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Ice to treat soft-tissue injuries contraindicated by creator of protocol

en.wikipedia.org

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Re: Ice to treat soft-tissue injuries contraindicated by creator of protocol

#11

Post by davidmurdoch »

harimau777 wrote: post #8
tpoacher wrote: post #6

This is a weird article / statement. RICE, afaik (former doctor here), was never about prolonged use for healing. The intent is to mitigate the harms of the initial excessive inflammation/swelling response (which threatens to compromise tissue at the peak of the injury event), by dampening this response via cooling / constriction of blood vessels. But, absolutely, after this has settled a bit, you're supposed to appl…

Does that mean that alternating hot and cold is no longer recommended for long term healing?

He's saying it never was

Re: Ice to treat soft-tissue injuries contraindicated by creator of protocol

#12

Post by lr4444lr »

tpoacher wrote: post #6

This is a weird article / statement. RICE, afaik (former doctor here), was never about prolonged use for healing. The intent is to mitigate the harms of the initial excessive inflammation/swelling response (which threatens to compromise tissue at the peak of the injury event), by dampening this response via cooling / constriction of blood vessels. But, absolutely, after this has settled a bit, you're supposed to appl…

Aside from tissue necrosis or nerve damage due to extreme compression, (which seem to be situations where you'd be at an ER or urgent care anyway due to the severity that entails) what other harms need mitigation? It seems that ice is recommended for every minor or moderate injury handled purely at home.

Re: Ice to treat soft-tissue injuries contraindicated by creator of protocol

#13

Post by tpoacher »

QuadrupleA wrote: post #9
tpoacher wrote: post #6

This is a weird article / statement. RICE, afaik (former doctor here), was never about prolonged use for healing. The intent is to mitigate the harms of the initial excessive inflammation/swelling response (which threatens to compromise tissue at the peak of the injury event), by dampening this response via cooling / constriction of blood vessels. But, absolutely, after this has settled a bit, you're supposed to appl…

How is the initial swelling dangerous / compromising?

It's been years since I've practiced, so take my understanding with a grain of salt, but, the idea is that the swelling will be excessive, and because the space to accommodate it is limited, this can end up constricting the blood vessels and compromise blood perfusion, despite the fact that the inflammatory response is trying to 'open' them.

Therefore by artificially causing them to open slightly less, you control the swelling, and stop it from pooling so much that it then blocks blood flow completely.

The extreme scenario of this is called compartment syndrome, where the blood flow is completely blocked, leading to necrosis of the affected area; this is an orthopedic emergency, where 'fasciectomy' needs to be performed; effectively slicing open the compartments to allow the expansion to occur without compromising blood flow.

Re: Ice to treat soft-tissue injuries contraindicated by creator of protocol

#14

Post by tpoacher »

lr4444lr wrote: post #12
tpoacher wrote: post #6

This is a weird article / statement. RICE, afaik (former doctor here), was never about prolonged use for healing. The intent is to mitigate the harms of the initial excessive inflammation/swelling response (which threatens to compromise tissue at the peak of the injury event), by dampening this response via cooling / constriction of blood vessels. But, absolutely, after this has settled a bit, you're supposed to appl…

Aside from tissue necrosis or nerve damage due to extreme compression, (which seem to be situations where you'd be at an ER or urgent care anyway due to the severity that entails) what other harms need mitigation? It seems that ice is recommended for every minor or moderate injury handled purely at home.

Well, I don't know; an educated guess is that it's not just blood vessels that could be compromised by excessive swelling, however localised.

Having said that, the RICE acronym is often extended to PRICE, to indicate that the typical treatment also involves a "Plaster of Paris". So in the presence of a plaster, the confinement is even more strict, so you would want to control the swelling response inside the tightly-fitting plaster anyway.

But, again, disclaimer, haven't practiced in years, and even then I was not specifically an orthopedic doctor. :)

Re: Ice to treat soft-tissue injuries contraindicated by creator of protocol

#15

Post by mb7733 »

tpoacher wrote: post #6

This is a weird article / statement. RICE, afaik (former doctor here), was never about prolonged use for healing. The intent is to mitigate the harms of the initial excessive inflammation/swelling response (which threatens to compromise tissue at the peak of the injury event), by dampening this response via cooling / constriction of blood vessels. But, absolutely, after this has settled a bit, you're supposed to appl…

As a patient, in the past I've absolutely been directed to ice injuries for weeks. (Not so much in the last ~10 years, as the world caught up to the fact that this was a bad idea.) Sources like the Red Cross or WebMD article on RICE[0] _still_ recommend it for at least 48 hours after a minor injury, even though this has been debunked.

So I think it's good that the Wikipedia article emphasizes that the protocol is outdated.

[0] https://www.webmd.com/first-aid/rice-method-injuries

Re: Ice to treat soft-tissue injuries contraindicated by creator of protocol

#16

Post by rob74 »

> Ice has been used for injuries since at least the 1960s, in a case where a 12-year-old boy needed to have a limb reattached. The limb was preserved before surgery by using ice

Of course, for detached limbs, ice is really good to conserve them until they can be reattached. But that's not the majority of injuries fortunately. Also, compression is really good for wounds that are bleeding profusely. For soft tissue injuries, maybe not so much?

Re: Ice to treat soft-tissue injuries contraindicated by creator of protocol

#18

Post by radlad »

alistairSH wrote: post #2

It's amazing how much medical knowledge we have to unlearn (and sometimes relearn) as time passes. Some of it from experts; much of it folk wisdom. And how much of that knowledge was based on overzealous extrapolation (as appears to be the case here). Heat vs Ice for injuries Fats vs Sugars vs Proteins (and everything else diet-related) Leeches went out of favor, but now see limited use again (for very specific thing…

What exactly do we need to unlearn about Fats vs Sugars vs Proteins?

Re: Ice to treat soft-tissue injuries contraindicated by creator of protocol

#19

Post by dogtorwoof »

tpoacher wrote: post #6

This is a weird article / statement. RICE, afaik (former doctor here), was never about prolonged use for healing. The intent is to mitigate the harms of the initial excessive inflammation/swelling response (which threatens to compromise tissue at the peak of the injury event), by dampening this response via cooling / constriction of blood vessels. But, absolutely, after this has settled a bit, you're supposed to appl…

Off topic, why did you stop being a doctor?

Re: Ice to treat soft-tissue injuries contraindicated by creator of protocol

#20

Post by alistairSH »

radlad wrote: post #18
alistairSH wrote: post #2

It's amazing how much medical knowledge we have to unlearn (and sometimes relearn) as time passes. Some of it from experts; much of it folk wisdom. And how much of that knowledge was based on overzealous extrapolation (as appears to be the case here). Heat vs Ice for injuries Fats vs Sugars vs Proteins (and everything else diet-related) Leeches went out of favor, but now see limited use again (for very specific thing…

What exactly do we need to unlearn about Fats vs Sugars vs Proteins?

In my life, eggs have been both bad and good. Butter vs margarine. Atkins vs paleo vs whatever else. Calorie restriction vs more exercise.

Lots of junk science. Lots of marketing fluff. But, also lots of recommendations that were assumed correct but didn't stand up to deeper scrutiny.

Note, I'm not saying any of this is bad, or that scientists are stupid and wrong all the time. Just always amazed about how much our understanding of the human body has changed in the last ~50 years.

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