By: Bailey Hewitt, PT, DPT
A hot (or rather cold) topic that is often posed within the Sapphire Clinic walls is when and how much to ice after an acute injury. This is a reasonable question as the protocols & principles have morphed quite drastically over the years.
RICE
In 1978 Dr. Gabe Mirkin created the first acute injury response acronym of REST, ICE, COMPRESSION, ELEVATION. This concept included ice a key stakeholder in the reduction of the inflammatory cascade to elicit an accelerated recovery.
PRICE
Nearly a two decades later, the “P” was added to represent PROTECT by Kerr, Daley and Booth via ACPSM standards. Yet, this didn’t seem to quite cover it as there was no progressive re-introduction to building sport tolerance and REST discouraged movement.(3)
POLICE
In order to addressed these limitations, the “OL” was added, which represented OPTIMAL LOADING. Current research continues to support the notion that OL “…aids in recovery through cell generation induced by light mechanical loading in the early stages.(4)” Translation: relative rest through light movement is key in telling our brain we still need that body part and need it quickly.
Example: Pumping (stepping on an imaginary pedal) the ankle after sprain. This contraction creates a light muscle pump that naturally flushes excess inflammation from the body.
During this same time period, further contradictory evidence was emerging suggesting that the inflammatory cascade of an injury could be BENEFICIAL in recovery; Further, it indicated that the application of ice could hinder this response despite its ability to inhibit pain. In response, Dr. Mirkin officially retracted RICE in 2014 to draw attention to this new opposing evidence. (3,4)
Inflammatory cascade:
Say you roll your ankle, your body sends out macrophages which are inflammatory cells that deliver Growth Factor hormones to the injured area which kick starts the healing process by flushing out the damaged tissue. Where ice can impact this process is by blocking the body’s natural release of this hormone, thus delaying healing and increasing recovery time. (4)
PEACE & LOVE
Just when you thought the acronym couldn’t get any longer, PEACE & LOVE emerges in 2019 to address the limitations of POLICE. PEACE is designed to address subacute injury while LOVE is targeted toward the subsequent stages of tissue healing.
Science has proven that the inflammatory process can be beneficial but this is not applicable to all situations because science has also shown that long term inflammation can be equally detrimental. Chronic inflammation is often the cause of increased pain, muscular inhibition, reduced range of motion, etc.
With that being said, ice is an option to reduce pain and limit inflammation of minor acute injuries but should likely not be used to fully eliminate our natural healing process. On the other end of the spectrum, as in the case of a severe inflammatory event, one would want to interfere with the cascade to limit the detrimental effects of edema that can impact an individual’s recovery (i.e. post-op).
Conclusion
It is not a simple yes or no answer and like all good things in life, “it depends”. I hope this helps guide your thought process should you need to treat an acute injury in the future. If you are unsure how to respond appropriately, please seek out professional medical attention.
References:
- Glasgow P, Phillips N, Bleakley C. Optimal loading: key variables and mechanisms. British journal of sports medicine. 2015; 49(5):278-279.
- Journal of American Academy of Orthopedic Surgeons, Vol 7, No 5, 1999
- Mirkin, G. & Hoffman, M. (1978). The sportsmedicine book. (1st ed.). Little Brown and Co.
- Bleakley, C. M., Glasgow, P. & MacAuley, D. C. (2012). PRICE needs updating, should we call the POLICE? British Journal of Sports Medicine. 46, 220–221.
- Mirkin, G. (2014, March 16). Why Ice Delays Recovery. https://www.drmirkin.com/fitness/why-ice-delays-recovery.html
- Dubois, B. & Esculier, J-F. (2020). Soft-tissue injuries simply need PEACE and LOVE. British Journal of Sports Medicine. 54, 72-73.
- Vuurberg G ,Hoorntje A ,Wink LM , et al. Diagnosis, treatment and prevention of ankle sprains: update of an evidence-based clinical guideline.Br J Sports Med2018;52:956.doi:10.1136/bjsports-2017-098106
- Singh DP , Barani Lonbani Z , Woodruff MA , et al. Effects of topical icing on inflammation, angiogenesis, revascularization, and myofiber regeneration in skeletal muscle following contusion injury.Front Physiol2017;8:93.doi:10.3389/fphys.2017.00093
Hardrock 100: Heather Brooks Q & A
First off, why run the Hardrock 100? Can you explain what it is to those that may not know?
How did you start ultrarunning?
Hardrock was cancelled due to snow in 2019, cancelled due to COVID in 2020, and is finally happening in 2021! You’ve had three tries at preparing for the race. What have you done similar and different? What has your training looked like this year?
Fortunately, I’ve had my coach (Gabe Joyes – 4th @ HR in 2017) for the entirety of this rollercoaster. My training has been pretty consistent with his guidance but has evolved with more experience. I will say that I’m now embracing the importance of pacing and nutrition. It truly does make/break your race experience!
You have a wild story for how you got into Hardrock off of one ticket and then multiple race cancellations since you got in. Can you give us the full story?
I ran and finished Bighorn 100 in 2018, was selected from the HR lottery in December of 2018 and was supposed to run the race July 2019. Well, June of 2019 came around and they cancelled it due to avalanche activity on the course. As a result, I ran Palisades 100 in 2019 instead.
The HR organization rolled over everyone selected in the lottery from 2019 to 2020. As we all know, 2020 rocked the universe and thus another HR cancellation!
So, the HR organization decided that anyone who was selected from the 2019 lottery (that had never raced HR) was allowed to run the 2021 race. Everyone else, who has ran the race before, was out.
To say the least, I feel VERY lucky that I still get to toe the line to and experience HR!
What’s your advice to someone that hears “100 miler” and thinks “I can’t do that!”?
Listen, I was a basketball player….ANYONE CAN RUN 100 MILES! You just have to make up your mind and put in the work.
What was your biggest challenge while preparing for Hardrock?
Staying dedicated to the training and the process for three years, absolutely. Luckily Missoula has been THE best support throughout the entirety of the training and I am grateful for that time.
What are your goals for the race?
Celebrate Heather and finish the dang thing!
What are your biggest reservations heading into the race?
I’m quite nervous about the lightning…also, I have no idea how 14,000 feet will feel haha!
What are you most excited for during the race?
Kissing that rock!
How can folks follow along from home?
Hardrock100.com
Bitterroot Runoff Recap 2021
Bitterroot Runoff Recap 2021
We had a beautiful morning at the Bitterroot Runoff Trail Runs this Saturday! Runners got to experience private singletrack outside of Lolo, followed by pancakes, Big Dipper Ice Cream, and Big Sky Beer after the race.
Typically, the Bitterroot Runoff is our first race of the year in mid April. This year, due to COVID concerns, we chose to push it to July.
Compared to last time we raced at this venue during the Hootenanny, the weather was the polar opposite. Instead of 33 degrees Fahrenheit and rain all day, the trails were dry and there wasn’t a cloud in the sky. Fortunately on race day, the temperature stayed relatively cool early in the day and it wasn’t too smokey.
Results
On the men’s side, we saw a father-son-duo Michael Curtis and Ian Curtis take the titles for the 5-mile and 10-mile, respectively. Ian, a former Hellgate High School cross country runner who now runs collegiately in Minnesota, had a battle on his hands with Mike Adams out of Ronan. On the climbs, Ian would build a gap from Adams, but on the descents, Adams would blow past Ian. This game continued until the final mile of the race, where Ian pulled away and came away with the win.
The women’s race saw Nicole Murray win the 10-mile for the second consecutive year. Nicole will be attempting the Bitterroot Runoff/Treadmill Challenge double this year, with only 2 days of separation between the two races. In the 5-mile, Leilani Contos came away with the title. Leilani has been cleaning up at our races, most recently winning the 10k at Mountain to Meadow.
Photos
You can find the photos from the race HERE. Thank you to our lovely photographer, Anastacia Wilde, for being out there crushing it on race morning.
Thank you to the volunteers to showed up and helped make this event possible. We had great volunteers helping out at packet pick up, manning
the aid station, and handing out breakfast and ice cream after the race.
Huge thank you to all of our great sponsors for supporting this event. We had gels and electrolyte drinks from Hammer Nutrition keeping everyone fueled during the race, Joe from Big Sky Brewery handing out post-race refreshments, Evie from Sapphire Physical Therapy giving out post race massages, Big Dipper Ice Cream cooling everyone down afterwards, and Saucony supporting this event!
2021 Treadmill Challenge
Ice After Injury?
By: Bailey Hewitt, PT, DPT
A hot (or rather cold) topic that is often posed within the Sapphire Clinic walls is when and how much to ice after an acute injury. This is a reasonable question as the protocols & principles have morphed quite drastically over the years.
RICE
In 1978 Dr. Gabe Mirkin created the first acute injury response acronym of REST, ICE, COMPRESSION, ELEVATION. This concept included ice a key stakeholder in the reduction of the inflammatory cascade to elicit an accelerated recovery.
PRICE
Nearly a two decades later, the “P” was added to represent PROTECT by Kerr, Daley and Booth via ACPSM standards. Yet, this didn’t seem to quite cover it as there was no progressive re-introduction to building sport tolerance and REST discouraged movement.(3)
POLICE
In order to addressed these limitations, the “OL” was added, which represented OPTIMAL LOADING. Current research continues to support the notion that OL “…aids in recovery through cell generation induced by light mechanical loading in the early stages.(4)” Translation: relative rest through light movement is key in telling our brain we still need that body part and need it quickly.
Example: Pumping (stepping on an imaginary pedal) the ankle after sprain. This contraction creates a light muscle pump that naturally flushes excess inflammation from the body.
During this same time period, further contradictory evidence was emerging suggesting that the inflammatory cascade of an injury could be BENEFICIAL in recovery; Further, it indicated that the application of ice could hinder this response despite its ability to inhibit pain. In response, Dr. Mirkin officially retracted RICE in 2014 to draw attention to this new opposing evidence. (3,4)
Inflammatory cascade:
Say you roll your ankle, your body sends out macrophages which are inflammatory cells that deliver Growth Factor hormones to the injured area which kick starts the healing process by flushing out the damaged tissue. Where ice can impact this process is by blocking the body’s natural release of this hormone, thus delaying healing and increasing recovery time. (4)
PEACE & LOVE
Just when you thought the acronym couldn’t get any longer, PEACE & LOVE emerges in 2019 to address the limitations of POLICE. PEACE is designed to address subacute injury while LOVE is targeted toward the subsequent stages of tissue healing.
Science has proven that the inflammatory process can be beneficial but this is not applicable to all situations because science has also shown that long term inflammation can be equally detrimental. Chronic inflammation is often the cause of increased pain, muscular inhibition, reduced range of motion, etc.
With that being said, ice is an option to reduce pain and limit inflammation of minor acute injuries but should likely not be used to fully eliminate our natural healing process. On the other end of the spectrum, as in the case of a severe inflammatory event, one would want to interfere with the cascade to limit the detrimental effects of edema that can impact an individual’s recovery (i.e. post-op).
Conclusion
It is not a simple yes or no answer and like all good things in life, “it depends”. I hope this helps guide your thought process should you need to treat an acute injury in the future. If you are unsure how to respond appropriately, please seek out professional medical attention.
References: