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 …”
Even the actual non-metaphorical parts are Annoying. "A is for... I think it was Anti-inflammatories?" "No no, I think it was Avoid anti-inflammatories..." "Damn that distinction seems important :/."
Canada's use of MAID (Medical Assistance In Dying) is a creepy one for euthanasia. Seems to imply that dying people are a dirty mess to be swept out the door and into the trash bin.
>> Over the years, acronyms guiding their management have evolved from ICE to RICE[1], then to PRICE[2] and POLICE (...) (PEACE) to subsequent management (LOVE). PEACE & LOVE (...)
Boy, really? I was interested until stumbling on those bits. We've certainly reached peak-acronym.
I learned it as HELM: Heat, Exercise [the the appendage or body part through its range of motion], Lower [the appendage or body part] and Massage.
Basically the opposite of RICE, all 4 were focused on maximizing blood flow to the soft tissue injury. And anecdotally, I can confirm it works way better than RICE or the alternatives. I used to be out for 2-3 weeks after running issues when I used RICE, etc. After I switched to HELM I was back on the pavement the next morning.
The issue with HELM is that it can be significantly more painful than RICE, etc., as you must avoid using anti-inflammatories and painkillers.
TLDR; IRRC:
Don't take anti-inflammatory, don't keep it stationary, don't fight swelling at all, but do keep it moving and teach your body to avoid the motion that caused the injury.
So easy to remember, since, you know, we damaged our meat in these types of injury.
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!
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.
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.
This is a good example of how there isn’t really a cutesy acronym that will fix your injuries. Your body is yours and figuring out what works for you is part of the process of health. I have been climbing for years and what prevents injuries and aids recovery is a constant game with ever changing rules, so you have to enjoy the ups and downs.
"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.
"We also question the use of cryotherapy. Despite widespread use among clinicians and the population, there is no high-quality evidence on the efficacy of ice for treating soft-tissue injuries. Even if mostly analgesic, ice could potentially disrupt inflammation, angiogenesis and revascularisation, delay neutrophil and macrophage infiltration as well as increase immature myofibres."
To be clear, though, they say "avoid icing" (i.e. The use of cold compresses for pain relief). It isn't what the article is primarily about, but it still is not their recommendations.
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.
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.
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.
Yes, I had a similar experience with a clavicle fracture 15 years ago. I saw a surgeon but somewhat surprisingly, she wanted to let it heal on its own if it could. Today my left shoulder is an inch shorter than the right and I have a knob where the two halves fused back together but it doesn't hinder me in any noticeable way.
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.
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.
That ice would reduce swelling feels intuitive to me. What is less intuitive is whether or not reducing swelling is in fact a good thing.
The way I see it, swelling could be one of two things:
1) a mechanism that the body engages in order to heal or alleviate healing, similar to fevers, or
2) a negative side-effect caused by, say, inflammation or something.
There are probably studies that indicate which of the two it is, I don't know. But if it is #1, then reducing it is just a way to actively work against the body.
Yes, athletes have been both icing and heating injuries for centuries, and doing many other things that make no sense.
However, it could be the case that icing injuries is a good idea if you need to perform the next day (or otherwise soon) but a bad idea if you want to heal the best/soonest that you can.
Or it could all just be nonsense, no shortage of that, no matter how popular.
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.
Let’s throw anecdotal data since we are at it, for me in my over 20 years of bodybuilding experience with plenty of “soft tissue” injuries what works best is cold-warm theraphy.
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.
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.
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."
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.
> 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]
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."
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.
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.
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.
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.
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?
> 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.
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.
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.
[+] [-] Hnrobert42|3 years ago|reply
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 …”
[+] [-] yshavit|3 years ago|reply
[+] [-] saurik|3 years ago|reply
[+] [-] Mountain_Skies|3 years ago|reply
[+] [-] Vox_Leone|3 years ago|reply
Boy, really? I was interested until stumbling on those bits. We've certainly reached peak-acronym.
[edit] And now I see it's an old story.
[+] [-] wmeredith|3 years ago|reply
[+] [-] gamblor956|3 years ago|reply
Basically the opposite of RICE, all 4 were focused on maximizing blood flow to the soft tissue injury. And anecdotally, I can confirm it works way better than RICE or the alternatives. I used to be out for 2-3 weeks after running issues when I used RICE, etc. After I switched to HELM I was back on the pavement the next morning.
The issue with HELM is that it can be significantly more painful than RICE, etc., as you must avoid using anti-inflammatories and painkillers.
[+] [-] jvanderbot|3 years ago|reply
https://progressiveptandrehab.com/rice-and-meat-physical-the...
TLDR; IRRC: Don't take anti-inflammatory, don't keep it stationary, don't fight swelling at all, but do keep it moving and teach your body to avoid the motion that caused the injury.
So easy to remember, since, you know, we damaged our meat in these types of injury.
[+] [-] PhileasNietzche|3 years ago|reply
"Couldn't they have come up with something simpler, since the healing of soft-tissue injuries is so simple?"
[+] [-] slowmovintarget|3 years ago|reply
Hippies will hate it, though.
[+] [-] jedmeyers|3 years ago|reply
[+] [-] optimuspaul|3 years ago|reply
[+] [-] todd8|3 years ago|reply
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|3 years ago|reply
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.
[+] [-] ericmcer|3 years ago|reply
[+] [-] sizzle|3 years ago|reply
[+] [-] denton-scratch|3 years ago|reply
ICE stands for Impact, Confidence, and Ease. I think the acronym is rather stretched and awkward.
[+] [-] elif|3 years ago|reply
"We also question the use of cryotherapy. Despite widespread use among clinicians and the population, there is no high-quality evidence on the efficacy of ice for treating soft-tissue injuries. Even if mostly analgesic, ice could potentially disrupt inflammation, angiogenesis and revascularisation, delay neutrophil and macrophage infiltration as well as increase immature myofibres."
[+] [-] llbeansandrice|3 years ago|reply
[+] [-] elil17|3 years ago|reply
[+] [-] dwighttk|3 years ago|reply
All this is confusing.
[+] [-] unknown|3 years ago|reply
[deleted]
[+] [-] ehnto|3 years ago|reply
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.
[+] [-] chis|3 years ago|reply
[+] [-] zdragnar|3 years ago|reply
[+] [-] thefaux|3 years ago|reply
[+] [-] nov21b|3 years ago|reply
[+] [-] philliphaydon|3 years ago|reply
I have no idea of it’s effective but it seems to have helped her.
[+] [-] kristiandupont|3 years ago|reply
The way I see it, swelling could be one of two things:
1) a mechanism that the body engages in order to heal or alleviate healing, similar to fevers, or
2) a negative side-effect caused by, say, inflammation or something.
There are probably studies that indicate which of the two it is, I don't know. But if it is #1, then reducing it is just a way to actively work against the body.
[+] [-] jackmott42|3 years ago|reply
However, it could be the case that icing injuries is a good idea if you need to perform the next day (or otherwise soon) but a bad idea if you want to heal the best/soonest that you can.
Or it could all just be nonsense, no shortage of that, no matter how popular.
[+] [-] gwd|3 years ago|reply
[+] [-] neuralRiot|3 years ago|reply
[+] [-] fsh|3 years ago|reply
[+] [-] guerrilla|3 years ago|reply
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.
[+] [-] nonameiguess|3 years ago|reply
[+] [-] OnACoffeeBreak|3 years ago|reply
[+] [-] kube-system|3 years ago|reply
[+] [-] wirthjason|3 years ago|reply
[+] [-] jackcviers3|3 years ago|reply
> 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/ (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|3 years ago|reply
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."
[+] [-] londons_explore|3 years ago|reply
Maybe rather than washing wounds, it'll turn out it's best to jam them with soil to get the immune system revved up...
[+] [-] grumple|3 years ago|reply
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.
[+] [-] jameal|3 years ago|reply
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.
[+] [-] unknown|3 years ago|reply
[deleted]
[+] [-] eric_b|3 years ago|reply
[+] [-] scottLobster|3 years ago|reply
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.
[+] [-] londons_explore|3 years ago|reply
So what changed that it is no longer beneficial?
[+] [-] bennyelv|3 years ago|reply
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.
[+] [-] nashashmi|3 years ago|reply
[+] [-] nashashmi|3 years ago|reply
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.