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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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Opinion & Analysis

A new NCAA transfer rule gets passed… and college coaches are NOT happy

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New rules just keep on coming from the NCAA; college coaches are not happy about this one.

In a summer of block buster coaching changes, the NCAA has done its best to stay atop the news cycle by making some significant changes, which will impact the recruitment process. In an article two months ago entitled “The effect the NCAA’s new recruiting rules will have on college golf,” I spoke to college coaches about a new rule, which will not allow unofficial or official visits until September 1 of the players Junior Year. To go along with this rule, the NCAA has also put in place a new recruiting calendar which will limit the sum of the days of off campus recruiting between a head and assistant coach to 45 days starting August 1, 2018.

The 45-day rule will have several potential impacts for both recruits and assistant coaches. For recruits, it is likely that after a couple (2-3) evaluations, coaches will make offers and ask for speed responses to ensure they are not missing out on other options. I also think you will see far less assistant coaches recruiting, which ultimately hurts their opportunities to learn the art of recruitment.

The new transfer rule

In the past, players were subject to asking their present institution for either permission to contact other schools regarding transfer, or a full release.

Now, starting October 15, players can simply inform their institution of their intensions to leave and then start contacting other schools to find an opportunity. This is a drastic shift in policy, so I decided to poll college coaches to get their reactions.

The poll was conducted anonymously via Survey Monkey. Participation was optional and included 6 questions:

  1. New NCAA Legislation will allow players to transfer without a release starting October 2018. Do you support this rule change?
  2. Do you believe that this rule will have APR implications?
  3. Who do you think will benefit most from this rule?
  4. What are the benefits of allowing students to transfer without a release? What are the potential harms?
  5. New NCAA Legislation will make December a dead period for recruiting off campus. Do you support this legislation?
  6. What implications do you see for this rule?

In all, 62 Division I golf coaches responded, or about 10 percent of all Division I coaches in Men’s and Women’s Golf. The results show that 81.25 percent of DI coaches said that they do NOT support the rule change for transfers.

Also, 90 percent of coaches polled believe that the rule will have APR implications. APR is Academic Progress Rate which holds institutions accountable for the academic progress of their student-athletes through a team-based metric that accounts for the eligibility and retention of each student-athlete for each academic term.

The APR is calculated as follows:

  • Each student-athlete receiving athletically related financial aid earns one point for staying in school and one point for being academically eligible.
  • A team’s total points are divided by points possible and then multiplied by 1,000 to equal the team’s Academic Progress Rate.
  • In addition to a team’s current-year APR, its rolling four-year APR is also used to determine accountability.

Teams must earn a four-year average APR of 930 to compete in championships.

While the APR is intended as an incentive-based approach, it does come with a progression of penalties for teams that under-perform academically over time.

The first penalty level limits teams to 16 hours of practice per week over five days (as opposed to 20 over six days), with the lost four hours to be replaced with academic activities.

A second level adds additional practice and competition reductions, either in the traditional or non-championship season, to the first-level penalties. The third level, where teams could remain until their rate improves, includes a menu of possible penalties, including coaching suspensions, financial aid reductions and restricted NCAA membership.

Clearly coaches are not happy about the move and feel that the rule unfairly benefits both the student athletes and major conference schools, who may have a swell of calls around middle of October as Student athletes play great fall golf and look to transfer. Although coaches are unhappy about the new rule, it is very difficult to predict what direct impact the rule will have on teams; coaches are extremely smart and understand recruiting and development within the frame work of college better than anyone can imagine. As a result, I think coaches will react in many ways which are impossible to predict.

The survey also asked, “new NCAA Legislation will make December a dead period for recruiting off campus. Do you support this legislation?” For this, coaches were more divided with 45 percent in favor of the rule, and 55 percent not.

Although coaches supported the legislation, many (41/62) suggested that it would potentially hurt international recruiting at tournaments like Doral and the Orange Bowl and they had, in the past, used December as a time to recruit.

As we move forward with these changes, here are some potential things that recruits, and their families should consider, including consequences of the rules:

  1. With a limit of 45 days and these transfer rules, it is likely that coaches will be doing significantly more investigation into a player’s personalities and family situation to make sure they know what they are getting.
  2. Coaches may also start skipping over better players in favor of kids they think will be a good fit and are likely to stay
  3. Rosters may get bigger, as coaches are trying to have larger numbers to potentially offset transfers

Unfortunately, we enter a new era of rules at the worst time; we have never had a more competent and deep group of college coaches, the clear majority of whom are tremendous stewards of the game. Hopefully this rule will have insignificant effect on the continued growth of college golf but only time will tell.

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Opinion & Analysis

Is golf actually a team sport?

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Do a little research on the top PGA Tour players, and what you’ll see is that most (if not all of them) employ a team of diverse professionals that support their efforts to perform on the golf course. Take two-time major champion Zach Johnson; he has a team that includes a caddie, a swing instructor, a sports psychologist, a physiotherapist, an agent, a statistician, a spiritual mentor, a financial adviser… and of course his wife.

“I know this seems like a lot, and maybe even too much,” Johnson readily admitted. “But each individual has their place. Each place is different in its role and capacity. In order for me to practice, work out and just play golf, I need these individuals along the way. There is a freedom that comes with having such a great group that allows me to just play.”

My best guess is that Zach Johnson commits hundreds of thousands of dollars each year to this team, and I assume most players on the leading professional tours are making significant investments in their “teams.” There are three questions that jump out at this point. First, is a team necessary? Second, how can anyone compete without one? And third, how to pay for it?

From the club player to the collegiate player to the aspiring/touring professional, everyone can benefit from a team that offers individual instruction, support, guidance, and encouragement. Such a team, however, needs to be credible, timely, beneficial and affordable.

To be affordable, serious golfers should build their team one piece at a time. The obvious first choice is a swing coach. Golf swing coaches charge from $100-$1,500 per hour. The cost explains why players have historically been responsible for their own practice. The next piece, which is a newly developing trend, should be a performance coach who specializes in the supervision of practice, training and tournament preparation. Performance coaching on-site fees range from $200 to $3,000 per day.

So is team support essential for a player to be as good as he/she can be? My research says it is. When a player schedules a practice session, that session is usually based on what the player likes to do or wants to do. “Best Practices” utilized by world-class athletes suggest strongly that great progress in training always occurs when someone other than the player writes, administers and supervises the programs and sessions. The team approach says the player should focus on what needs to be done. Sometimes what the player wants to do and the things needed to be done are the same thing; sometimes they aren’t.

Now for the question of how to pay for it all. Wealthy players, or those with substantial or institutional support, have access to what they need or want… whatever the cost. If you use an on-site coach, teacher or other professional you will be paying for blocks of time. Fees can be hourly, weekly, monthly, yearly or lifetime arrangements based upon several factors. If your coach of choice is not local, you can also incur travel and per diem expenses. The process of paying for someone’s time can really add up. You can review what I charge for various services that require my attendance at edmyersgolf.com.

For those of you who don’t have easy access to on-site expertise or don’t want to incur the expense, I want to offer an approach that business, industry, colleges/universities and entrepreneurs are turning to: “Distance Coaching.” Distance learning is made possible through modern technology. In today’s world, expertise can be delivered using FaceTime, Skype, texting, email and (old fashion) phone calls. Textbooks, videos, specific programs and workbooks can be accessed from anywhere at any time by anyone with a desire to do so… and who knows what’s coming in the future. Through Distance Coaching, individuals can employ professional expertise on an as-needed basis without incurring huge costs or expenses.

The primary team expenses that can be avoided are those associated with face-to-face, on-site visits or experiences. Distance Coaching brings whatever any player needs, wants or desires within financial reach. For example, a player in Australia can walk onto the practice ground and have that day’s practice schedule delivered to a personal device by his/her performance coach. The player then forwards the results of that session back to the coach — let’s say in Memphis, Tennessee. The player is then free to move onto other activities knowing that the performance, training and preparation process is engaged and functioning. In the same vein, that same player in Australia may have moved into learning mode and he/she is now recording the golf swing and is sending it to the swing teacher of choice for analysis and comment.

So what is the cost of Distance Coaching? Teachers, trainers and coaches set their own fees based upon their business plan. Some require membership, partnership or some other form of commitment. For example, I offer free performance coaching with the purchase of one of my books or programs, as do others. Where face-to-face, on-site fees for performance coaching is available for $200 a day, the same expertise from the same coach can cost as little as $50 a month using the distance format, tools and technology. I highly recommend that players responsibly research the options available to them and then build the best team that fits their games, desires and goals. I’m happy to forward a guide of what to look for in a performance coach; just ask for it at edmyersgolf@gmail.com.

Back to Zach Johnson; he recently admitted that his lack of recent success could be traced to his lack of focus and practice discipline. Additional, he concedes that he has been practicing the wrong things. “It goes back to the basics,” he said. “I have to do what I do well. Truth be told, what I’m practicing now is more on my strengths than my weaknesses.”

Zach Johnson has a great team, but as he concedes, he still needs to put in the work.

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What is “feel” in putting… and how do you get it?

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You’re playing a course for the first time, so you arrive an hour early to warm-up. You make your way toward the practice green and you see a sign at the first tee that reads, “GREEN SPEED TODAY 11.”  That brings up two issues:

  1. How did they arrive at that number?
  2. How is that information valuable to me?

How did they arrive at that number?

They used what’s known as a stimpmeter — a device that’s used to measure the speed of a green. With a stimpmeter, the green’s surface is tested by rolling a ball down the 30-inch ramp that is tilted downward at a 20-degree angle. The number of feet the ball rolls after leaving the ramp is an indication of the green’s speed. The green-speed test is conducted on a flat surface. A total of three balls are rolled in three different directions. The three balls must then finish within eight inches of each other for the test to be valid.

For example, if the ball is rolled down the ramp and were to stop at 8 feet, the green would be running at an “8.” Were the ball to roll down the ramp and stop at 12 feet, the green would be running at a “12.”

Stimpmeter history

The stimpmeter was invented by Edward S. Stimpson, Sr., a Massachusetts State Amateur Champion and former Harvard Golf Team Captain. After attending the 1935 U.S. Open at Oakmont, he saw the need for a universal testing device after watching Gene Sarazen, who was at the top of his game, putt a ball off the green. He was of the opinion that the greens were unreasonably fast, but he had no way to prove it — thus the motivation for creating the invention.

The device is now used by superintendents to make sure all of their greens are rolling close to the same speed. This ensures that golfers are not guessing from one putt to another if a green is fast or slow based on the way it is maintained. The device is also used by tournament officials who want to make sure that green speed is not too severe.

Do Stimp readings matter for my game?

Not very much. That piece of abstract knowledge is of little value until you can translate it into your own personal feel for the speed of the putt. There is a method that will allow you to turn green speed into a legitimate feel, however, and you don’t even need a stimpmeter or a stimp reading to do it. I call it “Setting Your Own Stimpmeter.”

Before we get to how to do it, the first step is to determine if the putting green is the same speed as the greens on the course. The best source of information in this regard are the professionals working in the golf shop. They will be happy to share this information with you. You only need to ask. Assuming that the speed of the putting green is close to the speed of the greens on the course, you are ready to begin setting your own stimpmeter. This is done by inputting data into your neuromuscular system by rolling putts and visually observing the outcome.

Contrary to what most golfers believe, a golfer’s feel for distance is based in the eyes — not in the hands, which only records tactile information. It’s just like basketball. On the court, you look at the distance to the hoop and respond accordingly. While you would feel the ball in your hands, it doesn’t play a role in determining the proper distance to the hoop. Based on what you saw with your eyes, you would access the data that had been previously inputted through shooting practice.

Setting your own Stimpmeter

  1. Start by finding a location on the putting green that is flat and roughly 15 feet away from the fringe.
  2. Using five balls, start rolling putts one at a time toward the fringe. The objective is to roll them just hard enough for them to finish against the edge.
  3. You may be short of the fringe or long, but it is important that you do not judge the outcome— just observe, because the feel for distance is visually based.
  4. You should not try and judge the feel of the putt with your hands or any other part of your body. You can only process information in one sensory system at a time — that should be the eyes.
  5. You should continue to roll balls until you’ve reach the point that most of them are consistently finishing against the fringe. Once you can do that, you have successfully set you stimpmeter.

The key to the entire process is allowing yourself to make a subconscious connection between what your eyes have observed and the associated outcome. You must then trust what you have learned at a sub-conscious level. A conscious attempt to produce a given outcome will short-circuit the system. When it comes to judging speed, you must be prepared to surrender your conscious mind to your sub-conscious mind, which is infinitely wiser and more capable of calculating speed. Want proof? Work through the steps I’ve outlined below. .

  1. After having loaded the data as described in the exercise above, pace off a 25-foot putt.
  2. Using the same five balls, putt to the hole as you would normally using your conscious mind to control the outcome.
  3. Mark the location of the five balls with a tee pushing them down until they are level with the surface of the green.
  4. Allow your eyes to work slowly from the ball to the hole while clearing your conscious mind of any thought.
  5. Using the same five balls, putt to the hole allowing your subconscious mind to control the outcome.
  6. Compare the proximity of the five putts that you just hit to those marked with a tee. What do you observe?

Did you have trouble clearing your mind of any conscious thought? Assuming that your conscious mind intruded at any point, the outcome would be negatively affected. You should then repeat the exercise but this time, emptying your mind of any thought. You will have mastered the technique when you are able to quiet your conscious mind and allow your subconscious to take over.

This technique will improve your proximity to the hole on longer putts. And you know what that means? Fewer three-putts!

Editor’s Note: Rod Lindenberg has authored a book entitled “The Three-Putt Solution”  that is now available through Amazon. 

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