Ice on injuries = nono

[dust]

http://guardianlv.com/2014/04/ice-age-melting-rice-may-no-longer-be-the-treatment-of-choice-for-injuries/

 

Really, this should be common sense. Of course you don't try to freeze an injury!

 

Practitioners of Eastern medicine have, of course, known this all along, and I'm sure it won't be a surprise to most of you bums, but I thought it was worth noting -- particularly that even the apparent originator of the RICE treatment himself has, eventually, realized his mistake.

 

He should go further though, no? Stillness, cold, compression, lack of blood... every part of RICE is counterproductive (& the last two parts of MCE remain so).

 

Life itself begins with movement, warmth, space... what would make us think healing is any different?

[gendao]

Like most modern Western medicine, ice has been used mainly to suppress the symptoms - which actually backfires from healing the actual problem...

and LED light therapy would be some much better alternatives that actually enhance the HEALING process - although they are generally not as easily available.

[dust]

Out of interest,

 

Can a case be made for ice?

 

And in what cases of injury/illness would cold be considered beneficial in TCM/other Chinese medicine? (if any)

[thelerner]

Out of interest,

Can a case be made for ice?

Interestingly enough, the link in the OP says this:

"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. "

 

It is against total rest, saying some movement, even light exercise is good to keep blood flowing.  I think there's been a switch away from bed rest paradigm to get moving and back to exercising (responsibly)  in order to heal faster.  

[Aetherous]

Out of interest,

 

Can a case be made for ice?

 

And in what cases of injury/illness would cold be considered beneficial in TCM/other Chinese medicine? (if any)

 

Athletic Trainer now Chinese Medicine student here...

 

I can definitely make a case for ice...the main reason it's used by professionals is that it prevents "secondary hypoxic injury", which is another way of saying that the inflammation from being injured will prevent optimal blood flow and cellular nutrition in the area, and will cause further tissue damage if left to heal on its own. You get injured, do nothing, and you get a greater injury which takes longer to heal than if you had iced.

 

That's the idea. Does the research support it? From what I recall from years ago, yes mostly.

 

That being said, I think it's possible for herbs to do what ice is supposed to do (here is one version although I think a more intelligently designed formula could be made), without the harmful aspect of it causing cold to enter the channels.

 

Here's something to think about...in Chinese Medicine they use moxibustion, which when done in a dispersing fashion, is an intense heat. It is fire entering the channels. Why do they not consider that to be the external pathogenic factor of "heat"? They should. Why the bias against "cold" when used as a therapy? In some texts, such as the Zang Zhong Jing, it gives an indication for using ice to treat a patient (at least the translation I read seems to) when indicated. Perhaps throughout the years, Chinese Medicine was biased against cold therapy because of the Shang Han Lun (Cold Injury Treatise) being the primary classic text used...all about how cold is the pathogen that enters in a certain way and causes all diseases...at least the book seems to be about this when viewed superficially.

 

My view: appropriate treatment is all about right patient at the right time getting what they need. Icing seems inappropriate when it causes the area to go all white and blue and freezing to the touch. But think about an acute injury that's red and heat is radiating off of it. You apply ice for 20 minutes (the typical time period suggested) and the area is still basically hot and red in a short period of time. This is within the first 72 hours of the injury, which is the appropriate time to use it for preventing secondary hypoxic injury...not necessary, and actually counter-productive, after this initial phase of healing.

 

Or just go the topical herbs route, and do massage and light movements of the area. I think even topical herbs would be damaging, though, if they're not entirely needed...you don't want to "cool" an area of your skin unless it really needs it, whether through cold water/ice or "cold" herbs. Just because it comes from nature, or an "ancient" healing tradition, doesn't mean it's healing for every person.

 

Anyway...all this being said, it's not the opinion of Chinese Medicine that ice is ever okay. Just mine. It was cool to read the originator of RICE saying what he did, but it's also a bit of an extreme view.

[dust]

OK. Some good points of discussion. Bear in mind I don't know anything...

 

I can definitely make a case for ice...the main reason it's used by professionals is that it prevents "secondary hypoxic injury", which is another way of saying that the inflammation from being injured will prevent optimal blood flow and cellular nutrition in the area, and will cause further tissue damage if left to heal on its own. You get injured, do nothing, and you get a greater injury which takes longer to heal than if you had iced.

 

Surely inflammation/swelling has 2 purposes? To increase circulation and surface area in the injured area, increasing blood flow; and to tell you how much it is OK to move (pain = stop).

 

 

Here's something to think about...in Chinese Medicine they use moxibustion, which when done in a dispersing fashion, is an intense heat. It is fire entering the channels. Why do they not consider that to be the external pathogenic factor of "heat"? They should. Why the bias against "cold" when used as a therapy?

 

I don't know why (purposefully applied) external heat is generally not considered to be pathogenic as cold is. It would seem logical that yang balances yin and yin balances yang.

 

In this case, though, inflammation is not a cause, it is a symptom, right? Treating the symptom is not the same as treating the cause

 

 

My view: appropriate treatment is all about right patient at the right time getting what they need. Icing seems inappropriate when it causes the area to go all white and blue and freezing to the touch. But think about an acute injury that's red and heat is radiating off of it. You apply ice for 20 minutes (the typical time period suggested) and the area is still basically hot and red in a short period of time. This is within the first 72 hours of the injury, which is the appropriate time to use it for preventing secondary hypoxic injury...not necessary, and actually counter-productive, after this initial phase of healing.

 

For sure, treatment should be patient-appropriate.

 

OK, so let's say the case for short periods of ice has something to it   But is this how the treatment is usually applied?

 

I've been around a few times when someone has been injured, usually an ankle sprain/twist or a knock/blow to some area, and at least one person has said "Get the frozen peas!" The injured then proceeds to sit there with something very cold attached (and in the case of leg injury, with the leg up), and usually for a lot longer than 20 minutes -- ice is applied until the pain seems to be gone. The general consensus is that if it's not hurting, it's getting better.

 

So they say "Oh, yeah, ice works wonders!" But of course little healing has taken place in this time, and I would argue that this was the primary, most important, time for extra blood to be getting in and starting the healing process..?

[Aetherous]

Surely inflammation/swelling has 2 purposes? To increase circulation and surface area in the injured area, increasing blood flow; and to tell you how much it is OK to move (pain = stop).

 

From what I understand, the problematic type of inflammation here actually decreases circulation, rather than increasing it, which is what causes the secondary hypoxic injury. Also, as you mentioned, the body has a self-healing or further-injury-preventing mechanism, of guarding the area.

 

Is the body guarding the area good? In the sense that it's giving us a sign that we shouldn't bang that body part against any hard surfaces, or tear the muscles further or something, yes...that prevents further injury caused by us. So, the body is smart. But it also prolongs the healing process and increases the amount of tissue that's being damaged, due to stagnation or even blood stasis...so we can help prevent further injury and also decrease healing time, by icing.

 

I don't know why (purposefully applied) external heat is generally not considered to be pathogenic as cold is. It would seem logical that yang balances yin and yin balances yang.

 

Yes I think you're right. There can be a time for every treatment...and a time not for it.

 

In this case, though, inflammation is not a cause, it is a symptom, right? Treating the symptom is not the same as treating the cause

 

There are a few different ways of thinking about "root" versus "branch" in Chinese medicine, which sometimes is the cause versus the signs and symptoms. In my view, there is the injury that happens which is one cause, and then the body's response which can be a cause of further injury.

 

From a Sports Medicine perspective, icing is all about managing the body's response. It's not treating the symptom of warmth or swelling...from how I was trained, the sole purpose of icing is to prevent secondary hypoxic injury. A side effect is that it can be analgesic/relieve pain.

 

OK, so let's say the case for short periods of ice has something to it   But is this how the treatment is usually applied?

 

Only professionally by smart people. Sometimes professionals are lazy with their education and work, so you might see people applying ice on all injuries.

 

Regular non-professional people should also understand the right time and wrong time of icing. From a Sports Medicine perspective, I'd say that within 72 hours, apply for 20 minutes at a time, a few times per day. From a common sense perspective, I'd only apply it when the area appears really inflamed and feels hot...if we categorize that kind of presentation as "extreme yang" (to make up a term) then we could use "extreme yin" (ice) to balance it. But even within 72 hours, if the area isn't really hot, red, etc...then I don't think it'd be so good.

 

And perhaps herbs are much better to use...for instance you can add blood movers in addition to cooling.

 

I've been around a few times when someone has been injured, usually an ankle sprain/twist or a knock/blow to some area, and at least one person has said "Get the frozen peas!" The injured then proceeds to sit there with something very cold attached (and in the case of leg injury, with the leg up), and usually for a lot longer than 20 minutes -- ice is applied until the pain seems to be gone. The general consensus is that if it's not hurting, it's getting better.

 

Well it's true in a sense...pain is a sign that there's an injury or illness. So when the pain's gone, it seems like things are good...however, doing what you said they do, that's not good. People should work on what's causing the pain in effective ways, and then it will truly heal quickly.

 

So they say "Oh, yeah, ice works wonders!" But of course little healing has taken place in this time, and I would argue that this was the primary, most important, time for extra blood to be getting in and starting the healing process..?

 

You definitely want blood flow in the area. The whole point of doing anything or doing nothing during the acute phase, is to prevent further tissue injury by decreased circulation. Inflammation doesn't mean increased circulation though...the word actually implies a pathological process. The tissues are 'inflamed'...not functioning well.

[Songtsan]

It seems that ice/heat combinations might still be useful after acute phase of injury - vasoconstriction/vasodilation would push out old blood and bring in new. Question would be timing and ratio. There have been instances of the cold saving someone from dying too - such as drowning victims being resuscitated at close to an hour after 'death,' so this might be applicable for certain specific instances which require a slowdown of body processes. There is also talk of how inflammation responses, while protective, also cause cell damage at the same time...interesting topic. Can't wait to hear about more studies.

[dust]

Thanks Aetherous. Very informative.

 

Songtsan -- I wasn't aware of the cold being used for resuscitation. Interesting.

 

Yeah, if anyone has studies they can point out, might be interesting..

[Songtsan]

Well, it was when people were fished from water in the winter time. They were brought back to life up to an hour after stopping breathing, such as here: http://www.cbsnews.com/news/brought-back-from-the-dead/

 

Now your OP referred to acute injuries, not death, so its still a different ball game. My guess is that nothing is good all the time, and everything is good some of the time

[dust]

Now your OP referred to acute injuries, not death, so its still a different ball game.

 

Haha! Yeah, my OP was about 'RICE', which as far as I'm aware is not recommended for treating death...

 

But my other post was asking if ice could be recommended in any particular circumstance. Sounds like this might be one.