from Hacker News

Ice to treat soft-tissue injuries contraindicated by creator of protocol

by stank345 on 4/16/24, 12:42 PM with 64 comments

  • by tpoacher on 4/16/24, 1:21 PM

    This is a weird article / statement. RICE, afaik (former doctor here), was never about prolonged use for healing. The intent is to mitigate the harms of the initial excessive inflammation/swelling response (which threatens to compromise tissue at the peak of the injury event), by dampening this response via cooling / constriction of blood vessels.

    But, absolutely, after this has settled a bit, you're supposed to apply warmth, not heat, to encourage increased perfusion to the area and promote healing.

    So, apples/oranges. There's nothing in the statement above to say that RICE is contraindicated as an initial management, and the implication that RICE was meant to be applied past initial management simply isn't true in the first place (afaik).

    I could be wrong as to how others used it, however. I wouldn't put it past a hospital to mindlessly make it a protocol that would then be followed blindly, I guess...

  • by throwaway5752 on 4/16/24, 3:05 PM

    Since people here are arguing about things that the article doesn't state, or mistating things it does state, here is the actual relevant text

    The current research supports the role of ice in temporary pain relief, but there is little evidence supporting the use of ice to aid in healing, or even swelling reduction.[7] Further research is needed to further understand how ice should be applied. At this time, due to the lack of evidence, there is no consensus on the ideal temperature ranges, time frames, application methods, or patient populations when using ice on a soft tissue injury.[16] Most studies use icing protocols of intermittent 10-20 minute applications, several times a day for the first few days following an injury.[7]

    and

    Currently, the RICE protocol is no longer recommended and has given way to other protocols for treating soft tissue injuries. Most recently, in 2019 the mnemonic "PEACE & LOVE" was coined by Blaise Dubois. The PEACE component stands for protection, elevation, avoid anti-inflammatories, compression, and education. It guides the treatment of acute soft tissue injuries. The LOVE component stands for load, optimism, vascularization, and exercise. It guides the treatment for the sub-chronic and chronic management of soft tissue injuries.

  • by mtalantikite on 4/16/24, 3:05 PM

    Tangentially related, the article mentioned the first re-attachment of a limb from a 12-year old boy whose limb was preserved with ice prior to surgery at MGH. That jogged my memory, as my AP Chemistry teacher told us that story one day in class. Turns out he grew up in Somerville and knew the kid from the neighborhood, and all the kids used to hop the freight trains to catch a lift to various places around Somerville and the surrounding areas. He may have even said that he was there when it happened. He said that the kid was fairly new to hopping the trains like that, as you learn to pull yourself in between cars or very close to the train so that you don't hit a wall and, well, lose an arm. [1]

    [1] https://en.wikipedia.org/wiki/Ronald_A._Malt#First_Successfu...

  • by lambdaba on 4/16/24, 1:24 PM

    I suppose it's related, that for athletes, ice baths after exercising are to be avoided because they hinder hypertrophy.

  • by nickburns on 4/16/24, 1:18 PM

    one wonders how it ever even seemed like common sense to disrupt the body's evolved immune response to acute, traumatic soft-tissue injury, never mind good conventional medical advice.

    ice to preserve a detached structure? sure. quelling the inflammation of organs or the brain? yeah, those types of inflammation can turn into a cascading collection of responses, often (but not always) having distinct non-traumatic root causes.

    but disrupting increased (life)blood flow to the site of acute, traumatic soft-tissue injury? seems like some otherwise logical lines crossed there, not to mention just a bad idea on its face.

  • by iwontberude on 4/16/24, 1:15 PM

    And here I thought the ice was intended to be a pain reliever, not a way to induce healing.

  • by rob74 on 4/16/24, 1:43 PM

    > Ice has been used for injuries since at least the 1960s, in a case where a 12-year-old boy needed to have a limb reattached. The limb was preserved before surgery by using ice

    Of course, for detached limbs, ice is really good to conserve them until they can be reattached. But that's not the majority of injuries fortunately. Also, compression is really good for wounds that are bleeding profusely. For soft tissue injuries, maybe not so much?

  • by alistairSH on 4/16/24, 1:12 PM

    It's amazing how much medical knowledge we have to unlearn (and sometimes relearn) as time passes. Some of it from experts; much of it folk wisdom. And how much of that knowledge was based on overzealous extrapolation (as appears to be the case here).

    Heat vs Ice for injuries

    Fats vs Sugars vs Proteins (and everything else diet-related)

    Leeches went out of favor, but now see limited use again (for very specific things, not blanket "release the bad humours!" quackery.

  • by jschveibinz on 4/16/24, 2:15 PM

  • by Jerqfase on 4/16/24, 4:25 PM

    Funny that anyone would point to icing a detached limb as a solution for the ones still attached.

  • by kazinator on 4/16/24, 2:20 PM

    It is contraindicated from the parameter of speed of recovery/healing.

    While that's important in order for someone to get back to work or a sport, the most important parameter should be quality of recovery, in my opinion.

  • by readthenotes1 on 4/16/24, 6:28 PM

    Declared unsuitable in 2014 after 30+ years, and I'm just now finding out.

    I feel a bit like Woody Allen in Sleeper...

  • by rawling on 4/16/24, 1:57 PM

    (2014)?