Comment by faitswulff
4 days ago
If anyone's heard of RICE (Rest, Ice, Compression, Elevation) for healing joints, the new guidance is called POLICE: Protect, Optimal Load, Ice, Compression, and Elevation. The key differences being Protect and Optimal Load, meaning don't re-injure it and expose it to some level of weight-bearing or usage.
It's HELM now: Heat, Exercise, Lower, and Massage. They're all designed to maximize blood flow to, and inflammation in, the injured area. (Note that exercise just means to keep it moving.) Ice and elevation restrict the flow of fluids in and out of the injured area; ice especially slows down recovery and is only recommended for pain management.
(This is basically a simplified version of the protocol NFL teams have been using.)
I love how this is basically the complete opposite of the old protocol lmfao.
Makes sense to me, though :D
The guy who termed RICE (Gabe Mirkin) later came out and said he made a mistake. Specifically with the "Ice" part (and partially with Rest). See: https://drmirkin.com/fitness/why-ice-delays-recovery.html
IIRC the underlying assumption was that you should be reducing inflammation (RICE is almost all about reducing inflammation). Since then, we've learned that inflammation is a good thing, and helps things heal faster.
I'm curious now if the anti-inflammatory diets popular with dietitians and health influencers could have a negative effect when you really do want inflammation, like when fighting an infection or recovering from injury.
https://www.health.harvard.edu/staying-healthy/quick-start-g...
https://nutritionsource.hsph.harvard.edu/healthy-weight/diet...
1 reply →
Also, elevation is useless and compression is potentially harmful as restricting blood circulation and compressing tissue limits healing.
Anyone can RICE their joints. It's foolproof, more or less objective and requires no monitoring from a professional.
What defines optimal load? It sounds impossible to gauge, unless maybe if you're working with a physical therapist. Then, what happens if load more than the optimal level? Is the outcome worse than if you just stuck to RICE? I think these are things that have to be considered for medical protocols.
Optimal load is right before it starts hurting. You progressively load, and when it starts hurting you unload. Your body will send pain before there is damage to be done.
Edit: in fact some discomfort or right kind of pain is good. Else you give to atrophy.
That’s not how pain works. Pain is a noisy and error-prone signal that gives you a good approximation for “stop doing that.” But the edge of pain sensation doesn’t indicate what is or isn’t a good idea during recovery. It’s not a bad place to start, but everyone has different pain tolerances, some injuries are in nerve-poor areas, and repetitive stress or tendinitis are definitely not going to appreciate getting lit up right away.
5 replies →
Your edit shows that there is no good rule for the threshold where pain would indicate too much load vs. still being in the beneficial range. We don’t even have a good way to assess subjective pain (one’s 3 is another one’s 7, etc.). “Optimal load” is really just a tautology.
7 replies →
RICE, as a protocol, isn't all that effective. The doctor who invented it recanted support after new evidence showed the importance of inflammation for the healing process. And, it turns out, he just kind of made it up to fit a handy pneumonic. POLICE is similarly invented and hard to recommend, but modern practices do recommend bearing load sooner rather than later. Can determining optimal load be done without a doctor? It probably depends on the severity and type of injury. But that's not really the point of a medical protocol, the point is to define best practices that help achieve the best outcomes.
When I broke a joint in my pinky a few years ago it was pretty easy to tell. Early on the range of motion was the limiting factor, and I'd move it back and forth as much as I could without any pain. After that I worked on strength in a similar way, do as much as I can with no pain. I went from "you'll never play an instrument again" to rock climbing and Viola practice.
Overall, seeing my strength and range of motion slowly get better was immensely satisfying and your body is pretty good at letting you know when you're getting close to a limit.
I broke my elbow last year (in a very minor way but still), when I was in the A&E the doctor told me to keep moving it and that I wouldn't be able to move it in a way that would affect negatively affect recovery. Within about 10 days it was markedly better and within 21 days I was back riding my bike, and now a year later as far as I can tell it's as good as new.
I didn't need physio or anything, the doctor just told me to keep using it as normally as possible.
>What defines optimal load?
Uncomfortable but not painful, just like pretty much everything else physiology-related in life.
> I think these are things that have to be considered for medical protocols
What makes you think those things haven't been considered?
The comment you replied to said, "the new guidance is..." I took that to mean those things have been considered.
I mean considered per patient. Pro wrestler Kerry von Erich had to get his broken foot amputated because he thought it felt good enough to walk across the room to get a cheeseburger. Not everyone can gauge these things on their own, especially considering people with broken bones may be taking pain killers. Not everyone can have professionals, or even loved ones, around them to monitor it.
5 replies →
We're still icing and elevating? I've always felt dubious about our attempts to rectify our bodies evolving inflammation. It doesn't seem like any great evil to let the body part get more blood, signals to stop us using it, and a lower range of movement.
No, reducing inflammation can help manage pain, but beyond that is not beneficial (actually is detrimental) to healing. https://drmirkin.com/fitness/why-ice-delays-recovery.html