
MOVE an injury not RICE (2017) - cellis
https://thischangedmypractice.com/move-an-injury-not-rice/
======
TallGuyShort
That "inflammation exonerated" section is excellent. I think OTC NSAIDs are
abused every bit as much as opiates, though not as harmful obviously. The
point should be to manage your pain, not eliminate it. If I am still injured,
I should know it so I don't over do it before my body has healed. Let your
body do it's thing to fix the root cause - don't just bandaid it. I've known
people to preemptively pop 800mg ibuprofen before a workout, to numb the pain
they know is coming. Terrible idea, IMHO.

~~~
inspector-g
> If I am still injured, I should know it so I don't over do it before my body
> has healed

To address this specific point (not the rest of your comment, which I largely
agree with): this is in line with the "old" bio-medical model of pain, and not
up to date with the modern bio-psycho-social model of pain. In many cases, the
biological insult to tissues will fully heal far in advance of pain
subsidence, or conversely will heal long after pain subsidence. The point
being that a pain experience is not an accurate indicator of the state of
one's tissues.

For a primer on this more modern model of pain experiences, please give this
excellent video a watch:
[https://www.youtube.com/watch?v=lCF1_Fs00nM](https://www.youtube.com/watch?v=lCF1_Fs00nM)

~~~
firethief
So sometimes it overshoots and sometimes it undershoots, but is there a better
heuristic readily usable by non medical professionals? (Sorry if this is
addressed in the video; I have only read the summary)

~~~
inspector-g
Well, the field surrounding pain/injury is large and nuanced, so not only is
that a difficult question to answer but it's also _sort of_ the wrong
question. And, firstly, I strongly recommend watching the linked video (if you
have time). But I'll try my best here anyway.

Let's start with injury - what constitutes an injury? As in, how should the
word "injury" be defined? This is a more complex issue than one might
initially assume; not all pain is associated with an insult to tissue, not all
insults lead to mechanical damage, insults that _do_ lead to damage do not
necessarily lead to pain, etc. So, mostly, injury tends to be defined as
anything that leads to a reduction in function/performance in an organism. The
ramifications of this definition are important, because things like a compound
fracture, delayed-onset muscle soreness, and pain with no (known) underlying
cause all meet the definition's criteria.

That last bit is the most important (and why I strongly recommend watching the
video), because pain is _not_ an input to the brain, rather it is an output of
some function in the brain that takes a large number of inputs _other than
pain_. This is basically the crux of the whole bio-psycho-social model, and
why I said the original question is sort of the wrong question regarding
injury. So here's the revelatory part, as it relates to the original question:
aside from large and obvious traumas like a compound fracture, one cannot
conclude that, because they are experiencing pain, physical damage to tissue
has taken place. So looking for a heuristic to determine the state of some
tissue after experiencing an event that led to pain is not really the right
approach from the beginning, as one cannot be confident (and should not
assume) that the tissue's state is awry at all.

~~~
EnderViaAnsible
I'm afraid I must strongly disagree with your comment, or at least your
conclusion.

The existence of pain itself is predicated on its accurate coupling to injury,
since the purpose of pain is inhibitory: this hurts, so stop doing it,
[because tissue is injured], and it must not continue to be injured.

There are of course some counterexamples where this line of thinking fails:
pain localized to previously amputated limbs comes to mind.

But overall I can think of very few instances where this is true. The
_magnitude_ of pain may or may not be proportional; the _location_ may or may
not be correct (as in referred pain); but in the vast majority of cases that
can I bring to mind, pain very much does indicate tissue damage.

(And the biopsychosocial model of pain doesn't change that! The brain, after
all, is tissue.)

~~~
inspector-g
> pain itself is predicated on its accurate coupling to injury, since the
> purpose of pain is inhibitory

> pain very much does indicate tissue damage

These statements are not supported by modern research. The bio-psycho-social
model indicates that pain is a threat _detection_ and deterrent mechanism, NOT
a "status report" _from_ the painful tissue to the brain. In other words, the
brain is concerned that something might lead to physical trauma, yet none need
to have taken place for pain to be generated.

There are certainly biological inputs to the "pain generator" function of the
brain (like sensing a foreign object touching one's skin), but psychological
factors/contexts and social factors/contexts can be equally strong inputs (and
ultimately generate a significant pain experience without any, or with very
little, biological input).

Think of the magnitude of pain response to a given situation as an indicator
sitting somewhere on a spectrum between "benign" and "dangerous". The more
psychologically threatened one feels, the more the pain response will be
shifted toward the "dangerous" end (i.e. higher magnitude). The more socially
threatened one feels, the more the pain response will be shifted toward the
"dangerous" end.

Here is a somewhat contrived but favorite example of mine. One night, you wake
up to go to the bathroom. In the dark, you unexpectedly step on your child's
lego brick left on the floor, and it hurts immensely - it feels like the pegs
are actually spikes! This is mainly because of how it has surprised you; the
context is that it's dark, you expected the trip to the bathroom to be just a
few simple steps, and (for sake of argument) have never stepped on a lego
before. Your brain feels rather threatened by this surprising situation and
generates a large pain response. Now, a night or two later, it happens again,
and though it hurts it definitely isn't as bad. Another night or two later, it
happens a third time, and barely hurts at all (you're basically to the point
of expecting it now). I think we can agree that no tissue damage has really
been done, and if pain was simply a state-of-tissue indicator then the
magnitude of pain should have been the same each and every night.
Additionally, if tissue damage need be present for pain to be present, why did
it hurt at all?

Lastly, I'll note that lack of apparent examples != lack of evidence.

------
gshdg
For those just reading the headlines and comments: before you try this at
home, please note that the paper indicates that this EXCLUDES certain types of
injuries, such as fractures.

------
kazinator
What athletes and coaches have known for decades, basically.

RICE is for serious things that render you incapacitated.

If you can remain active with the injury then you do so, and monitor it: if it
gets better with activity, then keep with it. If it worsens, back off. Very
simple.

~~~
philwelch
The physically active people I know (of whom I am not one!) seem to follow
this pattern compulsively anyway. They always hurt themselves being physically
active and they hate not being physically active so they get back out there
again.

------
fjsolwmv
This seems intentionally misleading. RICE is acute care immediately following
an injury, to prevent further damage and relieve pain. MOVE (a terribly
strained acronym) is for rehab/physical therapy. What is newsworthy here?

------
ummonk
On a slightly related note: I've never been able to get into the "start your
day with a cold shower" thing, and find myself skeptical of its health
benefits. I find that I need a very warm shower to massage my muscles, while a
cold shower leaves them cramped and sore, reducing my ability to heal from
exercise and engage in extensive physical activities through the week.

~~~
SargeZT
I do both. I take a normal hot shower for everything up until I'm completely
soaped up; then I switch to a cold shower and rinse myself off.

~~~
pacaro
Same, if only to ease the transition out of the shower

------
jammur
Very timely article, as I'm currently sitting in the doctors office waiting
room to be seen for a sprained ankle.

> The resulting vasoconstriction from cooling, not only reduces tissue
> oxygenation with necrosis if extreme, but inhibits the inflammatory response
> needed to initiate healing.

Wondering if this means applying heat would speed up healing due to increased
blood flow.

~~~
LeifCarrotson
There's a balance. Excessive inflammation pushes joints and ligaments out of
position. However, it's the way the body brings fluids to heal the injury.

Manage it, don't let it go wild, and don't try to drug/compress/ice it into
oblivion and make it last longer.

Currently have my moderately sprained ankle elevated. This is the worst sprain
I've had in 20 years, so taking it really easy.

------
swasheck
This is covered at length in a book titled “Good to Go.” It was such a good
read and addressed so many things that I’d taken as a given about recover.
Highly recommend the approach and the style of the author.

[https://www.goodreads.com/book/show/40180017](https://www.goodreads.com/book/show/40180017)

------
Theodores
I would have been okay with RICE. After breaking 1.5 arms (well, it felt like
it, just an elbow fracture), I wish I had known about RICE. Six hours later,
in A+E I get a bit of fabric and some string with the 'you've broken it mate!'
serenade from the X Ray department.

Two weeks after that I watch something about sports injuries and realise how
much better things would have been had I just bought some ice after my bicycle
crash and got myself a cab home instead of riding the ten miles or so, up and
down over a big hill.

This was with the NHS and if I was running that department I would have a big
bag of ice, right there on reception with a 'help yourself' sign. People
wouldn't have to wait for four hours before being seen to, not that RICE was
even on offer.

RICE would have been nice, maybe with an upgrade to this MOVE thing.

~~~
dmurray
Sounds like you'd benefit from taking a first aid course. You can see if the
Red Cross offer one near you, or your local mountain rescue or lifeguard
station if you live near one of those. As well as RICE you can learn some more
useful skills: treat injuries and burns, administer CPR, etc.

That said, for suspected broken bones an X-ray really is recommended.
Depending on the nature of the fracture, you might need a cast instead of a
sling and even the most experienced doctor can't tell you which until they've
seen the X-ray results.

