Hi Dr Damien

Thanks for the input, always good to see different ideas.

I understand your points and do not agree with the proven effectiveness, but i only have one question and this is probably the main reason I wrote about RICE. Is the application of ice seen to be effective because it gives symptomatic relief, or is it actually proven to shorten the repair time of an acute injury?

My argument is that all the research into the effectiveness of RICE seems to be based on treatment of symptoms, which fair enough, is sometimes called for, but I would like to see some proof of whether RICE is more effective in the entire recovery, compared to another approach, for example acupuncture, myofascial release and normalising sympathetic control of blood flow rate to the injured area. I have used this approach, eg on a sprained ankle (lateral ligs),and had the dancer performing (although slightly abbreviated performance) the next night after the injury. I used no ice no elevation, only ensured that the leg was well supported by the hip and upper leg and that the calf muscles were functioning to support the ankle. This eas done with acupuncture and myofascial release massage, freeing the space for muscles and ensuring correct natural biomechanical stability. Added to this I ensured the sympathetic nervous system was controlling blood flow rate. I saw him once more and he was back to full time dancing. The point is, would he have improved as well if he had iced his injury immediately after the injury? I would like to see this type of research, not research which tells us how the body responds to cold...we already know that.

Sometimes I think we might have been baffled by evidence of symptom relief, and because it is so widely used, we accept it as gospel. I am not saying it is not effective, just is it effective for symptoms or for the bigger picture of full repair. Personally I feel our job is not to treat the damaged tissues but to support the body in it time of repair. If we can remove any obstacles getting in the way of the body repairing itself, eg poor blood flow rate, tight fascial tissues (not necessarily scar tissues...normal in repair), weak supporting muscles, and if necessary pain (acceptable in certain cases), then I think we are well on the way to guiding the body into full repair.

What we must remember is that every injury is new for the body, and as much as it is designed to repair damaged tissues, a knee injury is different to an elbow injury , and it is our job to guide the body, educate it, and show it how to repair each area of the body, so it does a good job first time. Eg, it makes no sense using weight bearing exercise for the elbow when it is a hing joint in an essentially non-weight bearing arm.

Personally I am not sure about cross frictions as scar tissue is natural and I feel it has been given a bad name by my profession's teaching as if it ALWAYS sticks, which makes the use of x-frictions sound feasable. I all my years of practice, I have rarely seen poor scarring in an acute muscle/ligament injury, and believe it should be left alone to repair without any outside interference. It makes the body sound like it is completely inept at fixing itself, which is crazy. Tissues will heal, we must ensure the environment of the repair is satisfactory.

By the way, not sure if you heard, but I have been led to believe, about 8 years ago US was proven in research not to work. For this reason and for the reason that deep heating can slow the rate of blood flow by deep vasodilatation, thus decreased O2, etc. I have not and will not use US in practice at may not be evidence based. Once again, just because we know what it does to the body does not prove it is actually effective.

Please also see other thread on RICE in forum...I think in Sports or general discussion.

Thanks for your input again, I think it is important to question treatment regimens sometimes, even though the approach might be seemingly solid. As we learn more about the body so things should change.

regards

Pete