RICE: The End of an Ice Age?

[cvcalhoun]

And here is the article from Dr. Gabe Mirkin, who came up with the RICE treatment, and now thinks ice is not a good idea:

http://www.drmirkin.com/public/ezine111410.html

[PotomacCyclist]

There is a controversy about whether ice is ideal for post-workout recovery among runners. Similar concerns as expressed in the article, that the ice may actually delay recovery and healing (from normal post-workout muscle microdamage).

I tried using ice and ice packs when I first took up triathlon and running. I never felt it doing anything. There used to be a cold water pool at the gym. It was difficult to head down there immediately after a long outdoor run, so I would only use it after some swim workouts. That was an awful experience and again, I didn’t really feel anything. (My feet would get so cold that I could never stay in there for more than 20 seconds or so, not long enough to have any effects on muscles.)

Eventually I just stopped using the ice packs and I never even considered using an ice bath at home, like many runners do.

Running websites have some articles about the benefit or lack of benefit of icing. None of them have ever convinced me that it was a worthwhile practice. Some articles say there is no benefit and others say that it has a negative effect on recovery.

Same thing with anti-inflammatories like NSAIDs. The less, the better. For the vast majority of people and cases, no NSAIDs is best. There is concern that NSAIDs delay bone healing. If runners take NSAIDs on a regular basis, they might leave themselves open to the risk of developing stress fractures. I don’t think stress fractures are as common among cyclists, but many cyclists have been found to have lower bone mineral density than even the average sedentary person. So regular NSAID use is probably a bad idea for cyclists as well. (It’s a bad idea for anyone, unless a competent doctor prescribes them for a specific purpose for a specific situation.)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259713/

In general, people should avoid taking any type of drugs unless specifically prescribed by a competent doctor. All drugs have side effects, even over-the-counter drugs like aspirin and acetaminophen.

***
As for rest, medical professionals have long discovered that movement helps with recovery from soft tissue injury. However, it’s very important not to move an area with a broken bone until it is stabilized.

For other injuries, movement helps with circulation. That circulation pushes beneficial nutrients and repair materials to damaged tissues. (This is the case for regular post-workout microdamage too.) After tough workouts, that circulation also helps to clear out metabolic waste products from the muscles. (Not necessarily lactate, which the body uses as a fuel, but other products like ammonia.)

***
I’m not a medical professional but I have read up on the issue a lot over the past 5-6 years. If I ever broke a bone or suspected that I broke a bone, I wouldn’t move the limb (or torso) until medical staff can stabilize it properly. For a muscle injury, I would try to introduce movement as soon as possible, but without forcing too much range of motion early on. I’ve heard doctors say this many times, that they now try to get the patient moving as soon as they can (as long as there aren’t broken bones or other issues to worry about). Immobilizing an injured body part can cause problems of its own. The body is not designed to remain completely stationary for extended periods of time. For example, if you immobilize a shoulder for extended periods (days or weeks), you can develop a frozen shoulder:

http://orthoinfo.aaos.org/topic.cfm?topic=a00071

[cvcalhoun]

Thanks for that perspective. Unlike one of the member of my BAFS team **coughcoughSubbycoughcough**, I would not try working out with a broken bone. But for less serious injuries, it’s nice to have some guidance on self-care. And I’m always reluctant to believe the first article I read on the Internet, especially when it goes against conventional wisdom.

@PotomacCyclist 82541 wrote:

There is a controversy about whether ice is ideal for post-workout recovery among runners. Similar concerns as expressed in the article, that the ice may actually delay recovery and healing (from normal post-workout muscle microdamage).

I tried using ice and ice packs when I first took up triathlon and running. I never felt it doing anything. There used to be a cold water pool at the gym. It was difficult to head down there immediately after a long outdoor run, so I would only use it after some swim workouts. That was an awful experience and again, I didn’t really feel anything. (My feet would get so cold that I could never stay in there for more than 20 seconds or so, not long enough to have any effects on muscles.)

Eventually I just stopped using the ice packs and I never even considered using an ice bath at home, like many runners do.

Running websites have some articles about the benefit or lack of benefit of icing. None of them have ever convinced me that it was a worthwhile practice. Some articles say there is no benefit and others say that it has a negative effect on recovery.

Same thing with anti-inflammatories like NSAIDs. The less, the better. For the vast majority of people and cases, no NSAIDs is best. There is concern that NSAIDs delay bone healing. If runners take NSAIDs on a regular basis, they might leave themselves open to the risk of developing stress fractures. I don’t think stress fractures are as common among cyclists, but many cyclists have been found to have lower bone mineral density than even the average sedentary person. So regular NSAID use is probably a bad idea for cyclists as well. (It’s a bad idea for anyone, unless a competent doctor prescribes them for a specific purpose for a specific situation.)

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3259713/

In general, people should avoid taking any type of drugs unless specifically prescribed by a competent doctor. All drugs have side effects, even over-the-counter drugs like aspirin and acetaminophen.

***
As for rest, medical professionals have long discovered that movement helps with recovery from soft tissue injury. However, it’s very important not to move an area with a broken bone until it is stabilized.

For other injuries, movement helps with circulation. That circulation pushes beneficial nutrients and repair materials to damaged tissues. (This is the case for regular post-workout microdamage too.) After tough workouts, that circulation also helps to clear out metabolic waste products from the muscles. (Not necessarily lactate, which the body uses as a fuel, but other products like ammonia.)

***
I’m not a medical professional but I have read up on the issue a lot over the past 5-6 years. If I ever broke a bone or suspected that I broke a bone, I wouldn’t move the limb (or torso) until medical staff can stabilize it properly. For a muscle injury, I would try to introduce movement as soon as possible, but without forcing too much range of motion early on. I’ve heard doctors say this many times, that they now try to get the patient moving as soon as they can (as long as there aren’t broken bones or other issues to worry about). Immobilizing an injured body part can cause problems of its own. The body is not designed to remain completely stationary for extended periods of time. For example, if you immobilize a shoulder for extended periods (days or weeks), you can develop a frozen shoulder:

http://orthoinfo.aaos.org/topic.cfm?topic=a00071

[PotomacCyclist]

I would add that general rest (in the form of sleep and also in the form of cutting back on workouts if you are seriously overtrained/exhausted/overstressed) does help with recovery, whether it’s from illness, injury or exhaustion.

It’s also important to distinguish between movement and training through an injury. Movement for the purposes of recovery can be very simple and basic. Sometimes it just means that you are moving, not immobilized. On the other hand, I know of far too many runners in particular who think they can ignore injuries and keep running through them. Then they turn what is a minor, short-term injury into a years-long serious injury. Even coaches and running writers do this, which I don’t understand at all. One writer on Runner’s World said that she had hamstring issues but never addressed the problem. (One problem was muscle imbalances among the hamstrings, quads, glutes and core. She thought that calisthenic exercises like burpees were strength training. Burpees are a good general exercise but they are more of a muscular endurance exercise, not the same thing as true strength training.) She said that she ran for several YEARS on that bad hamstring! And she is supposed to provide advice on running and injury prevention to other runners for a national publication. She isn’t the only one like this.

Nutrition is very important too, for regular recovery as well as for recovery from illness/injury. The body needs amino acids/protein to repair injured tissues and calcium and complementary nutrients to heal injured bones. If you don’t eat properly, you would delay healing. Nutrition isn’t a magic pill but it is a necessary element of a solid recovery plan.

[cvcalhoun]

Yeah, my wife is a member of MyFitnessPal. She was shocked to figure out how much more protein she needs when exercising. And I exercise a lot more than she does. We’ve both taken to including a scoop of protein powder in our morning oatmeal, and being more vigilant about protein the rest of the day.

@PotomacCyclist 82557 wrote:

Nutrition is very important too, for regular recovery as well as for recovery from illness/injury. The body needs amino acids/protein to repair injured tissues and calcium and complementary nutrients to heal injured bones. If you don’t eat properly, you would delay healing. Nutrition isn’t a magic pill but it is a necessary element of a solid recovery plan.

[PotomacCyclist]

Protein is important but most people won’t need massive amounts (unless you are doing heavy training like Tour de France preparation, when you would need a lot more of everything: carbs, protein, unsaturated fats, fiber, green vegetables, etc.). I only mentioned protein because some people tend not to eat any at all, or very little of it. Most tend to eat more protein than they actually need.

I would go with natural sources as much as possible. As for me individually, I’ve had a lot of issues with trying protein powders. It tastes like chalk and it tends to dry up my insides, leading to stomach issues. I’ve never been able to use protein powder for more than a couple days before the stomach problems start, so I don’t use it at all now. Turkey, chicken, salmon, almonds and pistachios taste a lot better anyway.

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