Thurs 08/09/12 WOD

Very good post by Mobility WOD about inflammation and injury.  Go to your typical physical therapist or athletic trainer and the first thing they will tell you is ice it.  I iced all through my football career and I was always hurting, just over the past year I was given the advise to restore blood flow to injured area and stop icing and I am now a huge believer.  Here is the post and video by Mobility WOD.

Here goes. You should stop icing.  We were wrong.  I know.  I’ve even been guilty of advocated for short icing stints on this blog.  I was wrong.  For the past year, I’ve been engaged in a personal moral debate about icing that in retrospect, seems silly if not out right obvious.  We should not ice.  For the last year, I’ve advocated for no icing with every athlete  with whom I’ve helped  either  post-surgery or post-injury.   The outcomes have been nothing short of stunning.  Even  way back in Episode 204, “Donnie Thompson, Strongest Powerlifter Ever, Cares About Your Swelling,” (15 months ago) we started shifting our management of swelling chiefly to compression.  And that was before I met Gary Reinl of Marc Pro.  Every athlete worth his or her salt knows of the old RICE acronym.  And dammit if I wasn’t already hearing and experimenting with reduced icing protocols for the last few years (remember numb and done?).  My problem with NOT icing, I told myself was that I didn’t have other good tools on hand to minimize the pain of swelling (which is the real athlete problem eh?).  As it turned out, the solutions presented themselves (excellent compression apparel, Dick Hartzell’s compression protocol, and the Marc Pro) at the same time that common sense matched up with my own clinical experience and test/retest ethic.  Maybe it was because I finally felt like I had other mechanisms with which to deal with the swelling, that I could resolve the dissonance I had around this outdated modality.  Don’t get me wrong, if you need to make something numb, ice is great.  As Mr. Reinl points out, “Yes, (making something numb is good) if the short-term goal is pain control and the prevention of the body’s normal cellular and vascular response to injury.”

Let me quote Dr. Nick DiNubile, Editor in Chief of The Physician And Sports Medicine Journal (physsportsmed.com) “Seriously, do you honestly believe that your body’s natural inflammatory response is a mistake?”

Well what does the research and  literature say?

“When ice is applied to a body part for a prolonged period, nearby lymphatic vessels begin to dramatically increase their permeability (lymphatic vessels are ‘dead-end’ tubes which ordinarily help carry excess tissue fluids back into the cardiovascular system). As lymphatic permeability is enhanced, large amounts of fluid begin to pour from the lymphatics ‘in the wrong direction’ (into the injured area), increasing the amount of local swelling and pressure and potentially contributing to greater pain.” The use of Cryotherapy in Sports Injuries,’ Sports Medicine, Vol. 3. pp. 398-414, 1986

Or how about this comprehensive literature review from the Journal of Emergency Medicine?

“Is Ice Right? Does Cryotherapy Improve Outcome for Acute Soft Tissue Injury?” JEM, 2008; Feb. 25; 65–68

Abstract: Aims: The use of ice or cryotherapy in the management of acute soft tissue injuries is widely accepted and widely practiced. This review was conducted to examine the medical literature to investigate if there is evidence to support an improvement in clinical outcome following the use of ice or cryotherapy. Methods: A comprehensive literature search was performed and all human and animal trials or systematic reviews pertaining to soft tissue trauma, ice or cryotherapy were assessed. The clinically relevant outcome measures were: (1) a reduction in pain; (2) a reduction in swelling or edema; (3) improved function; or (4) return to participation in normal activity. Results: Six relevant trials in humans were identified, four of which lacked randomization and blinding. There were two wellconducted randomized controlled trials, one showing supportive evidence for the use of a cooling gel and the other not reaching statistical significance. Four animal studies showed that modest cooling reduced edema but excessive or prolonged cooling is damaging. There were two systematic reviews, one of which was inconclusive and the other suggested that ice may hasten return to participation.” Conclusion: There is insufficient evidence to suggest that cryotherapy improves clinical outcome in the management of soft tissue injuries.

Look, I know you have iced your body about a billion times.  I also know that it’s hard to resolve the dissonance about potentially retarding your own healing response by doing so.  I personally had a difficult time  slaying this icing error beast until I was confronted directly with the physiology, and my own clinical experience working with surgeries, injuries, and even rhabdo–all without  ice.  It’s hard to fight the drag of orthodoxy.  Why do we do what we do?  Because we always have?  We can do better.  Our goal needs to be to improve adaptation by improving circulation, clearing congestion, and facilitating healing.  Pretty much everyone I know has stopped taking NSAIDS for the same reasoning that we should stop icing.  Let’s kick the ice habit too.

Here is the interview with the inflammation slayer, Gary Reinl, from the recent Crossfit Games.  Be prepared to have your mind blown.

 

 

WOD

3 Rounds for time of:

Row 600 m

25 Burpees

25 Box Jumps-24/20

Run 800 m

 

 

08/08/12 WOD Results

 

 

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2 thoughts on “Thurs 08/09/12 WOD

  1. This is interesting. I’ve been out of crossfit for several months now due to “jumpers knee.” This is basically “inflammation” and micro tearing of the patellar ligament. It’s an overuse injury, and guess what. I overdid it. I’m starting to get a reputation for that.. Some people have eyes bigger than there stomach. I have eyes bigger than my physical capabilities..

    Anyhow, you look up the typical treatment for my injury and it’s always RICE. Lot’s of ice, lots of anti-inflammatory meds. Lots of rest.

    Tried that. Guess what. It didn’t work. Sitting basically immobile was cool for a few days. Sitting for too long would result in more pain and suffering. The advil/IB was good for a few hours, but then the throbbing pain would come roaring back. Not too mention it was genuinely jacking up my digestive system.

    Since I started eating Paleo earlier this year, my ideas about what I put in my body quickly changed. At the beginning of this the docs and PTs would tell me “we gotta get that inflammation out of your knees.” Part of me would wonder why my body would trigger a response such as this. Was it out of control? Cancerous in nature? Surely it’s some type of damage management? Surely my body understands what is best, it’s not trying to kill me, RIGHT? Default to paleo logic: What the hell did cavemen do without anti-inflammatory meds?

    When the anti-inflammatories and stretching didn’t cut it the doc suggested coritsone injections. “Arthritis” they said I had. Surely this would help the nagging “inflammation.” Sorting this out in my own head: 29 years old, 150lbs and what I consider to be very healthy.. I have arthritis? I thought that condition was reserved for the elderly, the inactive, overweight, and those who generally eat like sh!t. I had done everything possible to avoid this, yet here I was. Death, taxes.. and arthritis. The things you can count on.

    I held off on the cortisone and did some more research. Thankfully (or not) last year I had completely severed my pectoralis major/minor. As with this injury I had to do some sorting out in my own head: What was the cause, how do I avoid this again. My conclusion.. I had taken a corticosteroid and antibiotic combo several months before my pec explosion to help with some sinus issues (which I later discovered to be caused by my diet.) Known side effects? Tendon rupture.. Great. Cortisone is in this same family of meds: Know side effects: Soft tissue damage and degeneration. No way in hell I’m putting that stuff in my knee.

    Fast forward to today. I’m seeing a new doc for “regenerative therapy.” Essentially the goal is to trigger your bodies natural healing response. One of the methods is Platelet Rich Plasma injections.

    http://en.wikipedia.org/wiki/Platelet-rich_plasma

    This process takes your own blood and spins it up to enhance the concentration of white blood cells, stem cells and growth factors which your body needs in order to repair soft tissues.

    That’s right.. I’m going to pay a man a large sum of money to inject MY OWN BLOOD back into where it’s supposed to go. I’m having them do what my body was supposed to do in the first place. This will trigger SWELLING hurt like hell and restart the HEALING process. Several studies have shown this is the best treatment for my injury. Studies have shown regrowth of ligaments and even cartilage (which is unheard of.) It’s autologous, little to no chance of side effects and free of synthetic chemicals. Depending on how much crap you eat-hell, you could call it organic. But it’s considered “experimental” and my insurance will not cover it. Why? ..put your tinfoil hats on: It’s too damn easy and doesn’t require a giant pharmaceutical company to create the product- I digress.

    The point of this rant was really to say: What if I had allowed my body to heal? My knees were swollen and hurting because they were trying to warn me. What if I had rested and taken time off when I started to hurt? Would my ligament still look like a frayed piece of rope?

    A large part of me thinks this may not be the case.

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