The Ice-less Management of Acute Ankle Sprains

I’ve written several articles on the use of ice on injuries, the need for inflammation, and the intricate physiological process of tissue healing.  Despite the mounds of evidence that ice is not all it is cracked up to be, there still exists a dogmatic polarization that it has magical tissue-healing properties. I often get told “Prove […]

RICE: The End of an Ice Age

“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 In 1978, Gabe Mirkin, MD coined the term RICE. Health care practitioners to laypersons are quick to recognize RICE as the ‘gold standard’ treatment option following […]

Why Ice and Anti-inflammatory Medication is NOT the Answer

In July I posted a blog discussing The Overuse of Cryotherapy. The controversy surrounding the topic made it one of the most popular blogs I’ve written. What is surprising to me is that a controversy exists at all. Why, where, and when did this notion of anti-inflammation start? Ice, compression, elevation and NSAIDs are so commonplace […]

Ice: The Overused Modality?

Many years ago I got tired of watching my athletes roll in to the athletic training room and slap on ice. These athletes are in a drug-like induced state of ice addiction. Their athletic trainers keep feeding the disease, by recommending cold treatment and doing the easy – here’s ice, shut-up, leave. I felt I was […]

Mechanotransduction

You have an athlete with a stress fracture. The physician prescribes active rest and places the athlete in a non-weight bearing boot. Sound familiar? Suppose I told you the better option is to place some load on that bone and non-weight bearing is not recommended. Would you think I am nuts? Maybe I can convince you […]

Knee Osteoarthritis and ACL Injury

Six months (+/- a few) is the standard time needed for an athlete to return to competition following anterior cruciate ligament (ACL) surgery. To reach this date, therapy must be thorough and exact. Range of motion, neuromuscular control, or strength deficits that go unaddressed, negatively influence return to play and can also lead to other […]

Blame the Brain: Tips for the Physical Therapist and Athletic Trainer

“Novel treatment of muscle weakness following joint injury has sought to develop interventions that can excite the neuromuscular system and allow for more effective interactions between the nerves and muscle.” Chad and Brent both play the same position for the same basketball team—same practice routine, same strengthening program, same injury prevention program—but Chad is suffering […]

10 Reasons – Icing Injuries is Wrong

If you know me, you are aware of my anti-ice stance. The ice debate continues to heat up. As peer-reviewed data continues to pour in, the evidence for the use of ice to treat musculoskeletal injury still lacks. I’ve written about ice many times, but many of my anti-ice articles are science-y and focused around […]

Future of Medicine

In time everything we do to treat injuries, prevent disease, or reverse disease will eventually change. Think of all the things we used to do in medicine. Cocaine was used for toothaches. In the 1600’s, “hydrotherapy” was used to would wash away insanity in mental patients. Jan Baptist van Helmont would literally drown people to death and then […]

Icing Injuries: Are We Evidence-Based?

Are you an evidence-based practitioner? Think about it; are you really? An athletic trainer working a Division 1 women’s volleyball tournament with elite Top-25 teams sent me a text: “You should do a study on the average number of ice bags used by volleyball teams after a match… Entire teams are getting ice on both knees […]

Causes and Treatment of Achilles Tendinopathy

Overview and etiology: The term “tendinitis” or any [insert any body part] with “itis” is tossed around as if it is the only possible cause for musculoskeletal pain. However, the “itis” is not really true. A tendon, specifically the Achilles tendon, is not really inflamed, rather it is deranged (tendiopathic / tendinopathy). In January 2013 the […]

Gamma Gain, Myofascial Pain Syndrome and Treatment Using Myofascial Release and Strain-Counterstrain

Introduction and Anatomical Overview: Muscle is made up of two types of fibers, intrafusal and extrafusal. Extrafusal fibers are the contractile fibers and intermixed within the extrafusal fibers are intrafusal fibers. Housed within intrafusal fibers is a specific type of mechanoreceptor. Mechanoreceptors, in general, are interspersed through the entire body – hair, skin, ligaments – […]

Kids and Distance Running

By now, some, if not most, have read the article of the 6-year-old girl who became the youngest ever to complete a half-marathon. Not only did she become the youngest ever, she finished 5th out of 10 in a group of competitors aged 14 and under – she was the only competitor under 12 years […]

Physiology of Reversibility: If You Don’t Use It, You Lose It!

Have you heard the old adage “if you don’t use it, you lose it”? Does this really happen? If so, to what degree does one “lose it”? I was riding dirt bikes since the age of three, began racing motocross at age six and ‘retired’ –moved from home and went to graduate school – around the age […]