RICE vs MEAT: Which is better for an acute injury?
RICE is the acronym for Rest, Ice, Compression and Elevation. It is considered to be the standard approach to an acute injury within the initial 24 to 48 hours.
The basis of this approach is that inflammation causes the pain associated with the injury. Take away inflammation and you take away the pain.
In addition to RICE, conventional medicine recommends over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen. These drugs work by blocking the chemicals which initiate the inflammatory cascade.
NSAIDs can cause ulcers, inhibit bone healing after fracture, as well as inhibit the healing of tendons and ligaments.
RICE + NSAIDS = less pain now, but sub-optimal healing and possibly, chronic pain later.
The problems with the RICE approach:
Rest = lack of movement. Movement is necessary to bring in fresh blood and nutrients, remove waste and promote lymphatic drainage of inflammatory metabolites.
It has only been within the past few years that surgeons have started recognizing the importance of movement after surgery to facilitate the healing process.
Research regarding the clinical effectiveness of ice (cryotherapy) is lacking. In addition, ice causes local vasoconstriction of blood vessels, thereby preventing the healing process.
In addition, ligaments are essentially avascular. They have very few blood vessels to deliver nutrients for repair. They rely on diffusion of nutrients from the joint. Icing inhibits this process and slows down cellular metabolism.
Compression and elevation are both important. I’ll get to these soon.
There is an emerging trend away from RICE and toward MEAT – Movement, Exercise, Analgesia and Treatment.
Before I serve the MEAT, let’s talk more about inflammation
Inflammation is our body’s natural mechanism for healing. It involves a complex series of biochemical events which concentrate white blood cells, platelets, and growth factors to the area of injury to allow cleanup and repair.
Now for the MEAT…
Movement of an injured body part prevents the formation of adhesions and increases circulation, which is essential for transporting nutrients to the injured area and carrying away metabolic waste.
Ideally, range of motion movements should begin immediately after the injury (assuming that a fracture has been ruled out or movement is contraindicated for some other medical reason).
After the acute stage of injury, corrective Exercise should be implemented. I like to use the National Academy of Sports Medicine (NASM) Corrective Exercise protocol.
- Inhibit the tight muscles which have reflexively become hypertonic to provide a temporary “splint” to the area, by using trigger point therapy or self myofascial release. This therapy involves compression and massage, both of which promote circulation and relaxation of soft tissues. Compression is usually held for 30-60 seconds.
- Lengthen tight muscles through Active Isolated Stretching (AIS). AIS involves stretching the areas by contracting the opposite muscles. This is generally performed ten times for two seconds.
- Activate the weak muscles, which are generally the antagonists or opposite to the tight muscles. This creates balance around a joint and more optimal movement patterns. These are isolated types of exercises that focus on one particular muscle. The acute variables are two sets of 10-15 repetitions, with a 4/2/1 tempo (the focus being on the eccentric, or lengthening aspect of the contraction), e.g. calf raises.
- Integrate full body dynamic movements that mimic activities performed in daily living (e.g. pushing, pulling, squatting and lunging) – two sets of 10-15 repetitions, performed slowly and controlled.
Analgesia is the use of medications (whether natural or pharmaceutical) to decrease pain without interfering with healing.
You heal faster when you are not in pain. A common over-the-counter analgesic is Acetaminophen (i.e. Tylenol). Tylenol can help to decrease pain without inhibiting healing (i.e. blocking inflammation).
Unfortunately, this drug has adverse effects on the liver.
There are a number of over-the-counter nutritional supplements can be effective for pain.
I like the enzyme bromelain, found in pineapple. Bromelain can be effective for mild to moderate pain without interfering with normal tissue healing. The dosage is 500-1000mg three to four times per day between meals.
A non- chemical form of analgesia is electro acupuncture, which works by stimulating endogenous opiates (i.e. your body’s natural pain killers, AKA endorphins) as well as stimulating your body’s four major healing systems: Immune, Circulatory, Nervous and Endocrine.
Alternating heat and ice increases circulation and helps with healing – heat two minutes, ice 30 seconds – do this about ten times, three to four times per day.
Other effective treatments for acute injuries include manual therapy such as fascial release, dry needling and Voodoo Flossing- Compression with movement (see last week’s blog).
I’m all for plants, but when it comes to injuries… I prefer MEAT.