• Dr. Alexander Baldwin, PT

Healing Strategies: RICE vs MEAT


The convention and what most people have been taught for a long time is that after any injury, rest is the appropriate response. RICE is an acronym that stands for rest, ice, compression, and elevation. While these are effective strategies to reduce inflammation and pain, they can delay recovery, lead to an increase in the likelihood of recurring injuries, and are less effective than other strategies. This method is effective and helpful in the early phase of healing, such as the first day or two after an injury; however, RICE is counterproductive to long term healing. Inflammation after an injury is a normal, healthy, and necessary part of the healing process and RICE tries to eliminate inflammation. Without inflammation, healing will be delayed, which causes the tissue to not return to its previous strength capacity, resulting in scar tissue and making the issue chronic.


Rest- Rest is an important component of recovery, but rest alone will never allow healing to the fullest. Muscles, tendons, ligaments, bones, nerves, and even the brain need to be used to a certain extent when injured in order to promote strengthening and full recovery. In an injured muscle, tendon, or ligament, the body lays down connective tissue (collagen) in a random arrangement to cover and repair the damaged area. However, rest does not allow the new fibers to be properly oriented in line with rest of the tissue and, consequently, leads to weakness, recurrent injuries, and limitations in motion and strength.


Ice- Ice is useful for reducing blood flow, pain, and inflammation in an injured area. This is counter productive for a healing body. Inflammation is your body’s normal and natural healing response to an injured area. By applying the RICE method -- particularly ice and compression -- you reduce blood flow to the area and reduce your body’s ability to repair what was damaged. The swelling and heat are a response to increased blood flow for the body to repair and clean up the damage. Inflammation also allows necessary resources to move into the damaged area to repair it and allow proper healing. Ice can be useful for reducing pain and is something that should still be used for an acute injury, but should not be used for significant durations to ensure that proper healing can occur.


Compression- Similar in effect to ice, but without the reduction in temperature, compression reduces inflammation by applying external pressure to the injured area to prevent more inflammation from arising. This may help it feel less painful and more supported, but this limits your body’s capacity to heal as mentioned above. Compression is more effective with chronic inflammation when the body’s natural inflammatory response is not controlled, such as persistent inflammation for several weeks or chronic swelling. For example, immediately after an ankle sprain compression should not be applied.


Elevation- Elevation is used to help reduce inflammation and swelling in general. To be effective, the swollen area must be elevated above the level of the heart. For example, if the ankle is swollen, then you must be laying down with the ankle elevated. If you are sitting upright with your ankle on a chair, then it will not reduce the swelling as the ankle is not above the level of the heart. Elevation uses gravity to drain the extra fluid from inflammation in the limb. This poses the same limitations as ice and compression regarding inflammation and appropriate healing.


An alternative to the RICE method is the newer MEAT method. MEAT stands for movement, exercise, analgesics (pain medication), and treatment. The MEAT method is more effective at reducing pain, chronic inflammation, and improving strength. It also ensures a more rapid return to activity and reduces the likelihood of reinjury. This applies not only to injuries of muscles and tendons, but also to concussion injuries as well.


Movement- Movement is important to reduce stiffness, prevent abnormal scarring, prevent loss of motion, and help limit excessive and stagnant inflammation without impairing your body’s natural ability to heal. This should generally be gentle with no weight on the injured area, slow, and not painful. Movement allows for your muscles to help cycle the inflammation, reduce sensitivity of the injured area to movement, and reduce joint stiffness caused by inflammation.


Exercise- Exercise is different from movement in that exercises should be deliberate, repetitive movements with the intention of building strength, tissue tolerance, and improving range of motion. This helps improve blood flow, stimulate strengthening of the tissue, and prevent scar tissue, which all work to allow strong, healthy tissue to repair the damaged tissue. Exercise will allow proper alignment of the healing tissue fibers. This should be done gently at first, but as the tissues begin to heal, the duration, intensity, and level of challenge of exercises can be increased.


Analgesics- Analgesics are pain relieving medications. Analgesics can be helpful to allow movement and exercise before pain starts in order to allow further strengthening, movement, and function. These should generally not be anti-inflammatory medications for reasons listed above, but many options are. Anti-inflammatories can be used if nothing else is available, to avoid more intensive medications such as opioids, or due to medical issues with other analgesic medications. Over the counter medications you could consider include Advil, Ibuprofen, or Tylenol. Consult your doctor and pharmacist first about medication interactions and which medications are safe for you.


Treatment- Treatment is most important with moderate to severe injuries that take more than a few days to heal or are significantly painful enough to limit normal activities. For example, a significant ankle sprain that prevents walking, a strained back, a stress fracture, or a torn muscle are considered moderate to severe injuries. If swelling, pain, lack of motion, or weakness persist more than a few days then it is best to seek professional medical treatment. Seeing a Physical Therapist or Occupational Therapist, depending on the injury, is vital for a full recovery. A Physical Therapist will prescribe specific exercises and work with you to get back to where you want to be and provide guidance and education on what to expect and when/how to progress.



Research:


Low Back Pain- Bed rest with acute low back pain was shown to be less effective at improving pain and function compared to gentle movement and exercises.


General Healing- Studies have shown that rest as the primary intervention after injury significantly delays healing and is widely over recommended. While rest is important it is inadvisable to avoid all activity.


Concussion- Studies have shown that rest, darkness, and limiting stimuli after concussion does not aid in recovery and actually delays recovery. Evidence suggests that controlled activity that brings no symptoms is perfectly safe and beneficial to the recovery process.

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