However, in a recent blog post, one of the authors now claims the method is flawed. Doctor Mirkin termed the RICE acronym to remind people of the steps they need to take to heal injury. The letters stand for rest, ice, compression, and elevation. Besides rest, which many athletes only choose to employ if they must, ice is perhaps the most pervasive of each of these methods for treating injury. In his blog post, Mirkin focused on the flawed use of cryotherapy to treat injury.

Mirkin levies many charges against the practice of using ice to treat injuries and has the research to back them up. It seems the only saving grace for ice is its use as a pain reliever, a function that can be performed locally, unlike an oral drug. However, aside from this application, the case against ice seems strong. The majority of Mirkin’s blog post is centered around the process of inflammation as the body’s natural healing process. Mirkin argues that although ice alleviates pain, it also interferes with inflammation and thus slows healing.

Even if ice can be used in the short term to treat pain, Mirkin still warns against it, demonstrating through research that ice also weakens athletes. When ice is used during a game to treat pain, the area may need to be re-warmed to prevent weakness. However, it isn’t clear in Mirkin’s post (or perhaps the research) if this rewarming eliminates the pain relief.

Because of the role of inflammation in healing, Mirkin says that ice isn’t the only thing that can slow down injury recovery. Any anti-inflammatory substance or behavior might curtail this process, including various drugs like NSAIDs and immune suppressants.

Mirkin also warns that complete rest is often ineffective. Therefore, it seems that compression and elevation are the only two methods of injury care he now recommends, along with immediate, complete rest where necessary. Although Mirkin doesn’t specifically state why, it seems that elevation and compression may deal specifically with swelling without necessarily blunting inflammation.

So all of those bags of ice you see wrapped around athletes’ joints and muscles may be unwarranted, but there is still action we can take. For the big stuff like major injuries, severe pain, open wounds, and the like, consult a professional. For the more common minor injuries, Mirkin makes the following recommendations:

• Elevation: This process is the act of raising a body part above the heart to allow for the clearance of blood. Elevation can begin immediately while an injury is assessed. Elevation can also continue after the assessment to keep swelling in check, and is generally reserved for the limbs or the head.

• Bandages: For muscle and other soft tissue injuries, compression bandages work as well. The bandages will help control swelling and can be used even on the torso. Although it isn’t mentioned in the article, I suspect that other mechanical pressures like massage would be effective as well.

• Limited Use of Ice: Ice can still be used to treat pain for ten-minute sessions, but only right after the injury, if at all. Complete rest for minor injuries should continue for only about 24 hours.

Long story short, it looks like the acronym is no longer as catchy.

References:

1. Gabe Mirkin, “Why Ice Delays Recovery,” DrMirkin.com, 2014.

Photo courtesy of Shutterstock.

The post Reconsidering RICE as a Treatment Option for Athletes appeared first on Breaking Muscle.

Most of the cryotherapy research to date has involved using the therapy between workouts. Cooling the muscles after one workout helps with soreness for the next workout, but seems to make no difference in any of the studied performance variables. However, in a study this month in the Journal of Strength and Conditioning, researchers took a different perspective. Although cryotherapy doesn’t seem to boost performance between workouts, the researchers hypothesized that it might work within a given workout.

Cryotherapy can involve the use of bags of ice, ice packs, cooling garments, or cold water. When using water, you’ll often hear the term hydrotherapy as well. Hydrotherapy can be hot or cold, or in the case of contrasting hydrotherapy, both hot and cold. In this study the researchers used ice bags, which is perhaps the simplest and most accessible method for most of us.

Most people know cold is a vasoconstrictor, meaning it causes the blood vessels to constrict, thereby generally reducing blood flow. Most of the time, this would be a bad thing, since it would decrease the amount of blood available for the muscles to use and negatively impact performance. But this isn’t why researchers, athletes, and coaches are interested in cryotherapy.

When you exercise your muscles and other tissues swell due to the exerted effort, extra blood flow, and heat generated by the activity. The tissues exert force on the blood vessels. To a small degree, this effect can be beneficial, since it actually increases the rate at which nutrients enter the cells. However, at a certain point the pressure on the blood vessels becomes too much and their blood flow is limited. Once the blood vessels are blocked because of tissue swelling, cryotherapy becomes advantageous. Not only is it a vasoconstrictor, but it also reduces the swelling of all the tissues, and actually improves blood flow.

In this study, the researchers studied college-level pitchers. The highest relative forces a pitcher experiences are at the shoulder and elbow joints, and pitching performance is easy to measure by the speed of the pitches. These qualities made pitchers an ideal group for this particular test. Because pitchers were used for the study, the research applies especially to athletes who get an opportunity to rest and apply ice during their sport.

The researchers made up a simulated five inning baseball game – incidentally, the number of innings needed for a pitcher to be credited with a win – and had the pitchers perform up to sixty pitches total during that time, not including warm ups. The researchers measured pitching speed and either used ice on the pitchers’ shoulders or elbows between rounds, or did not use ice at all.

Not only did the cryotherapy help with perceptions of exertion and recovery, as it did with previous studies, but it also improved performance. When the pitchers used ice, they pitched faster, especially in the ^fourth and ^fifth innings, which indicates the ice reduced fatigue in later innings.

So while cryotherapy may not work as a longer term recovery aid, it does seem to be effective during an actual event, at least in preventing fatigue. 

References:

1. Stacy Bishop, et. al., “The Effect of Intermittent Arm and Shoulder Cooling on Baseball Bitching Velocity,” Journal of Strength and Conditioning Research, DOI: 10.1519/JSC.0000000000000256.

Photo courtesy of Shutterstock.

The post Intermittent Cryotherapy Improves Performance in Baseball Pitchers appeared first on Breaking Muscle.