Towards a more multi-faceted view of injury-pain management.

not exactly, bro.
not exactly, bro.

Last weekend, A.J. McLean of the Backstreet Boys was talking about the band’s reunion show on NPR, and mentioned that they were icing their back and knees backstage after dancing, which gave me 2 different reasons to grit my teeth while listening to Morning Edition.

There is a lot of advice available via the internet which combines RICE-rest, ice, compression, elevation- with ibuprofen for assistance with pain from an injury or post-workout pain and muscle soreness. But RICE has been debunked.

I see icing suggested for nearly everything from Plantar Fascitis,  both chronic and acute pain, “heel pain”, back injury, too much running. Heck, my kid was given ice by the school nurse for an earache! (shudder.) This is not my personal strategy. I am most likely to use– and recommend– basic self-care strategies like active recovery, warm or hot soaks with Epsom salts and herbs, gentle massage,  lymphatic activation and herb-infused liniments or infused oils. In certain cases, rest.

And longer term,  I suggest working towards prevention of injury. Strengthening the fabulous glutes, addressing your  weaker areas over time, improving balance and proprioception, building protective muscle with weight-bearing exercise, releasing tension with bodywork and personal mindfulness practice, sleep, exploring movement and mobility every day, hydrating with both water and good fats, eating bone broth and gelatin and paying attention to your nutrition may all help the body to resist injury and recover more quickly.

(Just a quick note here, I am saying “help”. Accidents happen, and I am not alleging that  there is ONE answer. Always seek medical care in an emergency and take the advice of your doctor, not some lady on the internet.)

To me the strategy of RICE and NSaids for pain ignores the causes of pain, ignores the lymphatic system’s role in our health, ignores the existence of fascia and values short-term relief over long-term wellness, helping us to feel like we are “doing something” whether or not it actually supports healing. Rolling your foot on an icy bottle to fix Plantar fascitis seems to misunderstand  how the body works as well as what preventive care means.

Yes, there are times when a quick-fix is the right choice for an individual, and should remain available to those who need to git-r-done, for whatever reason. I don’t wanna judge your choices.  But ultimately, I believe that the tide  of opinion, as well as solid scientific fact,  is turning away from icing and immobilizing and towards active recovery, and though many establishment folks are resisting a deeper view of recovery it IS happening.

When the doctor who coined the term RICE has officially retracted his support for the method we may want to reconsider, hmmm?

What I am really asking you to do is just think it through. I believe much of our current attitudes towards health in general and pain management in particular do not come from places of deep wisdom, innovative testing or knowing what is truly the best but what is easy, available, marketed, affordable and culturally sanctioned. Many people do not want to ask WHY we do things and whether they are right. And sometimes  health care professionals (including herbalists!) don’t have the time or desire to stay up on the latest information, to question their own practices–or don’t have the time to spend with each patient to truly support them. Maybe we just need to get them fixed up quickly.

Not everyone believes in self-care or preventive care. We claim that we “don’t have time”. We don’t always want to notice that we are overdoing it, that we are relying on poor movement patterns to get something done faster or generating force now at the expense of our longer-term health. Or that we haven’t exercised in 20 years, and it’s catching up to us. And perhaps there are issues inherent in the structure of our culture that tell us we have to shut up and move that entire pile of bricks RIGHT NOW. Perhaps marketing and “fitspo” tell us that if it doesn’t hurt we haven’t done enough. And perhaps some  people are not willing to feel a bit of discomfort in the short term to benefit longer term health. It is possible that our culture fears discomfort and pain, misunderstanding that sometimes pain can be just a symptom or a signal which is suggesting that we address underlying causes, look at our movement mechanics and patterns and imbalances.

Ultimately, I suggest you decide for yourself what is best for yourself. Wellness isn’t always as easy as “just take something” or just slap an ice pack on it. Addressing underlying issues can be a pain in the ass, literally. Self-care can be work, it can be play if you let it, but it definitely requires more thought than swallowing a pill. And those shoes that are slowly destroying you look so cute! There is a side effect to self-care though…a feeling of self-empowerment; the knowledge that we have a certain responsibility to help support our own health. I’ve got a few links here for you to explore, and trust me you can find a LOT of links to represent the opposite side–though not much in the way of great scientific studies to support RICE or preventive ibuprofen before a workout. (ugh!)

So let’s think before we reach for ice, and certainly before we perpetuate the ice myth to others. Ice is on its way out, kicking and screaming perhaps, but better late than never.

People, We’ve Got to Stop Icing Injuries. We Were Wrong, Sooo Wrong | Community Video

http://www.mobilitywod.com/2013/07/community-video-peoples-weve-got-to-stop-icing-a-year-later/ (video)

http://www.tabatatimes.com/de-iced-end-cold-war/

http://www.tabatatimes.com/stillness-enemy/

http://drmirkin.com/fitness/why-ice-delays-recovery.html

http://www.kennykane.com/gary-reinl/ (podcast)

http://library.crossfit.com/free/pdf/CFJ_09_2013_Ice_Achauer2.pdf

http://www.huffingtonpost.com/2013/08/23/ice-baths-strength-soreness_n_3795622.html

http://breakingmuscle.com/mobility-recovery/the-top-5-ways-fascia-matters-to-athletes

http://www.katysays.com/diseases-of-captivity/

http://www.methowvalleyherbs.com/2012/03/everybody-hurts-sometimes-relieving.html

http://www.liberatedbody.com/welcome/ (podcast)

http://www.therollmodel.com/

http://herbcraft.org/solseal.html

http://www.outsideonline.com/fitness/bodywork/performance-plate/Athletes-Guide-to-Bone-Broth-Soup.html

http://www.washingtonpost.com/news/morning-mix/wp/2015/01/22/how-bone-broth-became-kobe-bryants-secret-stone-age-weapon/

http://bearmedicineherbals.com/a-general-guide-to-creating-an-effective-pain-liniment-or-salve.html
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2 thoughts on “Towards a more multi-faceted view of injury-pain management.

  1. I agree. I am working on a woman who tore her meniscus in September and 5 months later was still in pain despite lots of PT. Her PT had her icing every day, and doing weights. It took several “ICE talks” but when she stopped icing her recovery was significant. Had to give her medical studies to give the PT, but she stopped. We need inflammation to rebuild.

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