint in my pinky a few years ago it was pretty easy to tell. Early on the range of motion was the limiting factor, and I'd move it back and forth as much as I could without any pain. After that I worked on strength in a similar way, do as much as I can with no pain. I went from "you'll never play an instrument again" to rock climbing and Viola practice. Overall, seeing my strength and range of motion slowly get better was immensely satisfying and your body is pretty good at letting you know when you're getting close to a limit.
- brendoelfrendo 2y ago
  RICE, as a protocol, isn't all that effective. The doctor who invented it recanted support after new evidence showed the importance of inflammation for the healing process. And, it turns out, he just kind of made it up to fit a handy pneumonic. POLICE is similarly invented and hard to recommend, but modern practices do recommend bearing load sooner rather than later. Can determining optimal load be done without a doctor? It probably depends on the severity and type of injury. But that's not really the point of a medical protocol, the point is to define best practices that help achieve the best outcomes.
- mathieuh 2y ago
  I broke my elbow last year (in a very minor way but still), when I was in the A&E the doctor told me to keep moving it and that I wouldn't be able to move it in a way that would affect negatively affect recovery. Within about 10 days it was markedly better and within 21 days I was back riding my bike, and now a year later as far as I can tell it's as good as new. I didn't need physio or anything, the doctor just told me to keep using it as normally as possible.
- parliament32 2y ago
  >What defines optimal load? Uncomfortable but not painful, just like pretty much everything else physiology-related in life.
windward 2y ago
We're still icing and elevating? I've always felt dubious about our attempts to rectify our bodies evolving inflammation. It doesn't seem like any great evil to let the body part get more blood, signals to stop us using it, and a lower range of movement.
- tempestn 2y ago
  No, reducing inflammation can help manage pain, but beyond that is not beneficial (actually is detrimental) to healing. https://drmirkin.com/fitness/why-ice-delays-recovery.html https://drmirkin.com/fitness/why-ice-delays-recovery.html
gamblor956 2y ago
It's HELM now: Heat, Exercise, Lower, and Massage. They're all designed to maximize blood flow to, and inflammation in, the injured area. (Note that exercise just means to keep it moving.) Ice and elevation restrict the flow of fluids in and out of the injured area; ice especially slows down recovery and is only recommended for pain management. (This is basically a simplified version of the protocol NFL teams have been using.)
- Panzer04 2y ago
  I love how this is basically the complete opposite of the old protocol lmfao. Makes sense to me, though :D
- memkit 2y ago
  I did this after breaking my ankle. I was carefully walking the next day, hiking within a week, and skateboarding within 2-3 weeks. Fully healed after a month or two. Everyone thought I was insane but I'm very glad I did it. I thought, why should we try to intervene with millions of years of evolution? Inflammation has to be there for a reason. Nitpick that statement all you want but in this specific case I'm glad I didn't mitigate the inflammation. I was unaware of the acronym HELM and told everyone I was doing the exact opposite of RICE on purpose.
kenjackson 2y ago
The guy who termed RICE (Gabe Mirkin) later came out and said he made a mistake. Specifically with the "Ice" part (and partially with Rest). See: https://drmirkin.com/fitness/why-ice-delays-recovery.html https://drmirkin.com/fitness/why-ice-delays-recovery.html
- askvictor 2y ago
  IIRC the underlying assumption was that you should be reducing inflammation (RICE is almost all about reducing inflammation). Since then, we've learned that inflammation is a good thing, and helps things heal faster.
  - tomjakubowski 2y ago
    I'm curious now if the anti-inflammatory diets popular with dietitians and health influencers could have a negative effect when you really do want inflammation, like when fighting an infection or recovering from injury. https://www.health.harvard.edu/staying-healthy/quick-start-guide-to-an-antiinflammation-diet https://www.health.harvard.edu/staying-healthy/quick-start-g... https://nutritionsource.hsph.harvard.edu/healthy-weight/diet-reviews/anti-inflammatory-diet/ https://nutritionsource.hsph.harvard.edu/healthy-weight/diet...
    - james4k 2y ago
      As I understand it such diets allow the immune system to work more effectively, not suppressing it like, say, corticosteroids do.
- jalla 2y ago
  Also, elevation is useless and compression is potentially harmful as restricting blood circulation and compressing tissue limits healing.

dfxm12 2y ago

Anyone can RICE their joints. It's foolproof, more or less objective and requires no monitoring from a professional. What defines optimal load? It sounds impossible to gauge, unless maybe if you're working with a physical therapist. Then, what happens if load more than the optimal level? Is the outcome worse than if you just stuck to RICE? I think these are things that have to be considered for medical protocols.

miketery 2y ago
Optimal load is right before it starts hurting. You progressively load, and when it starts hurting you unload. Your body will send pain before there is damage to be done. Edit: in fact some discomfort or right kind of pain is good. Else you give to atrophy.
- shermantanktop 2y ago
  That’s not how pain works. Pain is a noisy and error-prone signal that gives you a good approximation for “stop doing that.” But the edge of pain sensation doesn’t indicate what is or isn’t a good idea during recovery. It’s not a bad place to start, but everyone has different pain tolerances, some injuries are in nerve-poor areas, and repetitive stress or tendinitis are definitely not going to appreciate getting lit up right away.
  - jacksnipe 2y ago
    I’m in PT and dealing with orthos right now, and according to them, that IS how pain works for the vast majority of ortho injuries
    - potamic 2y ago
      Sorry, which comment are you affirming?
      - jacksnipe 2y ago
        Go until just before it hurts, which is a moving target that you will have to calibrate carefully
        shermantanktop 2y ago
        Would you give the same advice to someone with a chronic pain condition?
        jacksnipe 2y ago
        I don't know, I'm not a doctor and I'm not giving advice to anybody!
- layer8 2y ago
  Your edit shows that there is no good rule for the threshold where pain would indicate too much load vs. still being in the beneficial range. We don’t even have a good way to assess subjective pain (one’s 3 is another one’s 7, etc.). “Optimal load” is really just a tautology.
  - pessimizer 2y ago
    "As soon as it starts to hurt" is not some hopelessly complex and useless standard that involves delving into philosophies of subjective pain sensation. It is actually obvious and easy to follow. Use it, but when it hurts, stop.
    - devilbunny 2y ago
      Yeah, but given the huge variations in pain tolerance, some will reinjure it while others will never use it again.
      - theultdev 2y ago
        tolerating it doesn't mean you can't detect it. no amount of pain tolerance will help you if something is broken. you WILL feel it. simply stop when you do. it's not a hard thing to grasp.
        devilbunny 2y ago
        Clearly, you have never worked in healthcare. Sleeve tattoos but needs an IV? “Oh, I’m not good with needles, you need to sedate me first.”
        theultdev 2y ago
        How is that relevant?
        devilbunny 2y ago
paulcole 2y ago
> I think these are things that have to be considered for medical protocols What makes you think those things haven't been considered? The comment you replied to said, "the new guidance is..." I took that to mean those things have been considered.
- dfxm12 2y ago
  I mean considered per patient. Pro wrestler Kerry von Erich had to get his broken foot amputated because he thought it felt good enough to walk across the room to get a cheeseburger. Not everyone can gauge these things on their own, especially considering people with broken bones may be taking pain killers. Not everyone can have professionals, or even loved ones, around them to monitor it.
  - darrenf 2y ago
    > Pro wrestler Kerry von Erich had to get his broken foot amputated because he thought it felt good enough to walk across the room to get a cheeseburger. Honestly, I don't think wrestlers -- certainly those from the von Erich era -- are beacons of authority when it comes to sensible recuperation/rehabilitation from injury. Kevin von Erich said it was due to his brother trying to get some food but there are other accounts: > Moody says Kerry turned up on crutches and was feeling too much pain, so the doctors injected a liquid-type numbing painkiller on his injured foot so he could go on. The match went under 6 minutes with Kerry beating Adias, but according to Moody, even with his foot under a painkiller influence, Kerry still felt a lot of pain, which led to the amputation of his foot.
    - dfxm12 2y ago
      Maybe they aren't, but they also aren't unique in this regard. Obstinate tough guy types are obstinate no matter what their job is. I have neighbors and family members who had similar issues where the doctor says something like "you can walk, but take it easy" but they misjudge what "taking it easy" really means.
  - paulcole 2y ago
lwarfield 2y ago
When I broke a joint in my pinky a few years ago it was pretty easy to tell. Early on the range of motion was the limiting factor, and I'd move it back and forth as much as I could without any pain. After that I worked on strength in a similar way, do as much as I can with no pain. I went from "you'll never play an instrument again" to rock climbing and Viola practice. Overall, seeing my strength and range of motion slowly get better was immensely satisfying and your body is pretty good at letting you know when you're getting close to a limit.
brendoelfrendo 2y ago
RICE, as a protocol, isn't all that effective. The doctor who invented it recanted support after new evidence showed the importance of inflammation for the healing process. And, it turns out, he just kind of made it up to fit a handy pneumonic. POLICE is similarly invented and hard to recommend, but modern practices do recommend bearing load sooner rather than later. Can determining optimal load be done without a doctor? It probably depends on the severity and type of injury. But that's not really the point of a medical protocol, the point is to define best practices that help achieve the best outcomes.
mathieuh 2y ago
I broke my elbow last year (in a very minor way but still), when I was in the A&E the doctor told me to keep moving it and that I wouldn't be able to move it in a way that would affect negatively affect recovery. Within about 10 days it was markedly better and within 21 days I was back riding my bike, and now a year later as far as I can tell it's as good as new. I didn't need physio or anything, the doctor just told me to keep using it as normally as possible.
parliament32 2y ago
>What defines optimal load? Uncomfortable but not painful, just like pretty much everything else physiology-related in life.

windward 2y ago

We're still icing and elevating? I've always felt dubious about our attempts to rectify our bodies evolving inflammation. It doesn't seem like any great evil to let the body part get more blood, signals to stop us using it, and a lower range of movement.

tempestn 2y ago
No, reducing inflammation can help manage pain, but beyond that is not beneficial (actually is detrimental) to healing. https://drmirkin.com/fitness/why-ice-delays-recovery.html https://drmirkin.com/fitness/why-ice-delays-recovery.html

gamblor956 2y ago

It's HELM now: Heat, Exercise, Lower, and Massage. They're all designed to maximize blood flow to, and inflammation in, the injured area. (Note that exercise just means to keep it moving.) Ice and elevation restrict the flow of fluids in and out of the injured area; ice especially slows down recovery and is only recommended for pain management. (This is basically a simplified version of the protocol NFL teams have been using.)

Panzer04 2y ago
I love how this is basically the complete opposite of the old protocol lmfao. Makes sense to me, though :D
memkit 2y ago
I did this after breaking my ankle. I was carefully walking the next day, hiking within a week, and skateboarding within 2-3 weeks. Fully healed after a month or two. Everyone thought I was insane but I'm very glad I did it. I thought, why should we try to intervene with millions of years of evolution? Inflammation has to be there for a reason. Nitpick that statement all you want but in this specific case I'm glad I didn't mitigate the inflammation. I was unaware of the acronym HELM and told everyone I was doing the exact opposite of RICE on purpose.

kenjackson 2y ago

The guy who termed RICE (Gabe Mirkin) later came out and said he made a mistake. Specifically with the "Ice" part (and partially with Rest). See: https://drmirkin.com/fitness/why-ice-delays-recovery.html https://drmirkin.com/fitness/why-ice-delays-recovery.html

askvictor 2y ago
IIRC the underlying assumption was that you should be reducing inflammation (RICE is almost all about reducing inflammation). Since then, we've learned that inflammation is a good thing, and helps things heal faster.
- tomjakubowski 2y ago
  I'm curious now if the anti-inflammatory diets popular with dietitians and health influencers could have a negative effect when you really do want inflammation, like when fighting an infection or recovering from injury. https://www.health.harvard.edu/staying-healthy/quick-start-guide-to-an-antiinflammation-diet https://www.health.harvard.edu/staying-healthy/quick-start-g... https://nutritionsource.hsph.harvard.edu/healthy-weight/diet-reviews/anti-inflammatory-diet/ https://nutritionsource.hsph.harvard.edu/healthy-weight/diet...
  - james4k 2y ago
    As I understand it such diets allow the immune system to work more effectively, not suppressing it like, say, corticosteroids do.
jalla 2y ago
Also, elevation is useless and compression is potentially harmful as restricting blood circulation and compressing tissue limits healing.