repost from November 26, 2018
About a year ago one of my athletes sent me a link to a video from Kelly Starrett wherein he was having a discussion with a man by the name of Gary Reinl about the deleterious effects of administering ice
to exercise induced injuries and keeping the site of an injury immobilized.
Now take into consideration that my experience with injuries started at a very early age. I practically grew up in an emergency room. My pop is a doctor and he used to take me with him to the hospital throughout my childhood. I've been in the OR with him when he performed surgeries. When I was old enough I joined the Marines and was trained in combat first aid. After the service I went on to become an American Heart Association and an American Red Cross certified instructor trainer for CPR and BLS (Basic Lifesaving Steps). Throughout my entire life I've seen the same procedure performed at every level of care. And it all starts with the RICE method.
Rest, Ice, Compression, Elevation
I've used that method on more occasions than I can hope to count. So has every medical professional I've ever come across. So to hear someone saying that we've been doing it all wrong wasn't just a shock. It was practically heresy.
But Kelly Starrett isn't just a Doctor of Physical Therapy. He's a highly respected professional in his field. He's a published author of books good coaches use to help their athletes. The guy knows what he's talking about and he's recognized as a subject matter expert in physical therapy. So when he starts an argument against the use of ice and immobilization then we would do well to pay attention.
I was so intrigued by the subject that I decided to dig into it further. I read published studies, I listened to podcasts by industry professionals and I collected data. What I found was there is NO CLINICAL EVIDENCE that supports the perceived advantages of the RICE method. None.
See, God made our bodies in such a way that not only allows us to do amazing things but also to heal whenever our bodies get banged up. As an example, let's say you sprain your ankle. The first thing that happens is we feel pain. Then it swells up. The reason for the pain is so we use it less. The reason for the swelling is because the body starts sending chemicals through the blood stream to help repair the injury.
Here's the thing about RICE. Applying ice not only numbs the pain, allowing an athlete to potentially make the injury worse, but it also retards the blood flow needed by the injury to start the healing. Furthermore, the body can't get rid of waste produced by the injury through the blood stream. So the lymphatic system collects that waste and disposes of it through common secretion of bodily fluids. But guess what happens when you put ice in the mix. It all but STOPS that process from happening.
Now think about this for a second. GOD made our bodies respond to injuries the way they do. Are we really so arrogant to think that we know better than our Creator?!
Compression and Elevation has it's merits but Ice and Immobilization don't.
Kelly Starrett not only helped argued against RICE but he also provided a solution based on TONS of clinical evidence. The solution is to allow limited movement of the injured area. If the injury is severe enough that movement isn't possible then move the area before and/or after the site. Example: Severe sprain - wiggle the toes. It promotes blood flow. Traction should be performed. Traction is a form of compression that allows flow through of body fluid that causes swelling. This can typically be done with flossing bands. And then heat. Keep it warm. Not scalding hot. Just keep it warm by insulating the area or submerging the injury in warm water. These techniques promote blood flow which decreases recovery time. Now, take into consideration that there are levels of trauma that should absolutely be cared for by a doctor. Any deformation needs to be a trip to the emergency room. Short of that we can use this alternative method to get our athletes healthy again.
I presented this information to the powers that be and was told that I was playing a dangerous game by giving medical advice contrary to accepted practice so we would not be changing first aid procedures.
Fortunately, because I was the only one performing first aid, I went ahead and changed procedure anyway. I'm sure my athletes recognized that I suddenly stopped grabbing an ice pack and started grabbing a flossing band whenever any of them were injured. I just didn't care that I was going to piss off a doctor that doesn't keep up with the tide changing. My future coaches need to keep that in mind when taking care of your athletes. Never stop learning how to care for them. Do what's best for them. Period. You'll sleep better at night, trust me.
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