The long standard injury treatment is remembered by the mnemonic RICE, which stands for Rest, Ice, Compression, and Elevation. However, this often-used treatment approach is not necessarily the best approach for healing.
It would be wrong to throw it out completely, as there is a time and place for RICE. Specifically, RICE would also be an appropriate choice when compartment syndrome is a concern, which is a very serious complication that needs emergency management. Compartment syndrome most commonly occurs with bone fractures and with significant muscle trauma. Another instance of appropriate use would be after an acute injury. During the first 2-4 hours the RICE approach can be helpful in reducing the immediate pain of the injury. However the RICE approach should be quickly replaced with one that better supports healing, as healing is always the ultimate goal.
For the larger majority of sprains and strains I prefer an approach that is gaining traction in the medical community known as MEAT, or Movement, Exercise, Analgesia, and Therapy. Unlike muscles, other soft tissues like ligaments, tendons, and cartilage have poor blood supply and circulation, and so they don’t heal as quickly as muscle when injured. Improper or incomplete healing of ligaments can easily result in chronic injury, joint instability, and pain syndromes. The MEAT approach supports tissue healing improving recovery and outcome.
Let’s touch briefly on each element of the MEAT treatment approach.
Movement: Movement to pain tolerance is necessary for a couple of reasons. First, it promotes the movement of fluid to and from the injured area. The lymph system moves fluid from tissues and relies solely on muscle contractions to move fluid. Secondly, movement helps the ligaments heal under a small amount of stress. Placing the injured ligament or tendon under a small amount of load helps the new tissue grow in an organized way increasing its strength along the direction of tension.
Exercise: This is the next level beyond gentle movement that encourages further growth and strengthening of tissues, and like movement, is a great way to encourage circulation. Increased circulation allows for fresh blood and fluid to come into the injured area while facilitating the clearance of damaged tissue. Building on the movement concept above, for tendon injury the focus should be on eccentric loading, and remember, always within the pain boundaries. Your tissues are in a delicate state as they heal, you don’t want to re-injure an area by being too aggressive early on in recovery. A good sports med doc, physical therapist, or sports chiro will be able to provide you with targeted exercises related to your specific injury.
Analgesia: It has been shown that intense pain reduces one’s ability to heal, so pain management is an important component of injury treatment. NSAIDs should be avoided after an injury, as there is good evidence that this class of medications inhibit healing. This is not hard to imagine, as NSAIDs reduce inflammation and inflammation is a critical step to healing. Tylenol used sparingly can help reduce pain without inhibiting healing. Keep in mind that Tylenol is toxic for the liver, so the recommended dosing should never be exceeded. Acupuncture can be a great tool for pain relief. There are other naturopathic treatments, including herbs and supplements that can be very helpful at reducing pain. If your pain is not reduced enough discuss prescription medication options with your doctor.
Treatment: This is a rather open broad category. In my practice, my recommendations change based on how acute the injury is. I have found some particular supplements/nutrients to be quite helpful for my patients, particularly in the early stages of healing (first several weeks). You can find more info here about these supplements and are available for purchase as a bundle or individual components. I also find that kinesiology taping (think Olympic volleyball players), acupuncture, and contrast hydrotherapy, which is alternating hot and cold application, can be great during the acute phase of healing. If the injury is chronic, I find that prolotherapy or PRP treatments work great at encouraging injured ligaments, tendons, and cartilage to heal. In general, it is my opinion that cortisone injections should not be used to treat ligaments. Cortisone inhibits healing and ultimately leaves the structures weaker and more vulnerable to re-injury.
In summary, RICE does have a place at the table for injury management, but it should be used sparingly and in very specific injury situations. In general, for most injury, the MEAT approach should make up the majority of the treatment. More information on the potential detrimental effects of icing can be found here.