R.I.C.E vs. M.E.A.T

For many years, the R.I.C.E protocol has been the benchmark for nursing musculoskeletal sprains and strains (Quick reminder : muscles get strained and ligaments get sprained). It involves Resting the injured area immediately and embarking on treatment. This prevents reuse of the affected area and minimizes the risk of further injury. A big part of the treatment is Icing the affected area several times a day, usually no more than 20 minutes. Compression of the area is the next step and involves keeping the injured muscle or joint as immobilized as possible via bandages and compression garments (sleeves and stockings). The primary objective of icing and compression is to reduce swelling. The final step is Elevation of the injured area to promote and restore blood flow. R.I.C.E has proven to be an effective method for a number of years and is still utilized today by many physical therapists, strength coaches and personal trainers on their clients.

In recent years, a new alternative called M.E.A.T (Movement, Exercise, Analgesic, Treatment) has emerged and is threatening to replace R.I.C.E. Many of the current research and finding on M.E.A.T conclude that it is a more effective method for treating musculoskeletal injuries and here’s why:

Movement: Upon injuring a muscle, our natural instincts is to limit movement as much as possible. The M.E.A.T protocol suggests otherwise. Movement promotes fluid distribution towards and away from the affected area. Tissues of muscles must contract in order for this to happen. For example, an individual nursing a knee sprain can focus on the eccentric phase of the leg extension machine while a runner with an ankle sprain can use calf raises to circulate fluid to the muscles around their knees and ankles. Movements also prevents adhesion (when fascia sticks together and becomes wound up) which is common in musculoskeletal injuries. The bottom line is an injured muscle or joint can still move.

Exercise: This is a piggyback of Movement. Strengthening the muscles of and around an injured area sends fluid and blood to the surrounding muscles. Exercise selection is paramount and must be approached carefully. Because the affected area won’t be 100 percent, modifications and regression of strength training exercises should be called upon if required. This is basically the rehabilitation phase.

Analgesic: This requires the use of over-the-counter and prescription medications to relieve pain associated with an injury. Acute pain can initially make the healing and recovery process more challenging. NSAIDs like Tylenol and Aleve can be used in the early stages but should be discontinued down the stretch. Though they reduce inflammation, too much reduction isn’t good because inflammation is a vital process injured muscles and joints must go through in order to be healed. Keep in mind that too much consumption of NSAIDs can harm the liver so keep the dosage at a minimum. Other analgesic methods include acupuncture and the use of topical agents.

Treatment: This final phase includes lean tissue functional training and balance work to restore strength, mobility and stability in the injured area. It can also include the use of both cold and heat in the early stages of the injury. Keep in mind that cold reduces swelling while heat restores and promote blood flow. Both are crucial in the treatment of musculoskeletal injuries.

In application of both R.I.C.E and M.E.A.T, consider the following:

  • R.I.C.E still has a place in pain management but it should mostly be utilized during the early phase of the injury when the pain is acute.
  • M.E.A.T should ultimately make up the majority of the recovery.
  • New research shows icing may not be as impactful on joints as thought to be. Ligaments have no blood vessels to transport nutrients to surrounding cells and since cooling slows down metabolism and blood flow, it can actually delay recovery of the tissue. As a rule of thumb, apply ice only to a swollen joint no more than 20 minutes, no more than three times a day for no more than 2 days.
  • In some rare cases, inflammation can actually speak up recovery because it is the body’s natural defensive mechanism against injury. The marines have a saying that “pain is weakness leaving the body” which is basically the point here. Some individuals have to go go through and feel the pain during the early part of an injury in order for it to heal.
  • To prevent frostbites, never apply ice directly on the skin. Instead use towels and protective insulating materials to wrap the ice around the injured area. Many health stores like Rite Aid and Duane Reade sell insulated icing wraps.
  • If you’re still in doubt which method to use, talk to your doctor or a licensed fitness professional.
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Bodyweight Essential : The Plank

The pull-up & push-up exercises are without question two of the premiere movements in fitness. They remain a staple in building lean muscle and strengthening the upper body. Although not definite but if a third exercise were to follow the aforementioned movements, it’ll be the plank. Arguably the most universally preferred choice for developing the core and abdominals, the plank has been around for years and is as ancient as the squat. Planking requires virtually no equipment and can literally be performed anywhere thus making it a favorite for working the abs amongst many fineness enthusiasts.

The simplest way to get into a plank position is by first getting into a push-up position. From there, bend your elbows to 90-degrees and ensure that your shoulders are directly above your elbows. With your weight resting on your forearms and your legs fully extended, the exercise commences by holding that position for as long as possible. Ensure that there’s alignment from your head through your shoulder blades, butt and feet. The plank is an anti-extension exercise which means the lumbar spine will naturally want to ‘sag’ or go into lumbar extension and you have to resist it for the movement to be effective.

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When performed correctly, the plank develops the rectus abdominis, anterior core stabilizers, lumbar spine, quadriceps, glutes and shoulders. It requires major involvement of the shoulder girdle thereby making it difficult for those with preexisting shoulder pain. Individuals with chronic shoulder pain should seek out regressed versions of this movement (more on that later). Different metric standards exist for the plank making it difficult to determine what hold time is considered ideal. Some older individuals may not be able to hold a 1-minute plank while a 25-year old female could easily hold a 2-minute plank. As a rule of thumb, hold your plank for as long as possible and until your abs and shoulder start to burn.

For those interested in some challenge and competition, the world record for the longest plank belongs to Mao Weidong of China with a time of 4 hours 26 minutes and was set in September 2014.

If you enjoy doing the plank and would like to add some new challenges, here are a few progressions:

1. Body Saw Plank: This progression of the plank requires a TRX, stability ball or gliders. Set up the way you would for a regular plank but with your feet and legs placed on top or attached to either of the aforementioned accessories. From that position, glide your entire body back as far as possible while keeping your forearms stationary and then glide it forward as far possible again. If using a stability ball, the forearms should be mounted on a bench with legs extended on the ball. The advantage of the body saw plank is that it’s quick and it eliminates what could potentially be a long hold time. This is ideal for individuals pressed for time.

2. Plank on a Stability Ball: The unstable surface of a stability ball presents a unique challenge. Going from planking on the floor to planking on an unstable surface proprioceptively forces the body to adapt to new demands. Balance and motor control are enhanced thus forcing the abdominal muscles to react in a way it never did with the conventional plank. Variations include legs on ball/hands fully extended on the floor, forearms on ball/feet on the ground, hands fully extended on ball/feet on the ground and forearms on bench/legs extended on ball. Due to the advanced nature of this exercise, many people will have a hard time mastering it initially. Take your time in perfecting the old-fashioned plank before adding this progression to your routine.

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3. Lifting One Leg/One Arm Up: This is a very challenging progression of the plank so it must be carefully performed. This progression is performed by either lifting one leg up or one arm so you’re planking on only 3 of your 4 limbs. To plank on leg, simply lift either your left or right leg just a few inches off the ground. A higher lift will result in more gluteal activation. To plank on one arm, take one hand off the ground and extend it in front of your or place it on your opposite shoulder. The latter requires the hands to be fully extended. With either progression, the body will naturally want to rotate and you must resist falling to one side. The anti-rotation component coupled with anti-extension makes this progression ideal for strengthening the entire abdominal region.

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4. Plank Push-Up: This creative plank progression combines a traditional plank and a push up making it a great bang-for-your-buck choice for effectively targeting the abdominals, chest, triceps  and anterior deltoid. To perform this exercise, assume a plank position. From there, extend both your elbows one at a time until you’re in a full push-up position. Reverse the actions by bending both of your elbows and return to a plank. You can alternate hands or continually push off the same hand, though the former is more effective because both arms will be put to work. Intensity can be measured in reps (from plank position to push-up is 1 rep) or timed.

For those dealing with chronic shoulder pain, planking on a bench can be just as effective as planking on the floor. While holding until the abs begin to get a good burn is always recommended, the exercise should be discontinued if the shoulder region begins to flare up. Individuals with torn shoulder labrums and rotator cuff injuries should be especially conscious of this. This regression is also ideal for beginners who lack adequate core strength.

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If you routinely perform planks and have never done any of the progressions, trying adding some of them to your workouts. Most plank variations can be done anywhere which means you can do them in the office on a quick break or at home during a TV commercial break of your favorite shows. Exercises like Deadlift, Squat and Overhead Press can improve plank strength and hold time because of the recruitment of the lumbar muscles in the aforementioned exercises. It’s no surprise that individuals who are great at planking also perform compound movements.

I’ll talk about the side plank (the sister exercise to the traditional plank) on another post.