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Comment by dfxm12 | Hacker News Reader

Anyone can RICE their joints. It's foolproof, more or less objective and requires no monitoring from a professional.

What defines optimal load? It sounds impossible to gauge, unless maybe if you're working with a physical therapist. Then, what happens if load more than the optimal level? Is the outcome worse than if you just stuck to RICE? I think these are things that have to be considered for medical protocols.

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Optimal load is right before it starts hurting. You progressively load, and when it starts hurting you unload. Your body will send pain before there is damage to be done.

Edit: in fact some discomfort or right kind of pain is good. Else you give to atrophy.

That’s not how pain works. Pain is a noisy and error-prone signal that gives you a good approximation for “stop doing that.” But the edge of pain sensation doesn’t indicate what is or isn’t a good idea during recovery. It’s not a bad place to start, but everyone has different pain tolerances, some injuries are in nerve-poor areas, and repetitive stress or tendinitis are definitely not going to appreciate getting lit up right away.

I’m in PT and dealing with orthos right now, and according to them, that IS how pain works for the vast majority of ortho injuries

Sorry, which comment are you affirming?

Go until just before it hurts, which is a moving target that you will have to calibrate carefully

Would you give the same advice to someone with a chronic pain condition?

I don't know, I'm not a doctor and I'm not giving advice to anybody!

Your edit shows that there is no good rule for the threshold where pain would indicate too much load vs. still being in the beneficial range. We don’t even have a good way to assess subjective pain (one’s 3 is another one’s 7, etc.). “Optimal load” is really just a tautology.

"As soon as it starts to hurt" is not some hopelessly complex and useless standard that involves delving into philosophies of subjective pain sensation. It is actually obvious and easy to follow.

Use it, but when it hurts, stop.

Yeah, but given the huge variations in pain tolerance, some will reinjure it while others will never use it again.

tolerating it doesn't mean you can't detect it.

no amount of pain tolerance will help you if something is broken.

you WILL feel it. simply stop when you do.

it's not a hard thing to grasp.

Clearly, you have never worked in healthcare.

Sleeve tattoos but needs an IV? “Oh, I’m not good with needles, you need to sedate me first.”

How is that relevant?

Perception of pain is highly individual. Like I said, people who have tons of tats will complain about an IV. You aren’t afraid of needles, you just don’t like them when they are used for your health instead of marking up your body.

> “Optimal load” is really just a tautology.

It's not just a tautology, because it correctly implies that the right amount of load is not zero.

And it's hard to expect an acronym by itself to be very specific.

RICE, as a protocol, isn't all that effective. The doctor who invented it recanted support after new evidence showed the importance of inflammation for the healing process. And, it turns out, he just kind of made it up to fit a handy pneumonic. POLICE is similarly invented and hard to recommend, but modern practices do recommend bearing load sooner rather than later. Can determining optimal load be done without a doctor? It probably depends on the severity and type of injury. But that's not really the point of a medical protocol, the point is to define best practices that help achieve the best outcomes.

When I broke a joint in my pinky a few years ago it was pretty easy to tell. Early on the range of motion was the limiting factor, and I'd move it back and forth as much as I could without any pain. After that I worked on strength in a similar way, do as much as I can with no pain. I went from "you'll never play an instrument again" to rock climbing and Viola practice.

Overall, seeing my strength and range of motion slowly get better was immensely satisfying and your body is pretty good at letting you know when you're getting close to a limit.

I broke my elbow last year (in a very minor way but still), when I was in the A&E the doctor told me to keep moving it and that I wouldn't be able to move it in a way that would affect negatively affect recovery. Within about 10 days it was markedly better and within 21 days I was back riding my bike, and now a year later as far as I can tell it's as good as new.

I didn't need physio or anything, the doctor just told me to keep using it as normally as possible.

>What defines optimal load?

Uncomfortable but not painful, just like pretty much everything else physiology-related in life.

> I think these are things that have to be considered for medical protocols

What makes you think those things haven't been considered?

The comment you replied to said, "the new guidance is..." I took that to mean those things have been considered.

I mean considered per patient. Pro wrestler Kerry von Erich had to get his broken foot amputated because he thought it felt good enough to walk across the room to get a cheeseburger. Not everyone can gauge these things on their own, especially considering people with broken bones may be taking pain killers. Not everyone can have professionals, or even loved ones, around them to monitor it.

> Pro wrestler Kerry von Erich had to get his broken foot amputated because he thought it felt good enough to walk across the room to get a cheeseburger.

Honestly, I don't think wrestlers -- certainly those from the von Erich era -- are beacons of authority when it comes to sensible recuperation/rehabilitation from injury. Kevin von Erich said it was due to his brother trying to get some food but there are other accounts:

> Moody says Kerry turned up on crutches and was feeling too much pain, so the doctors injected a liquid-type numbing painkiller on his injured foot so he could go on. The match went under 6 minutes with Kerry beating Adias, but according to Moody, even with his foot under a painkiller influence, Kerry still felt a lot of pain, which led to the amputation of his foot.

Maybe they aren't, but they also aren't unique in this regard. Obstinate tough guy types are obstinate no matter what their job is. I have neighbors and family members who had similar issues where the doctor says something like "you can walk, but take it easy" but they misjudge what "taking it easy" really means.

I mean so we don't make a generally good recommendation because one pro wrestler got their foot amputated?

The fact that general medical guidance isn't tailored to you shouldn't come as a surprise. Whether you take it or not is up to you.

I mean so we don't make a generally good recommendation because one pro wrestler got their foot amputated?

Please try to converse in good faith.

The fact that general medical guidance isn't tailored to you shouldn't come as a surprise.

In general, doctors treat people, not ailments.

> Please try to converse in good faith.

Can you just trot that out when you don't like that the other person thought your point was ridiculous?

If you are able to say that the majority of people are bad candidates for POLICE over RICE then I'd engage with that. But it feels unlikely that you can do this because the prevailing medical wisdom seems to be that the majority of people are good candidates for POLICE over RICE.

I will acknowledge that if a patient is a drug-addled professional wrestler who is desperate for a burger then yes perhaps they should just stay off the foot.

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