RICE: Yes or No

[physiobob]

Tend to agree in principle. However the "ice" part is to reduce excessive swelling to the area and for pain modification really. It does not stop inflammatory processes "OR DOES IT". All it does is slow flow thereby reducing damage to tissue by excessive swelling to the surrounding tissue. Kind of like control a crowd leaving a football match rather than a stampede all at the same door at the same time. They all get out but don't kill each other on the way.

I think the better question here is "Does the Icing reduce inflammation?" or does it merely slow it down to an acceptable delivery rate?

[physiomitch]

Sorry, please read this after the above reply.

Just a further point on use of hot or cold in general. We need to keep aware of what is termed 'reciprocal blood flows'. This means we have a closed vascular system with a set volume of blood, and thus the body regulates the pressures to maintain a a balanced internal environment. Now if ice is applied to the skin, the surface blood vessels constrict, but to maintain even blood pressure, blood vessels somewhere else will have to dilate. This is known as reciprocal blood flow. So icing an injured area causing constriction will mean initially muscle vessels will compensate by dilating, but the longer the ice is applied, the deeper the compensation will become. Thus blood can actually be diverted away from and around an injured area to maintain good pressure and flow rate.

The converse with heat; this causes dilatation in the skin meaning there has to be constriction somewhere else. Examples of reciprocal blood flows are: between the skin and underlying muscles, between internal and external carotid arteries, between skin and gut, and importantly between paravertebral skin and spinal cord (can be harmful using cold or ice on the back resulting in congestion in the spinal cord).

Another reason maybe not to use ice for so long? Ideally we want to maximise blood flow RATE to allow the body to initiate the healing process. Interesting to note how acupuncture practitioners in the east treat acute injuries...they needle around the injured area (trapping the Dragon), essentially causing MORE injury, enhancing the body's processes, not stagnating them.

Pete

[physiomitch]

It is a good question. If you look at the physiology of injury again inflammation and vasodilatation go hand in hand. Various substances such as the amines (histamine, seratonin etc.) and prostaglandins, cause vasodiltation as part of the inflammation process. However I feel there is a misperception about blood flow. Dilating blood vessels does not increase blood flow, it increases blood volume. The rate of blood flow is important in good body function and if a blood vessel dilates, the rate will slow, just as a river will flow slower when it becomes wider. If the rate of blood flow is maintained by increase heart function then this is OK, but if not then there will be a slowing of blood flow rate.

At the same time blood pressure in the vessels can only increase if 1) The heart works harder to counter the dilated blood vessels and initial drop in pressure, or 2) if there is a blockage at the end of the vessel causin a backlog of blood. The reason for vasodilation in the injured area is to allow better permeability of fluids in and out othe the blood vessels, but also to allow a slowing of the rate of bloo so the necessary cells have an oppertunity to adhere to the damaged blood vessels or penetrate the blood vessels and adhere to the injured tissues. This is done electrically, as the injured area will be initially positively charged (internal cell fluid leakage), and all red and white blood cells and platelets are negetively charged. It is not a chemical attraction.

So again my question is: if vasodilatation is normal in injury (and apparently only lasts 10 to 15 mins), as a part of the inflammatory process then how can we be doing the body any favours by causing vasoconstriction? Logic indicates that this would reduce the inflammatory process as the necessary mast cells, red blood cells and other chemicals cannot get there in enough quantities to do what they are meant to do. It seems that we have been brainwashed into believing that if we do not treat with ice we will continue swelling or bleed to death, yet the blood vessels are immediately repairing themselves and vasodilatation only last 10 to 15 mins, so the body has the ability to control these factors, but it needs the process to continue to be able to do a sufficient job.

Again, are we helping the longer-term repair by icing or are we hindering it? Should we go against the body's natural practice and treat symptoms or should we allow the body to continue its natural methods and assist where we can?

Pete

[elinekk]

Hello everyone,

Ice is a very invasive way to reduce swelling and there are more ways that lead to Rome.
Elevation of the injured part, above the head, reduces the bloodflow in the area as well, preventing other tissue to damage from excesive swelling but does provide the area sufficiently.
Like some people have said, it is natural for the body to have an increased bloodflow to the damaged area in order to start of the healing process.
The reason ice has been used for so long is that it reduces the swelling promtly and dims the pain, for an athlete to return to the field straigh away or to, so they think, recover quickly.... (Even though recovery will not be made fully and and good as through the natural healing process, after all, blood provides for that.) Do understand that in sports, especcially in team sports, the rule "For you 10 others" count and sportsmen will take the risks to make to team.

I also read someone writing about Ibruprofen and other anti-inflamation drugs. Also with these I would be carefull as they stop the natural healing process of inflamation and research has found that tissue regrowth is not as good and strong as when no anti inflamation drug has been used.

Great to see so many people get into this kind of discussion and what a great toppic. I think its good to question the 'rules' at times, after all we are a developping trade, right.

Kind Regards,
Eline.