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.