Controversial topic #1: Icing
It’s a tried and true treatment, right? I pull a hammy…ice it. I sprain an ankle…ice it. Any type of injury occurs and I need an immediate treatment…ice it. But is ice really the way we should be going? I learned long ago in grad school, from the one and only Bill Prentice, how to manage the acute ankle sprain. We didn’t ice it…we compressed it. We did an open basket weave tape job and wrapped it with an ace wrap or elastikon on top of that with the following instructions to the athlete: “You are not going to have a good night sleep. This thing is going to throb and feel awful. Under no circumstances, unless you see your toes turning purple or are experiencing numbness in your foot (and then you are to call me), are you to take this tape off. It’s gonna be a rough night, so settle in. See you in the morning.” The inevitable response was “what about icing?” Our response was “if you put ice on and can feel it through the tape, great. If not, I am not worried about you icing.” EVERY TIME…and I mean EVERY time, the athlete got better very quickly. Swelling was minimal, movement was initiated very soon in the rehab process and they returned to the field rather quickly.
I didn’t know why we did this. I was a young grad student learning so many things and was in absorption mode, not question mode. All I knew was it worked and the women’s basketball players I worked with never missed much time, which pleased Coach Hatchell and CB Lehn (head AT for the team) thus making me a happy GA.
Now, I am learning why.
I encourage you to read RICE: The End of an Ice Age. Dr. Mirkin coined the term RICE in 1978. Now, he believes this:
“Coaches have used my ‘RICE’ guideline for decades, but now it appears that both Ice and complete Rest may delay healing, instead of helping.” – Gabe Mirkin, MD, March 2014
He advocates cooling the area for pain relief for short periods of time, so ice is not being thrown completely out the door. Read the blog mentioned above. Josh Stone does a great job of summarizing the research and recent comments from Dr. Mirkin. There is no need for me to rehash it here, so click the link and read the post. It will make you reconsider your current immediate treatment intervention, if nothing else.
Controversial topic #2: Dry Needling
Ok – you guys knew this was a shoe in. Let’s say it again….dry needling is NOT acupuncture! I had the most amazing experience recently covering the US Surf Open in Huntington Beach and was able to spend some time with an awesome OMD named Pedram Shojai. We had some down time during the competition and were able to talk shop. We used our buddy with back pain as a patient. We discussed where we would needle, our concerns, our thought process, etc. The two treatment plans were 100% different. He was talking about some amazing things that I thought were so cool but had no knowledge in. He was impressed at the anatomical nature of treatment and simply asked me to consider other things, and I of him. We had two totally different approaches, both of which could be effective. So, in the words of Edo Zylstra (which I have borrowed, have used and will use over and over again): Everyone who uses a calculator is not an accountant. Just like everyone who uses a fine filament needle is not an acupuncturist. Acupuncturists: I encourage you to spend time with dry needlers. Dry needlers: I encourage you to spend time with acupuncturists. I think both sides will quickly see the complimentary nature of our practices, placing the PATIENT at the center of our treatments and actions.
Controversial topic # 3: Self Myofascial Techniques
If I learned one thing over the last couple of years, it is that I can foam roll the crap out of someone! Why would I do that? Why would I try to alter the structure of tissue every day without giving it time to remodel? I don’t that with my manual work, I don’t do that with strength training, why I do I do that with foam rolling? There are multiple studies that show the positive effects of foam rolling on arterial function (Okamoto, 2014), increase in range of motion (MacDonald, 2013), and attenuating muscle soreness (MacDonald, 2014). I did a pretty thorough lit search for negative effects of foam rolling and quite frankly did not find any. If you guys know of a study, please post. I would love to see the other side of this story. Intuitively, I think I need to back off on the frequency and/or intensity of my prescription of foam rolling, but the jury is still out.
Controversial topic #4: Use of Ultrasound as a Diagnostic Tool
MRI’s and CT scans are the gold standard for many suspected diagnosis. But let’s consider some less expensive, more portable, more functional type of diagnostic testing. For example, sonography. Chang (2009) does a very nice job of discussing the use of sonography vs MRI. Sonography has become a more utilized and accepted diagnostic tool in the United States over the years. We need more comparison studies to MRI for accuracy in diagnosis as well as moving assessments of tissues. De Jesus et al (American Journal of Roentgenology. 2009;192: 1701-1707) did a great meta-analysis of MRI, MRI arthrography, and Diagnostic US to detect rotator cuff tears. MRI and US were comparable in this analysis in detection of rotator cuff tears. More comparison studies need to be done on different areas of the body, but the thought of having a more portable, less expensive, less claustrophobic, just as reliable diagnostic seems pretty appealing in this day and age of our country’s health care system.