[Dr Damien]

Well like I said before lateral thinking is fine, there is absolutely nothing wrong with it.But to make a really arguable case, then something should be wrong that one has seen or experienced over and over again. first of all, the question I have is what was the grade of the ankle sprain, how long did you have to treat for?since we all know that ligament sprains do not always carry the same extent of injury what was the situation with the patient you treated. I can not say what the situation would be if I gave u 30 patients to treat with the same protocol with differing scenerios.see what I mean?

Many of these techniques you mention are also lacking in evidence base so why pick out a technique that has consistently shown to be effective?I dont know if I am making sense? the evidence base of acupuncture is poor even though new papers turn out every other day.

Cryotherapy involves several techniques and my point is understanding why you do whatever you do.

Cryotherapy is not a symptomatic treatment alone, if anything at all acupuncture is because it addressed only pain in the most part just like Tens would.Myofascial release techniques work just like any soft tissue mobilization so where is the justification for thinking ice is problematic?

You sound like you have a great of experience doing what you do but I tell you if cryotherapy was not working effectively I would support your argument a 100% but it is and we have the literature to prove it.

I like the way you think and it is good, perhaps you should work more in research rather than in the clinic.this is where you and I are different, I will give weight bearing exercise to the upperlimb if I see reason to, for instance in a neuro case were weight bearing experience is important not because the patient will walk on his hands but because it helps joint memory.

I agree with you that you need to make the area satisfactory for healing but I tell you one thing about scars and inflammation, they can get excessive depending on personal body responses. So I would not go treating every patient like I treated the last, I would rather judge from what I see and act accordingly, if inflammation is not excessive then I may not consider ice. this brings me back to my initial question what was the state of ur patient?

if the body is so good at handling its own problems then why do we have diseases?why do we die?why can a simple infection turn fatal, why do we even need to guide healing? Maybe if we had never introduced the concept of medicine before then we may have evolved into superhuman beings but that is not the case.

I had a cut in my wrist some few years backthat was pretty deep but not deep enough to cause too much damage. I got it stitched and always tried to move it so it did not get stiff. yeah, if i did not have the pain to guide me then I may have moved it too much and caused more damage. Then again if I did not have the inflammation controlled with drugs who knows what the scars may have been like. this is eight years since and I still have a scar to show for it although its clearing up. Imagine having an excess scar tissue that is one ugly to look at disorganised in collagen laid down and quite frankly was a keloid.

So scar tissue are what they are temporary bridges between injured sites, they are not the main tissue but a replica and they need to be moved to ensure they organise properly. That is what frictions and mobilizations do.

Concerning the treatment of US being non effective, you need to be clear where the literature says US is not effective and its mostly in degenerative conditions and the reason is simple.Its degeneration, not too much inflammation going on, modalities designed to address that are likely to be ineffective.

I'm sure you know some physios who still believe US is ok and they have every right to believe so because they have used it and it worked.

trust me if you left a tendon, muscle or ligament to heal on its own.If you are lucky nothing will happen, if you are unlucky and with a muscle you get tethering or calcifications and you suddenly try exercises and you get myositis ossificans then you will appreciate the value of some of these doctrines.

Manual based physios are not strong advocates of therapeutic modalities anyway. I am a manual physio and I dont use any of them not because I do not want to but because I think I can do something with my hands;its a training thing for me.

If you must criticize anything at all, start by criticizing some of these techniques you use that lack evidence base.

I for one am not against anything that is being done, I am fully evidence based but I am also very practical, if the evidence is strongv and consistent within all parameters, sample size, blinding, randomized,methodology is good , equipments used are reliable and results are consistent then its most likely good.

when you think of changing the practice prove that something is wrong somewhere causing abnormal results, its that simple not imagining that things should work according to how you are used to doing them.Then everyone might as well claim that their practice is the best.see what I mean?

I respect ur opinion because it takes a fantastic mind to think like you do but I will be honest with you after sampling every single evidence out there and you have criticized them properly, then you can make an informed statement. For someone who is pro-acupuncturev and Myofascial release ,i am surprised that you want to pit against ice when these ones are even more on shaky grounds evidence based wise.

if the thought still bothers you and you cant seem to find the evidence to answer your question, then carry out a study and get it published but you must realise nothing that comes out from your study says anything, its only going to be an added piece to the jigsaw puzzle because after critical appraisal for methodological issues, no one's study is considered to be above anyone elses. they all add to knowledge somehow.

thanks for your reply, holla me if you feel the need to discuss anything, we could always clarify each other out.

by theway, you do not see abnormal scar tissue or excessive adhesions because the sites are deep and are not fully immobilized. so consider what is happening to your patient during your management as well, what are they doing or not doing.