You have probably heard, practiced or even followed this advice: after an acute injury (sprain, strong blow, tendinitis, etc.), you should apply ice to the affected area. However, new intervention protocols recommend against it as a general rule.
This seems counterintuitive, because the use of ice (cryotherapy) causes decreased nerve conduction and local vasoconstriction (narrowing of blood vessels), which provides short-term pain relief and reduces inflammation and swelling. edema.
So why is it better to abstain? To answer this question, let’s first look at what inflammation is and whether it is in our best interest to do something about it.
A natural reaction
Inflammation is a normal physiological process for the body to recover from injury. Immediately after the injury occurs, the blood vessels constrict to prevent blood loss. In a few minutes, once the wound is sealed, the caliber and permeability of these vessels increase to allow the entry of substances and immune cells with inflammatory effects. This is the time for neutrophils, which are responsible for “cleaning tasks,” to step in.
The increase in vascular permeability in turn generates an increase in the volume of fluid – the means of transport of all these substances – which reaches the area concerned. This swelling is known as edema and serves the physiological needs of healing.
When the inflammatory process reaches its peak, the accumulation of substances produces a series of biochemical signals that initiate the tissue proliferation or healing phase. The same processes that generated inflammation in the previous stage now release compounds such as lipoxins, which have great anti-inflammatory power.
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In addition, according to recent studies, neutrophils, which have come to “clean” the injured area, change their mode of action during this phase and also have anti-inflammatory and regenerative effects.
In other words, for the entire healing process to occur properly, inflammation must run its physiological course.
Protocol changes
As these biological mechanisms have become better understood, strategies for treating acute injuries have evolved.
Created in 1978 by American physician Gabe Mirkin, the RICE protocol focused on cryotherapy. Its acronym means Rest (rest), Ice (ice), Compression (compression) and Elevation (elevation). Since the 1980s, it has been replaced by the PRICE protocol which added the protection (the P) of the area concerned.
Later, in 2012, the POLICE protocol appeared. This method always recommends the occasional use of ice in very acute phases. But it offers a substantial change in the treatment of this type of injury. It replaces the R of rest with the OL of Optimal Loading (optimal loading). In other words, the patient should start moving as soon as possible, starting with movements that do not involve the injury and do not cause pain.
This optimal and progressive loading strategy has shown that early mobilization and functional rehabilitation are more effective than immobilization and total rest.
The current protocol: “PEACE and LOVE”
Despite the apparent effectiveness of the methods mentioned above in reducing pain, relapses (recurrences of old injuries) are common. Indeed, the most common tendon pathologies are often caused by a failure of the healing process. This is why it is often said that “sprains never heal completely”.
It is 2019, when Canadian experts Blaise Dubois and Jean-François Esculier propose their PEACE and LOVE protocol. Main new feature, this protocol suggests avoiding anti-inflammatories (A for Avoidance anti-inflammatory), including the use of ice.
These changes in approach respond to scientific evidence. We explained previously that vasodilation is necessary for the arrival of all the substances essential for healing. Presumably, ice slows the process and alters optimal healing pathways.
For example, a systematic review of 22 clinical trials, published in 2004, already warned of the limited evidence available that ice and compression can have a significant effect on wound healing.
The same year, the American specialist Scott F. Nadler declared:
“Although hot and cold treatment modalities decrease pain and muscle spasms, they have opposing effects on tissue metabolism, blood flow, inflammation, edema and connective tissue extensibility . »
In summary, ice and certain anti-inflammatories modify the inflammatory process and promote poor recovery and fibrosis processes. This can lead to tissue that does not regenerate properly and is more susceptible to further injury.
Mirkin himself, the creator of the RICE protocol, reportedly admitted in 2015 that “ice delays healing.”
What about pain?
Nociceptive pain (nociception) is the pain we feel in response to tissue damage. This warning signal generates adaptive changes (such as limiting movement and loading) to allow for adequate healing.
So, neutralizing nociception with ice or anti-inflammatories can delay or aggravate the injury, because it no longer fulfills its protective function if we do not take those necessary hours or few days of rest.
As a general advice, we can recommend that those affected follow the PEACE and LOVE protocol and, during the repair phase, consume foods rich in omega-3 (EPA and DHA) and supplement their diet with vitamin vs.
However, in the event of a serious injury, it is best to consult a doctor or physiotherapist, who will give you advice and suggest the most appropriate healing process.
This article is republished from The Conversation under a Creative Commons license. Read the original article. Beatriz Carpallo Porcar, San Jorge University and Paula Cordova Alegre, San Jorge University
