Kelly Starett

[stam19]

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Hello, I am a pre-PT hopeful. From spending to much time watching lifting videos on youtube, I found out recently about a PT named Kelly Starett who is making waves in the crossfit community. I'm just curious as to what practicing ortho PTs thinks of his philosophies. (For example, Starett really opposes the use of ice to reduce swelling.)

http://www.mobilitywod.com/2012/08/people-weve-got-to-stop-icing-we-were-wrong-sooo-wrong/

 

[AlanWattsBlues]

The somasimple forum shares some of their thoughts on Starrett here:

http://somasimple.com/forums/showthread.php?t=15747&highlight=starret

Though their perspective is probably not the same as the mainstream, I've found PTs are generally highly suspicious of the whole crossfit culture. An example is here:

http://www.huffingtonpost.com/eric-robertson/crossfit-rhabdomyolysis_b_3977598.html

Caveat: I'm just a first year student. Starrett's article on icing seemed like an attempt to manufacture controversy (which is what good self promoters do, I guess). What is he really saying? Maybe I misread, but it seems he's indicating that ice is effective for short term pain reduction, but there are potential drawbacks to over icing, so keep compression in mind as a tool for addressing edema.

Maybe I'm making a big leap here, but it would almost seem that ice PLUS compression would be a great way to control pain and edema associated with an acute injury. Perhaps he has an article about how "WE HAVE TO STOP ELEVATING!", but it seems like good old RICE isn't horrible advice.

So there's drama in the headline, but the meat of the text seems to not be all that controversial. Don't rely too much on ice (it's most useful for controlling pain), don't forget compression.

I'd be interested in learning other people's take on this icing issue.

 

[Sheldon]

Ice helps decrease pain. Compression helps to decrease edema. Ice + compression = ideal for the acute sprain or strain. I'll have to dig the reference out. It might be on SomaSimple or Body in Mind; however, there exists some good research to suggest ice does not help with edema.
Clinically, we use the Game-Ready device to assist with our athletes and post-surgical patients. It has varying levels of compresion and circulates ice water through its attachement. Pretty handy, patients love it.

 

[skitd103]

I'm a first year DPT student and I'm pretty familiar with Kelly Starrett. I've never heard anything bad about him and I personally think he is great. He has his DPT but doesn't do much with it clinically anymore (from what I can tell). He is a crossfit coach and he owns a gym, but he also has worked with a huge variety of athletes from olympic athletes and world-class powerlifters to average-joes who are into crossfit, yoga, etc.

I learned a lot from him before I got into my DPT curriculum and now I'm learning things that really go hand-in-hand to his philosophies. I'm a little biased against crossfit but he doesn't teach any of that horrible technique that crossfit has a rep for. He actually preaches proper technique more than anything (along with mobility) and shows how the proper technique will enhance performance and prevent injuries.

That article about ice actually is relevant physiologically. While I do think there is a place for ice (pain reduction or reduce excess swelling when it poses more of risk to damage tissue), I agree that it really isn't that beneficial. Here is why: inflammation is a natural process that is NEEDED for tissue repair. Why would you want to stop that? After an injury, blood vessel vasodilate to increase permeability and to help bring macrophages, lymphocytes, and other inflammatory cells/chemicals. Ice would vasoconstrict those vessels which would somewhat impede that inflammation process. I haven't been able to find much on this next point, but there is research cited in Kelly's article which states that prolonged ice causes a back flow of the lymphatics (which drain the fluid/waste from that inflammation) causing even more edema. I think this might have something to do with the Hunting effect of the blood vessels.

Conclusively, Kelly changed RICE to MCE (mobilize, compression, elevation). This is because mobilization helps pump the lymph away from the injured area (lymph vessels are somewhat similar to veins). No I don't think icing is as bad as NSAIDs, but I see the point he was trying to make. I still believe icing can be effective as a pain reliever and after rehab exercises as long as it isn't used in long durations.