MEAT v RICE
May 25, 2014
I have played sport for as long as I can remember football, rugby, cricket, hockey and skiing and everyone time I have been injured I have used and recommended to my patients the traditional RICE (Rest, Ice, Compression, Elevation) or NICER (NSAIDs, Ice, Compression, Elevation, Rest) protocol.
It would seem now that this method is not the best for all soft tissue injuries. The new standard for injured ligaments and tendons should be MEAT (Movement, Exercise, Analgesics and Treatments).
So why the change?
When we sprain a ligament there will be pain, instability, and swelling of the tissue. Traditionally it has been thought that the swelling is harmful and it needs to be reduced as soon as possible.
There are however differences in the blood supply to muscles, and that of ligaments and tendons. Muscles have a very good blood supply (hence the red colour of meat) and generally heal quickly. Swelling in muscle can lead to problems so reducing inflammation by the RICE method is beneficial.
Tendons and ligaments do not have such a good blood supply (hence their white colour) and so therefore heal more slowly and often progress to a more chronic injury. Ligaments are made of collagen and they hold bones together at the joint to prevent excessive movement. They receive a limited supply of blood from the joint arterial plexii but due to their static stabilizing nature they do not require a large blood supply. The area where the bone attaches to the ligament is the area most frequently injured and also the site of the most chronic sports injuries.
This is where the problem with the RICE method arises as it is designed to reduce blood supply by immobility and icing, which leads to slower healing in ligaments.
How does the MEAT method help
1). Movement helps improve blood supply to the injured area and that increased blood supply will help will increase nutrients and metabolites that repair and remove damaged tissue.
2). Exercise gentle range-of-motion exercises also help improve blood flow to the injured area.
3). Analgesics such as Tylenol can be useful as they relieve pain without affecting the body’s healing mechanisms. Some studies have shown that use of anti-inflammatories may reduce the body’s ability to heal (Effects of Nonsteroidal Anti-Inflammatory Drugs on Bone Formation and Soft-Tissue HealingLaurence E. Dahners, MD and Brian H. Mullis, MD)
4). Treatment to increase blood supply to the tissue. This has always been one of the foundations of osteopathic treatment to improve arterial blood supply to damaged tissues. Osteopathic treatment can use a variety of techniques such as deep soft tissue massage, inhibition techniques to fibro-osseous junctions and joint articulation to improve blood supply and healing.
To conclude then I would recommend the MEAT method for all ligamentous injuries such as the numerous knee and ankle injuries that I regularly treat in my osteopathic clinic.