RICE vs MEAT wrote:
Image:
http://www.caringmedical.com/cyberclinic/imgs/fig10-9.jpg
Your chart that does not display any tests, theories, or actual work, clearly changed my mind.
Even given the relative dearth of medical publications considering the effect of ice on microtrauma, the use of icebaths is very hard to write off.
Here are some things we must consider:
1) Elite athletes use ice baths in droves. Of course, as has been pointed out, this PROVES nothing. Many elite athletes wear gold necklaces, but it would be preposterous to recommend runners start wearing gold necklaces to increase their fitness. However, we must also consider that, since it is at least plausible that an ice bath has an effect on recovery, the widespread usage by elite athletes must be considered. Remember, you will be hard-pressed to find any scientific articles "proving" many of our stalwart training principles. Long runs, high mileage, stretching: These were the foundation of long-distance training LONG before any scientists investigated it in the lab. Furthermore, we can safely assume that there are enough runners in the world such that the very best of them must be doing something right.
2)Icing works on traumatic injuries and overuse injuries. It is very hard to dispute this, and harder still to find a doctor involved with athletes ("caringmedical.com" notwithstanding) who does not recommend icing for traumatic and overuse injuries. The core leap in reasoning for using icebaths is this: "Muscle soreness is caused by microscopic tears in the muscle fiber. Ice helps heal soft tissue injures. Therefor, it will heal the microscopic tears in my muscle fibers, making me less sore." This is the core argument we are debating. The specific mechanics of it (blood vessel constriction, eliminating metabolic waste products, or toxins, etc) are, as far as I can tell from reading this, not well understood.
3) It is very hard to scientifically prove the effectiveness of any training method. As I mentioned earlier, there have been no studies (to my knowledge) confirming the benefits of a long run, high weekly mileage, or doing strides during base training. Yet we all (malmo excluded; I'm not letting this become a debate about long runs) do these. And, surprise, surprise, they WORK.
Keep that all in mind.
777 wrote:
2)Icing works on traumatic injuries and overuse injuries. It is very hard to dispute this,
It's very easy to dispute this. Ice only stops edema, which can prevent an injured area from receiving the blood flow it needs for repair. Running is no injury, nor does it cause edema. There is no reason at all to use ice or ice baths. Runners need blood flow to the muscle cells for repair. In addition, icing would reduce intracellular entropy, reducing optimal cellular enzyme activity needed for recovery and repair.
fortunately coaches and athletes don't require confirmation from the scientists about what works and what doesn't. The scientists and their studies will always be behind the 8 ball in this caper.
The Detrimental Effects of Ice on Sports Injuries
The cells that make up ligaments, tendons, and organs are extremely temperature-sensitive. The metabolic rate at which these cells function is directly proportional to the temperature in their environment. For each 10 degree Celsius change in the temperature, there is a more than two-fold increase in the cell metabolism. (Guyton, A. et al. Textbook of Medical Physiology. Philadelphia, PA: W. B. Saunders, 1996, p. 620.) In other words, in order to increase cell metabolic rate by more than 100 percent, the temperature of the tissue must increase by 10 degrees. Conversely, cooling tissue will decrease that cell's metabolism.
It is obvious that ligaments require improved circulation to the area in order to heal after an injury, since the blood supply to ligaments is normally so poor. Yet ice is arguably the most widely used therapeutic agent in medicine today, which most definitely decreases circulation. Ice has been shown to be one of the most efficient forms of cryotherapy, and is often the first line of treatment for traumatic injuries. As with many common and time-honored remedies, the use of ice has developed over time. The effect of ice on the tissues and their healing has not been studied in depth until recently.
http://www.caringmedical.com/sports_injury/rice.asp
The Research on Ice
In one landmark study done at the University of Hawaii, Dr. Sherwin Ho and associates, put a commercially-available ice wrap on one knee for 20 minutes, and on the opposite knee a wrap was placed at room temperature. The knees were then injected with dye and scanned for blood flow. The study showed that all iced knees demonstrated a decrease in arterial and soft tissue blood flow, as well as decreased bone uptake of the dye, which is a reflection of changes in both the bone blood flow and metabolic rate. The average decrease in arterial blood flow was 38 percent, 26 percent in soft tissue blood flow (ligaments), and 19 percent in bone uptake. In the 21 people studied, the "ice effect" was not related to age, sex, knee circumference, or skin temperature after cooling. The authors go on to conclude that these findings provide a scientific rationale for the use of ice in limiting further hemorrhage and cell injury after traumatic musculoskeletal injuries and surgical procedures.
See the thinking in modern medicine? The last statement would only apply if swelling were occurring in a closed space, leading to the development of a compartment syndrome. This only occurs in muscles (and only those with a lot of damage) and never occurs in ligaments. The last statement would, therefore, not apply around the knee which is full of ligaments. The last statement in the article should read, "The findings provide a scientific rationale as to why ice should not be used in acute ligament injuries because ice has a dramatically negative effect on circulation and cell metabolism." The net effect would be impaired or at best, delayed, soft tissue healing. The decrease in bone was measured a full two hours after the ice wrap was removed. Imagine what the decrease in blood flow to the bone was during the ice wrap? The weak link in the musculoskeletal system that is responsible for most nonhealing sports injuries is at the point where the ligaments attach to the bone. These studies show that ice decreases both the soft tissue (ligament) and the bone blood flow. Realize that the blood flow decreased significantly with only a 20-minute wrap. Many athletes ice their injuries for much longer than 20 minutes. The next time the trainer comes toward you with an ice pack, tell him, "Thanks, but no thanks. I want my injury to heal."
Dr. Ho had already published articles in 1990 on the negative effects of ice, where he showed that as little as five minutes of icing a knee can decrease both blood flow to the soft tissues and skeletal metabolism. He found that icing a knee for 25 minutes decreases blood flow and skeletal metabolism another 400 percent! (Ho, S. Comparison of various icing times in decreasing bone metabolism blood flow in the knee. American Journal of Sports Medicine. 1990; 18:376-378.)
Healing is hindered by a decrease in blood flow and metabolism to the area. Icing increases the chance of incomplete healing by decreasing blood flow to the injured ligaments and tendons. This increases the chance of re-injury or the development of chronic pain.
I still find it hard to believe that nearly every top athlete in nearly every sport uses ice baths for both muscle soreness (recovery) and when they have an injury - I find it hard to believe they would do this if the evidence was so overwhelming that ice baths are 'bad'. They have to, at the very least, be advantageous.
I think there have been many well written and profound statements from both sides of this... excellent work letsrun.com... but I'm following in the footsteps of those who do this for a living and receive expert advice. I'm sure they themselves have researched this or their coaches have and they still find an ice bath worthwhile.
This is probably going to be ignored given the previous posts. But, what the hell.
The rationale for icing is actually pretty straightforward. Running does indeed "injure" the muscle with microtears, electrolyte and glycogen depletion, radical and oxidizing species generation etc. Sensing the muscles distress and damage resident monocytes/PMNs release local cytokines increasing immune cell activity, blood vessel permeability, etc. This is a good thing for repair to an extent. Problem is that increased permeability creates extra-capillary edema and local pressure on blood vessels which DOES compress local capillaries. And you've got monocytes/neutrophils trying to squeeze through blood vessels to get in on the action that can further slow blood flow and edema clearance.
OK. So we see how these effects can slow blood flow to tired muscles, yes? Poor blood flow can create local ischemia and set you up for more damage (ie reperfusion generates all kinds of reactive oxygen species, radicals and whatnot).
Icing and compression can help push the edema back into the blood vessels and lymph system and clear the area for blood flow to continue after you are done icing. No one is advocating long term icing, just enough to reduce the swelling can give your vasculature a chance to clean things up.
It is all well and good to quote obscure medical "studies" on icing and injuries, but the first response to any overuse injury should always be icing. It works, and nearly everyone here knows it. Podiatrists, physical therapists, and personal trainers all recommend icing.
does it? Everyone I've ever seen icing overuse injuries has taken just as long to recover as people not icing, if not longer. If people are running through an injury and using ice as a painkiller along with ibuprofen or whatever else, they're just injuring themselves more and more until finally they won't be able to run anymore and finally have to take time off. By that point their injury is usually more serious and requires more time off.
I wonder how many people are conditioned to think it's a good thing, so they naturally think they are better recovered after the ice bath.
Back in the 80's coaches used to send hurt runners or advise runners with sore legs to soak in a hot tub. We all thought that helped too.
I like icebaths, and definitely feel better on icebath days. This is what I was told Ice baths do for you, and it sounds plausible.
When you run, you tear muscle fibers. These fibers are then re-built as part of your recovery. The longer/harder you run, the more the damage.
When you take an icebath, you're in essence freezing down your legs. Nothing really occurs during the icebath, other than you're cooling your muscles all the way through. Hence wanting to be in the water 10 to 15 minutes. (personally I do no less than 15).
Once you get out of the ice bath, your body will pump more blood into your now 'frozen' muscles in your legs to warm them back up. This in turn will also help with the healing process (of your muscle fibers) as your body is pumping more blood to those areas that wouldn't necessarily get that much without the 'icing' effect.
In the 70's I read about Jack Foster and other Kiwis and Aussies finishing runs with a stretch of running in icy ankle-deep surf. Tried it, and it felt great. Also heard of spraying race horses' legs with cold water after workouts, which I do with my athletes after hard workouts. With a spray nozzle attached to a garden hose, you can move up and down with a forceful spray, a sort of ice massage. Athletes love it, and they aren't standing waist-deep in garbage cans of ice-water for 15 minutes at a stretch. To spray one kid takes perhaps twenty to thirty seconds.
As for the mechanism, clearly the jury is still out.
Ticktock wrote:
does it? Everyone I've ever seen icing overuse injuries has taken just as long to recover as people not icing, if not longer. If people are running through an injury and using ice as a painkiller along with ibuprofen or whatever else, they're just injuring themselves more and more until finally they won't be able to run anymore and finally have to take time off. By that point their injury is usually more serious and requires more time off.
I have iced and ibuprofen'ed my way through several injuries over the years. I think a majority of serious runners (read - not always fast) probably have. Shin splints, tendonitis flare up, ITB issues.... If I took off everytime I felt a little nagging injury I would never make it through a training program. I know it's a fine line to walk to keep from getting a big injury and I try to keep that in check. But ice is usually my first reaction to a small injury before I have to take days off from running. So far I've been succesful at managing that.
For me, I don't care what scientific studies show that ice does not help. I know it has helped me and will continue to use it. If it works, don't change it.
You’re right to ignore those ‘scientific crackpots.’
As I pointed out before, all the dancers in that Irish stageshow, Riverdance who’s legs in that form of dancing take a heck of a battering, especially the shins, have learnt from bitter experience that if they don’t jump straight into a huge tub of ice cold,(brimming with ice blocks) water after each performance - they won’t last out the tour.
In fact, I used to fantasise about jumping into one with Jean Butler, a Riverdance principle - who surely has the most gorgeously, shapeliest pair of female legs in the world.
