Ice Age is melting

Since 1978 when Dr. Gabe Mirkin coined the term RICE, Rest, Ice, Compression, and Elevation have been the gold standard for treating athletic injuries. But now the ice age is melting, and a series of studies that show that injury treatment with cold therapy and total rest may actually delay healing has even Dr. Mirkin changing his mind.

Saying not to ice an injury is controversial because everyone does it, including athletes, trainers, and physicians. The new line of thinking has caused extensive debate among experts who have relied on RICE for decades.

Ice has been the standard injury treatment for sore muscles and injuries because it helps relieve pain and swelling, and inflammation is considered bad. But current information shows that inflammation is the body’s first physical response to repairing tissue, and without it healing does not happen.

Applying ice causes blood vessels around the injury to constrict and shut off the blood flow that brings in the inflammatory cells needed for healing. The vessels do not open again for hours after the ice is applied. Decreased blood flow can cause tissue to die and even result in permanent nerve damage. In addition, the ice reduces pain, which is an alert to avoid motion that may be harmful.

A study published in The Journal of Strength and Conditioning Research examined the influence of icing on muscle damage. Data from the study did show that icing delays recovery and should not be the first choice of treatment for injuries. After icing there was an immediate increase in swelling. Indicators of muscle damage increased after application of ice.

Applying ice causes blood vessels around the injury to constrict and shut off the blood flow that brings in the inflammatory cells needed for healing.

And research published in The American Journal of Sports Medicine in June, 2013, said that although icing an injury relieved swelling it did not make recovery from muscle damage quicker. If the treatment reduces inflammation it delays healing. This includes the use of anti-inflammatory pain relievers like ibuprofen.

Inflammation is the same biological process used to kill germs in the case of illness or infections. If germs get into body the immune system sends proteins and cells into the infected area to kill them. When muscles are injured the immune system sends the same cells to promote healing in the damaged tissue.

Inflammatory cells called macrophages release hormones into the damaged tissues that help them heal. Applying ice to reduce swelling prevents the body from releasing the hormone and delays healing. This was shown in a Cleveland Clinic study published in the Federation of American Societies for Experimental Biology in November, 2010. The lymphatic system will naturally remove the swelling when the healing is done.

Mirkin, who wrote the Sportsmedicine Book in 1978 that introduced RICE, said last month that an injured person should stop exercising, although not resort to complete inactivity, since total rest also does not stimulate tissue repair. Complete rest causes tissue to waste, so he recommends using light exercise as a repair stimulus.

Mirkin says it is okay to apply ice for pain relief immediately after the injury occurs, but for short periods only. He suggests icing for 10 minutes, removing the ice for 20 minutes, and repeating the process once or twice, but stresses that there is no reason to continue icing more than six hours after injury. If the injury includes broken bones, loss of consciousness, or an inability to move, go to the doctor!

According to The American Journal of Sports Medicine in January, 2004, ice plus exercise may be of some help in healing ankle sprains.

A new acronym, MCE, replaces the old standard RICE, and leaves out cold therapy for injury treatment. MCE stands for Move safely when you can as much as you can, Compress, and Elevate. The ice age is melting.

By Beth A. Balen

Strong Athlete
Athletic Medicine
Athletic Medicine

What’s the German word for Tiki-taka?

There are many things that JOE would like to accomplish with the remainder of our lives like climbing Mount Everest, drinking a beer from every country in the world or marrying Jennifer Lawrence.

All in good time we say but one of our main life goals is to get Pep Guardiola and Sam Allardyce in the same room and hear what the two lads have to say to each other about football.

We think it would be hilarious because one of these men is a wildly successful world famous coach whose ideas have helped revolutionise the beautiful game with his belief that possession and movement is key to winning any football match.

The other is obviously Pep Guardiola.

Pep’s Bayern Munich team were at their ruthless best in their 4-0 win against newly promoted Paderborn as Robert Lewandowski opened his account for the German champions in sublime fashion.

Bayern were also totally dominant in possession as seen by this passing map. Wow.

bayern passing map

When it was all over, 27 of 30 penalties had been converted, Middlesbrough were on their knees in despair and Liverpool were too shattered to indulge fully in celebration. One of the most remarkable shoot-outs in English history brought relief for Brendan Rodgers’ team as they edged into the fourth round courtesy of an exhausting finale at Anfield and one final miss from the unfortunate Albert Adomah.

The Middlesbrough winger sliced the 30th and final spot-kick into the Kop to settle a seemingly never-ending tie at 10.42pm. Both teams had gone through the card in the shoot-out, goalkeepers included, with Patrick Bamford, whose penalty in extra-time stoppage time carried the Championship club so far, and Raheem Sterling having efforts saved before Adomah’s miss.

It was the longest penalty shoot-out in the history of the League Cup, the previous record set at 9-8 on three occasions, and more extensive than the FA Cup’s highest total when Macclesfield beat Forest Green 11-10 in 2001. Of major English competitions only the Football League Trophy can equal it, also boasting a 14-13 shoot-out.

Rodgers could afford a wry smile afterwards, even though Liverpool’s defending and lack of creativity were evident again, and this time against Championship opposition. It was simply cruel for the Boro manager, Aitor Karanka, having seen his side twice come from behind and pose a persistent threat all night.

“I don’t have words to explain my feelings now,” said the former Real Madrid assistant manager. “I’ve never experienced anything like that before. We have played a Champions League team at Anfield and we’ve met them face to face. Everything was brilliant except the last penalty.”

Liverpool beat Middlesbrough after 30-penalty Capital One Cup shoot-out

In normal circumstances this would have been the night Jordan Rossiter claimed the headlines, having marked his Liverpool debut with the opening goal from 30 yards. But with Liverpool unable to defend set pieces, enabling Adam Reach to head in a deserved Middlesbrough equaliser, Kolo Touré conceding a ridiculous penalty in the 122nd minute and both sides showing rare composure during the shoot-out, normality took its leave at Anfield.

“It’s good to win no matter how you win,” said the Liverpool manager. “We played OK, we didn’t create much to be honest but we showed good perseverance. We made too many mistakes, as it has been for us at the moment, and we got punished.”

Rossiter, a 17-year-old born not far from Anfield, has caught the eye in Liverpool’s youth teams in recent years and prompted inevitable comparisons with a young Steven Gerrard given his position, background and severe teenage haircut. It is premature of course, even though Robbie Fowler has also announced the midfielder has the potential to follow the Liverpool captain’s career path, but a long-range goal on debut is not a bad way to start.

Lucas Leiva’s through-ball should have been routine for the on-loan Chelsea pairing of Kenneth Omeruo and the goalkeeper Jamal Blackman as it rolled into the Middlesbrough area. Blackman, making his Boro debut, came but failed to collect, spilling the ball to Rickie Lambert but blocking the Liverpool striker’s first-time shot.

The rebound fell to Rossiter who drove low from distance under the goalkeeper’s poor attempt at an interception and into the centre of an unguarded goal. The goalscoring debutant’s reaction was one to behold: a combination of astonishment, bewilderment and delirium producing a celebratory routine that had clearly not been rehearsed.

Boro threatened on the counter-attack and from set pieces all game. There may have been greater energy and purpose to the Liverpool performance in the second half but, as has been the case for most of the season, it came almost entirely from Sterling, whose 122-minute outing was not ideal preparation for Saturday’s Merseyside derby.

Lazar Markovic was anonymous on his second start for the club, Adam Lallana’s work-rate could not be faulted but the £25m summer recruit was unable to find an end product while his former Southampton team-mate Lambert endured a difficult first start of the season. The boyhood Liverpool supporter was also handed the captain’s armband for the night, despite having appeared only as a substitute previously.

Middlesbrough levelled from an inevitable source when Mamadou Sakho was penalised for handball and Grant Leadbitter’s free-kick was glanced in by Reach. Adam Clayton had a chance to knock Liverpool out in the 85th minute but his close-range shot, after he was released by Lee Tomlin’s clever reverse pass, struck the outside of a post. Then Suso appeared to have decided the outcome when he fired through a crowded area in extra time. Bamford’s penalty, after Sterling had surrendered possession and Touré sent the on-loan Chelsea player sprawling, confirmed otherwise. It was merely a dress rehearsal for the madness to come.