Sep 1st, 2012
This picture has nothing to do with anything that follows.
Earlier this month, Kelly Starrett posted a blog entry and accompanying video entitled People, We’ve Got to Stop Icing. We Were Wrong, Sooo Wrong. suggesting that the use of ice to combat pain and inflammation after an injury would best be avoided. A brief sentence in the same entry suggested that the use of non-steroidal anti-inflammatory drugs (NSAIDs) is contraindicated in many circumstances as well.
Jonathan Sullivan, MD, an emergency room physician who also wrote Barbell Training is Big Medicine took issue with Starrett’s entry and penned a rather extensive rebuttal that is chock full of references. It is an engaging and lengthy read that looks at the mechanisms behind injury and inflammation and the state of the literature regarding icing and NSAIDs. Here’s a little sample:
Inflammation is the body’s natural-and therefore correct-response to injury. Your body knows what it’s doing, and interfering with the inflammatory response is therefore ill-considered.
This is the easiest argument to dispense with, because it’s just silly-not to mention selectively applied. For example, in the video it is made clear that ice and NSAIDs are bad because they interfere with inflammation, but compression, which suppresses post-inflammatory edema, is not. In any event, this argument proceeds from the assumption that pristine natural processes are always optimal to the realization of human ends, which is clearly not the case; and that the human body is a "perfect machine," which is just so much bullshit.
Here’s a reality check: Mother Nature doesn’t give a rat’s ass about your program, your WOD time, your 1RM bench press, or even your survival as an individual. She designed you to make new primate gene replicators, and then croak. Let’s not even talk about the design of the low back, the exquisite suicidal sensitivity of neural and cardiac tissue to brief ischemia, or the deplorable shortcomings of cartilage. Inflammation is not an ideal adaptation just because it’s the "natural" response to insult. Pain, scarring, functional impairment, tissue loss and cancer are also natural responses to insult-and all can result from inflammation. On the logic of the AAI (Anti-anti-inflamation) crowd, analgesia, wound repair by primary intention, tissue debridement, abscess drainage and tissue salvage are also bad ideas. If that’s what you really think, it’s unlikely we’re going to have a meeting of the minds. God help you if you ever get anaphylaxis or appendicitis.
I love well-placed profanity sprinkled amidst good scientific writing. Add in suggestions for the real purpose of reproduction a la Richard Dawkins’s The Selfish Gene and my smile grows wider, indeed. Sullivan’s article is entitled Stopping the Spread of Misinflammation and it is well worth the time you would spend reading it. Few things are ever as straightforward as they may seem and this article is an excellent reminder of that. Enjoy.