Kobe Bryant tweeted this out last week:
— Kobe Bryant (@kobebryant) January 12, 2013
Soaking in an ice tub is no fun, but is it useful?
The medical literature is very mixed on this. First, we must understand the problem. Bryant may not be as old as you think, but his knees are functionally much older. Through both degeneration and the removal of damaged cartilage, Bryant has little functional cartilage inside the knee. His meniscuses are worn down, as is the articular cartilage that overlies the bones (femur and tibia) that hinge at the knee.
Without this cartilage, every step Bryant takes is like a car driving without shock absorbers. Each jump, stop and landing is like a pothole, causing pain and swelling from the bone-on-bone contact.
Bryant has been willing to take on other therapies to help him play. He famously traveled to Germany to undergo Orthokine therapy. Orthokine is a process where a patient's blood is removed from the body, spun in a centrifuge to extract a platelet-rich plasma, then mixed with other substances before being injected back into the damaged area.
The procedure is not unlike PRP injections, which are becoming more common in sports medicine. However, because it is not approved for use in the United States, those that want to try it have to head overseas, lending it something of a dark air.
Bryant has also taken regular injections of lubricant into his knee. The most commonly used one is Synvisc, a dark viscous liquid that at first glance looks like motor oil (Newer formulations look less "refined.").
The purpose is not unlike oil: It is designed to provide some level of lubrication between structures inside the knee. Rather than the cushioning of the natural cartilage, the lubrication prevents the bone-on-bone grinding from causing bone spurs and lesions.
The downside of these type of injections is that they are very temporary. The body absorbs the substance over a matter of weeks, requiring a refill every so often depending on the patient's tolerance. Team doctors have become very adept at timing these injections, often saving them until just before big games.
Since Bryant's medical options are limited, the one thing he can do regularly is try to limit the swelling with ice. Whether it is in bags after the game or in a cold tub like Bryant was pictured, the effect of ice is well known.
Or is it?
There's surprisingly a lot of controversy about how to use ice properly inside the world of sports medicine. On the "pro" side, research indicates that the known effects—reduction of swelling and inflammation, short-term analgesic and some restorative acceleration—are a positive for an athlete, while the therapy itself is inexpensive and nearly universally available.
On the "con" side, there's a much larger body of research. This is largely because they have had to make their case more forcefully. It is common knowledge that ice works, but for an athlete, the effects that it does have in the short term may have longer term consequences.
The use of ice immediately after activity, especially to reduce inflammation such as in a basketball player's knees after a game or in a pitcher's arm after a start, does have some negative effects. The cold may slow the body's natural response to healing, slowing down the recovery. There has also been performance-based research that indicates little actual effect.
Recent research, most famously at the University of Alabama, has been focused on ice baths. While similar to what we saw in Bryant's tweets, the Crimson Tide use ice baths differently. The sports medicine staff sets up several bathtubs filled with ice (On particularly hot days, they do this in a tent just off the practice field).
Players coming off the field will dip in quickly, getting a shock of cold, reducing their core temperature quickly without interfering too much with the inflammatory response. It's an attempt at getting the benefits of ice therapy without the negatives. With the results, it's hard to argue against Alabama's use, though they are hardly the only team to use this.
Proponents will cite Alabama's three national titles, ignoring teams like Kentucky and UConn that use similar therapeutics.
Bryant's (Kobe, not Bear) use of the ice bath is probably something he has done since he came into the league. The cold tub is universal in most training rooms, especially ones run by old-school guys like Gary Vitti, who has been the Lakers' head trainer almost as long as Bryant has been alive.
The tweet was an interesting insight into what Bryant and the medical staff go through to keep him available and as functional as possible. With that said, the look behind the curtain and inside the training room actually tells us very little. Bryant's knees and the Lakers' fate still have a very cloudy future. Until then, Bryant will have more tweets like this:
The tub of youth is calling me tonight! Lol
— Kobe Bryant (@kobebryant) January 16, 2013
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