軟組織受傷使用冰敷已經過時?

2023-12-06 19:08
先回顧一下歷史. 冰敷是在 1978年由運動醫學醫師Gabe Mirkin提出的. 但在 2015 年 Gabe Mirkin 推翻了自己的建議.這段歷史可以參考下面兩個連結

 

參考資料1 . 下面中文是用google自動翻譯

Is it time to put traditional cold therapy in rehabilitation of soft-tissue injuries out to pasture?

參考資料2. 下面中文是用google自動翻譯. 裡面提到了Hyperbaric gaseous cryotherapy高壓氣體冷療法. 蠻有趣的. 順便將paper裡面表格附上.  
The R.I.C.E Protocol is a MYTH: A Review and Recommendations

摘要: 

1962 年 5 月 23 日，12 歲的埃弗雷特（埃迪）諾爾斯在馬薩諸塞州薩默維爾跳上一列貨運列車，導致他的手臂與身體完全分離。這名小男孩被送往馬薩諸塞州綜合醫院 (MGH)，年輕的住院醫師羅納德·A·馬爾特 (Ronald A. Malt) 醫生試圖挽救艾迪的斷肢。儘管醫學文獻中從未記錄過重大肢體的成功再接，但 Malt 博士和 12 名醫生組成的團隊進行了歷史上首次成功的肢體再接。
On May 23, 1962, twelve- year- old Everett (Eddie) Knowles jumped on to a freight train in Somerville, MA resulting in his arm being completely severed from his body.  The young boy was taken to Massachusetts General Hospital (MGH) where Dr. Ronald A. Malt, a young chief resident, attempted to save Eddie’s detached limb.   Despite the fact that there had never been a successful reattachment of a major limb recorded in medical literature, Dr. Malt and a team of twelve doctors performed the first successful limb reattachment in history.

該行動的成功很快就成為全球現象。新聞播音員蜂擁而至，聚集在醫生團隊中，以獲取有關奇蹟般的肢體再接術的基本事實，該手術被譽為醫學史上最具有里程碑意義的手術之一。然而，手術的基本事實相當複雜，一般大眾無法理解。相反，記者將注意力集中在故事中引起讀者興趣的方面。因此，應用冰來保存切斷的組織成為故事的主要焦點。（21、33、36）

The operation’s success quickly became a global phenomenon.  Newscasters swarmed the team of doctors to obtain essential facts about the miracle limb reattachment touted as one of the most monumental operations in medical history.  However, the essential facts about the surgery were rather complicated and would not be understood by the general public.  Instead, reporters focused on the aspects of the story that would be intriguing to the reader.  As a result, the application of ice to preserve the severed tissue became the main focus of the story. (21, 33, 36)

在 1962 年 5 月 23 日事件之前，使用冰塊治療損傷從未成為醫療方案的一部分，而利用冰塊保存組織的想法很快就被全球各地的報紙報道。隨後，隨著沒有直接參與手術的個人不斷重述這個故事，事實開始改變。最終，大眾很快就接受了這樣的觀念：任何傷害都應該用冰敷來治療，無論其嚴重程度或如何發生 (36)。

The use of ice to treat injuries was never part of medical protocol prior to the events of May 23, 1962 and the notion to utilize ice for tissue preservation was quickly published by newspapers around the globe.  Subsequently, as the story was continuously retold by individuals not directly involved in the surgery, facts began to change.  Eventually, the general public was quickly accepting the notion that any injury should be treated with the application of ice, regardless of its severity or how it occurred (36).

1978年，Gabe Mirkin博士出版了《運動醫學書》，並創造了縮寫詞「RICE」（Rest、Ice、Compression、Elevation）來代表四種治療急性運動傷害的活動。四十多年來，RICE 協議已在學術課程和公眾認知中根深蒂固。然而，2013年，RICE在其著作《 Iced!》中受到了Gary Reinl的挑戰。虛幻的治療選擇。”  Reinl 引用了大量研究和解剖學資源來支持這一觀點，即在用冰緊緊包裹（壓縮）受傷部位的同時，休息並不能有效加速恢復過程，還可能導致受影響組織進一步受損。

In 1978, Dr. Gabe Mirkin released “Sportsmedicine Book” and coined the acronym “RICE” (Rest, Ice, Compression, and Elevation) to represent the four activities for treating acute athletic injuries.  The RICE protocol has been ingrained in academic curriculum as well as in public perception for over four decades.  In 2013, however, RICE was challenged by Gary Reinl in his book “Iced! The Illusionary Treatment Option.”  Reinl cited numerous studies and anatomical resources in support of the notion that resting an injury, while wrapping it tightly (compression) with ice, is ineffective in accelerating the recovery process and could also result in further damage to the affected tissues.

Reinl 的書發布後，Mirkin 在其個人網站 (31) 的 2015 年出版物中公開放棄了他對 RICE 協議的最初立場。米爾金甚至為萊因爾的第二版《 Ice d!》寫了序言。幻覺治療方案”，並對他所創造的方案提出了修改意見；

Following the release of Reinl’s book, Mirkin publicly recanted his original position on the RICE protocol in a 2015 publication on his personal website (31).  Mirkin even wrote the foreword to Reinl’s second edition of “Iced! The Illusionary Treatment Option”, and offered his revised opinion on the protocol he created;

隨後的研究表明，休息和冰敷實際上會延遲恢復。溫和的運動有助於組織更快癒合，而冷敷則可以抑制啟動並加速恢復的免疫反應。冰敷確實有助於抑制疼痛，但運動員通常更感興趣的是盡快返回比賽場地。因此，如今，RICE 並不是急性運動傷害的首選治療方法 (36)。

Subsequent research shows that rest and ice can actually delay recovery.    Mild    movement helps tissue to heal faster, and the application of cold suppresses the immune responses that start and hasten recovery. Icing does help suppress     pain, but athletes are usually far more interested in returning as quickly as possible to the playing field. So, today, RICE is not the preferred treatment for an acute athletic injury (36).

根據現有證據，唯一合理的結論是，使用 RICE 技術來加速恢復過程顯然是一個神話。2015 年，米爾金博士公開放棄了他 1978 年的最初立場，其有效性明顯受到損害。

Based upon the available evidence, the only plausible conclusion is that the use of the RICE technique to accelerate the recovery process is unequivocally a myth.  Its validity was unequivocally compromised in 2015 when Dr. Mirkin publicly recanted his original position from 1978.

有大量科學證據表明，有一些行之有效的方法可以加速肌肉、韌帶和肌腱損傷的癒合，但不包括長時間休息並結合冰敷、壓迫和抬高。為了揭穿 RICE 神話，謹慎的做法是探索對損傷的生理反應以及冰敷、壓迫、抬高和不活動對這些過程的影響。最終的結論是，有更優化的技術來加速恢復過程，其中不包括同時對受影響區域進行壓縮和局部冷卻（冰）的一段不活動期。

There is an abundance of scientific evidence purporting proven methods to accelerate the healing of muscle, ligament, and tendon injuries that do not include extended periods of rest used in conjunction with ice, compression, and elevation.  To debunk the RICE myth, it is prudent to explore the physiological responses to injury and the effect ice, compression, elevation and inactivity have on those processes.  The ultimate conclusion is that there are more optimal techniques to accelerate the recovery process that do not include a period of inactivity in which compression and topical cooling (ice) is simultaneously applied to the affected area.

Hyperbaric gaseous cryotherapy 表格的中文翻譯同樣是直接使用google翻譯.