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Are golfers wasting their time icing injuries?

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Even in a world of “doctors used to say it was good for you, now they say it’s bad,” this one is a shocker: The doctor who coined the acronym RICE (rest, ice, compression, elevation) in 1978 has decided that the (complete) rest and ice are not beneficial to treating injuries.

Dr. Gabe Mirkin, whose RICE treatment plan has been the standard method of dealing with sports injuries for more than 30 years, recently published a blog post that says, in part:

When I wrote my best-selling Sportsmedicine Book in 1978, I coined the term RICE (Rest, Ice, Compression, Elevation) for the treatment of athletic injuries … Ice has been a standard treatment for injuries and sore muscles because it helps to relieve pain caused by injured tissue. Coaches have used my “RICE” guideline for decades, but now it appears that both ice and complete rest may delay healing, instead of helping.

You can read the entirety of Dr. Mirkin’s post here.

This information is significant and could represent a paradigm shift in the treatment of sports injuries in general and golf-related injuries in particular. Simply, reducing inflammation was previously seen as essential to healing. Now Dr. Mirkin and others view inflammation as vital to the healing process. Certainly, there is a gross parallel here with allowing your body to fight off infection vs. antibiotic overkill. As I am not a doctor, however, I’ll leave it at that.

Returning to the matter at hand, as anti-icing advocate Josh Stone of Stone Athletic Management writes: “A shift in paradigmatic treatment is on the horizon. Exercise is heating up and ice is melting down.” By “exercise,” it seems, Stone means load bearing and rehabilitation (alternated with rest) is the advisable course of action. In another post on his website, Stone gives the example of an athlete with a stress fracture to the leg whose been advised to wear a non-weight bearing boot. Stone’s remedy? “An intricate balance between rest and mechanical loading of bone to obtain optimal healing”

In keeping with this idea: Generally, Dr. Mirkin’s advice following injury is as follows:

  • Stop exercising immediately.
  • If possible, elevate the injured part to use gravity to help minimize swelling.
  • If the injury is limited to muscles or other soft tissue, a doctor, trainer or coach may apply a compression bandage.
  • Ice may be applied to reduce pain, however, it’s pointless to apply ice more than 6 hours after injury.
  • If the injury is severe, follow your doctor’s advice on rehabilitation.
  • If the injury is minor, you can usually begin rehabilitation the next day.

The entirety of the new direction of treatment following Dr. Mirkin’s study may only be apparent only to the most progressive doctors, kinesiologists, trainers and exercise physiologists. It is clear, however, that if Mirkin’s current suggestions catch on in the same way as his directions in 1978 did, your rehab and treatment for injury (golf or otherwise) won’t involve anything that lives in the freezer.

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13 Comments

13 Comments

  1. leftright

    Apr 30, 2014 at 8:08 pm

    Icing an injury, especially an acute tendonitis, mild muscle injury or a joint that has been over extended works quite well. I have been observing results for 4 decades and despite the good doctor’s turn around it is still preferable to doing nothing at all. I can even say, observable results from non-iced to iced injuries will take longer to heal and can actually cause chronic conditions. Instead of RICE, maybe another acronym like NIE would be better, NSAIDS, Ice and elevation. Compression usually does not work and if done incorrectly will cause more injury and swelling. ACE wraps are more for mild immobilization than compression anyway. To do away with ice in a sports environment, especially at a higher level of play is tantamount to negligence and assuredly will cause exacerbation of conditions in the long term. This article reminds me of the “Sugar Blues” book that came out in the 70’s that ended up not being worth the paper it was printed on.

    • Dean ATC

      Apr 30, 2014 at 11:34 pm

      There are so many things wrong with this post….I don’t even know where to start. So I’ll do it this way…

      1. Compression DOES work; and it’s even more effective when used with exercise

      2. Compression will NOT cause more injury and swelling (seriously, where did you come up with that one?)

      3. ACE wraps don’t immobilize anything (and unless something is fractured, there is really no reason to completely immobilize anything)

      4. The only thing ice is good for is mild analgesia. That’s the only reason I use it on my athletes. After 24 hours…..no more ice.

  2. Dr. G

    Apr 29, 2014 at 6:37 pm

    Stone gives the example of an athlete with a stress fracture to the leg whose been advised to wear a non-weight bearing boot. Stone’s remedy? “An intricate balance between rest and mechanical loading of bone to obtain optimal healing”

    Any physician not recommending nearly complete offloading for a stress fracture is beyond ludacris. Should that stress reaction turn into a frank fracture due to a lack of informing a patient that it is a possibility with “loading of bone”, the physician will find themself in a sticky situation. Wait 4-6 weeks, observe films along with signs and symptoms, then move on with loading.

    • Em

      Apr 30, 2014 at 8:28 pm

      Ludacris? You mean ludicrous? You ain’t no Dr.

      • Chris

        Apr 30, 2014 at 11:35 pm

        Ain’t? Do you mean are not? I love the grammar battles.

      • Travis

        May 1, 2014 at 8:44 am

        Maybe he’s talking about the rapper… so perhaps he means “beyond controversial”.

  3. Alex the Athletic Trainer

    Apr 29, 2014 at 2:35 pm

    Ben, first of all please refrain from calling us “trainers” we go to school for 4-6 years to become a certified athletic trainer from an accredited program at an accredited university as opposed to “trainers” who take an online class and teach people how to lift. Secondly, I have been following this article for a while now, and have done a lot of research on my own. Ice is important to help with pain management as well as to keep inflammation at a manageable level. I agree that icing after 24 hours is more or less a placebo/band aid for what is going on. Rehab is the only thing that will help to repair the damage done from an acute injury.
    There is still a lot of research that needs to be done, but ice is not the enemy like Dr. Mirkin and his followers like to portray.

  4. The Dr

    Apr 29, 2014 at 12:01 pm

    Just take an anti-inflammatory medication instead, as long as you are not allergic. But – ice is definitely good for concentrated, directed use onto the area immediately inflamed by impact.

    But lets not bring up bone fractures into this mix – you’re confusing different issues there, entirely. No amount of ice is going to HEAL bone fractures. It will, however, still alleviate some of the pain in the area surrounding the bone fracture IF there is any inflammation of the muscle or tissues.

    Reducing inflammation is the issue, and ice is OK for those who do not want to ingest any kind anti-inflammatory medication.

    • Dean ATC

      Apr 30, 2014 at 11:42 pm

      But that gets to the central question around this entire issue….which is why do we want to stop inflammation? Somewhere along the way we have gotten it into our heads that inflammation is the devil. When in fact, it is necessary for healing. It is our bodies natural reaction to injury and illness…..so it’s obviously supposed to occur (our body is pretty smart). Yet we want to ice and take NSAIDS and intentionally stop our bodies natural healing mechanism. Makes no sense.

  5. Chris

    Apr 29, 2014 at 10:44 am

    While I agree that sharp, sudden injuries may not benefit from ice (ACL, torn muscle, dislocated shoulder) I think it is important to understand that ice treatment can be greatly beneficial to long term injury prevention.

    If someone has tendinitis, but still wants to play the sport that is causing the tendinitis, frequent icing will keep the inflammation at a manageable level allowing the athlete to continue to compete. For example, you’ll see most basketball players icing their knees after a game. Similarly baseball pitchers will ice their entire throwing arm after an outing. Again, this helps control the inflammation and pain to allow the athlete to continue to be healthy and effective throughout a long season.

    • Joe

      Apr 29, 2014 at 3:20 pm

      It is becoming more common for pitchers to limit their icing. More influence is coming from Japan, where pitchers don’t ice their arm and have far fewer arm injuries. Correlation is not causation but it has been noticed. Active stretching and heat are becoming en vogue.

      • leftright

        Apr 30, 2014 at 8:13 pm

        I would be more inclined to cite genetics versus treatment of chronic arm conditions, especially in pitchers at the professional level. Another thing that contributes is the way young people are taught to play the game versus Japan. A study, maybe by one of those educated trainers trying to get his MS or PhD. would provide more insight into Japan versus the US pitchers.

  6. Pete

    Apr 29, 2014 at 10:28 am

    On most occasions the bullet: Stop exercising immediately is struck over and the round or what ever payed scheduled tennis court or alike is exploited to it’s full extent. Unless one cannot do anything but roll in pain and agony.

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TG2: GolfWRX Forum Member “Warrick” explains his love for Mizuno irons

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GolfWRX forum celebrity “Warrick” explains what he loves so much about Mizuno irons, where he got his name from, how he became a gear head, what’s in his bag currently, his all-time favorite golf course and more. Also, GolfWRX equipment expert Brian Knudson talks about playing Oakland Hills Country Club in Michigan for the first time.

Checkout the full podcast on SoundCloud below, or click here to listen on iTunes!

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Golfholics Course Review: Spyglass Hill Golf Course

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In this new course review series, Marko and Mike from Golfholics provide their takes on the golf courses they’ve played around the world. The first episode starts with the famed, yet often overlooked Spyglass Hill. Enjoy the video below, and don’t forget to check out more videos from Golfholics on their YouTube page!

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Redkacheek’s DFS Rundown: 2018 CJ Cup

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Wow, what a crazy start to this season! Not only has the cheat sheet and slack chat plays over at the Fantasy Golf Bag been on complete fire, but the new golf betting model has now hit on two outrights and one FRL in back-to-back weeks! We get a much better field this week so definitely plan to keep this heater going here at the CJ Cup this week. Brooks Koepka will be teeing it up for the first time since being named the 2018 POY, along with guys such as Justin Thomas, Jason Day, Paul Casey, Billy Horschel, and our new favorite Sungjae Im. As you can see, this will be a fairly exciting event for a setup as similar as last week’s tournament.

Let’s go ahead and take a look at this course and see if we can pinpoint some key stats to take us to another Big GPP win or at least a couple good choices for an outright win.

The CJ Cup will be played at the Club at Nine Bridges, a 7,196 yard par-72 golf course in South Korea. Although this may appear like a similar course to TPC Kuala Lumpur last week, this one will play quite significantly tougher. As you can see below, in 2017 there were more bogeys than birdies for the week which doesn’t happen much outside of majors. Justin Thomas won last year’s event after shooting 63 in the first round but failed to break 70 the following three days. JT finished at nine under, which tied Marc Leishman, who coincidentally won this last weekend (2019 Fall Swing narrative). So why so tough if it appears so short? Let’s take a look.

So first off, let’s get this out of the way first. These greens are brutal. No joke; these greens were the single most difficult greens to putt on all of last year. Everything from one-putt percentage to 3-putt avoidance, these ranked the No. 1 most difficult on Tour all year. But here’s the problem: We all know putting is the single most variable stat, so using SG:P will tend to lead to a very disappointing pool of players. For example, coming into last year the players ranked Top 10 in SG:P finished 11-33-47-40-28-64-36-26-71-36, respectively. There is a still a stat that helped fine-tune player pools last year that I will recommend this year: my first key stat to consider this week is 3-putt avoidance.

The next section here I will just briefly touch on the driving accuracy and GIR percentage for this course. It is very average for the PGA Tour…that is really all you need to know. Driving accuracy ranked 48th and GIR percentage ranked 38th in 2017. This course is not difficult tee-to-green, plain and simple. I will certainly add the usual SG:T2G this week along with GIR percentage, but this course will favor most guys this week.

So besides putting, why are these scores so poor considering the appearance of an easy course? Well besides putting on these greens, scrambling here is brutal. Scrambling also ranked No. 1 most difficult here last year but again, this is a stat that is extremely tough to see useful trends. I will, however, encourage you to use SG:ARG to help narrow down your player pool more efficiently.

Remember that this segment of the Fall Swing will not yield strokes-gained data, so we must only utilize the traditional stats the PGA Tour keeps. On top of all the micro-scoring stats mentioned above, let’s take a closer look at this course from a macro level. This will be fairly straightforward when building your model. The par 4s here are extremely difficult, so add SG:P4 Scoring to your research (par 3 scoring is also very difficult but sample sizes are usually too small to include each week). Par 5 scoring was difficult as well but there is a better stat we can use than the P4 scoring mentioned above. The final stat we will be using is simply bogey avoidance. This will do a fantastic job of incorporating T2G, scrambling and putting into our model/research.

Overall this course is really an amazing layout but will pose a difficult task for the players. Just like last week, I encourage you to ease into the season by playing light and also primarily playing GPPs.

With all that out of the way, let’s get into my core plays for this week…

Justin Thomas (DK $11,600)

Justin Thomas finally makes the core writeup. After a mediocre finish last week (5th place), he comes to Nine Bridges as the defending champion. Ironically, he beat out Marc Leishman, last week’s winner, in a playoff last year and I think he is going to be the guy to pay up for over $10k. JT won both CIMB Classic and The CJ Cup last year, and I would be very surprised if he doesn’t leave this leg of the Fall Swing (Asia) without a win. There’s a lot going for him outside of his recent form and course history (if that wasn’t enough), he ranks first in both SG:T2G and SG:APP, second in par 4 scoring, eighth in bogey avoidance and finally, surprisingly, 11th in 3-putt avoidance. If you are building only a few lineups this week, I think JT should be in around two-thirds of them.

Byeong-Hun An (DK $8,700)

Mr. Ben An makes the list again! Byeong-Hun An received a lot of praise from both Jacob and myself on the FGB Podcast last week and he did not disappoint with a 13th place finish, and really a strong chance to win going into the weekend. As part of a common theme you will see here, Ben An is the kind of consistent ball-striker to rely on each and every week. On the PGA Tour in the last 50 rounds, he ranks third along with a strong ranking in bogey avoidance (third) and GIR percentage (also third). He did play this event last year, finishing 11th at 4-under par, and if it weren’t for a final round 73 he had a realistic chance for the win! The price on Ben An is getting a little steep but I think we can still get some value out of it this week.

Kyle Stanley (DK $8,200)

Kyle Stanley should be considered a core play almost every week he is under $9K on DraftKings. One of the most elite ball strikers on Tour, ranking ninth in SG:T2G, 11th in SG:APP, sixth in GIR percentage and 14th in par 4 scoring, he sets up for another solid top 20. Last week Kyle finished 13th in Kuala Lumpur and now comes to Nine Bridges where he ended the tournament in 19th place last year. Kyle tends to be very “mediocre” so upside for a top 3 always seems to come sparingly during the season, but you still cannot ignore his skills at this price.

Charles Howell III (DK $7,700)

Charles Howell III is a lock for me this week. Coming off a strong showing last week (T5) but also an 11th-place finish at this event last year, he grades out as one of the strongest values this week at only $7,700. CH3 hadn’t played on the PGA Tour for over a month before appearing at Kuala Lumpur, causing him to fly well under the radar on his way to a solid top five finish. Always known as a superb ball-striker, Howell actually rates out 16th in bogey avoidance and 10th in 3-putt avoidance, both key stats for this golf course. Additionally, CH3 ranks inside the top 20 of both par 4 scoring and GIR percentage. In a no-cut event on a difficult ARG golf course, count on CH3 to gain enough placement points to pay off this solid price tag.

Ian Poulter (DK $7,600)

Ian Poulter may be extremely sneaky this week. We haven’t seen him since the Ryder Cup and most people that play DFS have severe recency bias. Poulter is a grinder, and considering the winning score should only be around 12-under par with lots of opportunities for bogeys, he should keep the wheels on all four days and have a chance on Sunday. One of the most surprising stats for me in my research on Poulter is that he ranks first in 3-putt avoidance, along with some impressive tee-to-green stats where he ranks inside the top 25 of all of my key stats mentioned above. Why is the 3-putt avoidance stat so important? As I noted in the course preview, these were the single most difficult greens to putt on last year with the worst 3-putt percentage. Outside of the key stats, it does seem like this course fits his eye as he finished 15th here last year. Ian Poulter will be another core play but I think he may come in quite under owned from where he probably should.

Joel Dahmen (DK $6,900)

Chalk Dahmen week is upon us and I am going to bite. Dahmen has been a DFS darling this year and last week was no different. Dahmen ended up finishing 26th which was largely due to a poor final round 71, which dropped him 11 spots. Even with that poor finish he was able to pay off his sub-$7K price tag, which is where we find him again this week. Dahmen ranks top 10 in this field in several key stats, including: SG:T2G, SG:APP, and bogey avoidance. If you need some salary savings but unsure about anyone under $7K, Dahmen should be your first look this week.

Also consider

Brooks Koepka
Jason Day
Marc Leishman
Paul Casey
Ryan Moore
Sungjae Im
Kevin Tway

Good luck this week everyone!

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