TO MOVE OR NOT TO MOVE AN INJURY: THE R.I.C.E. PROTOCOL VERSUS THE M.E.A.T. METHOD

With the exception of fracture and other serious injuries that warrant immobilization, the benefits of movement can never be ignored. First, movement in itself is the basis of physical activities, which helps boost physical health, including the processes that are involved in injury repair and healing. Movement increases blood and oxygen flow, which are both important for healing. When it comes to treating acute soft tissue injuries, the RICE protocol seems to be the most popularly used method, but this, however, contradicts the basic premise of movement.

The R.I.C.E. Protocol

We’ve always been told of the use of the RICE if we hurt our ankle, and we’re probably be putting an ice pack on it, wrapping it, and elevating it, thinking that these will help with the injury. We’re practically not sure about it, but we continue to follow this principle.

• Rest: Keeping the injured area from any movement to prevent aggravation
• Ice: Applying cold packs to decrease the inflammation and limit the bleeding
• Compression: Wrapping an area with compression bandage to reduce bleeding and swelling
• Elevation: Elevating the area above the heart drains excess fluids out and brings down swelling

The R.I.C.E. protocol is designed to reduce the inflammation following an acute injury, and so reduce the blood flow. Inflammation begins with  a decrease in blood flow to create a clot and control the bleeding but later proceeds with an increase to commence repair. And there is where the conflict begins.

TO FULLY ASSESS WHETHER THESE STEPS CAN ACTUALLY HELP WITH THE HEALING PROCESS OR NOT, IT’S IMPORTANT TO UNDERSTAND THE PHYSIOLOGICAL PROCESS THAT ARE INVOLVED INJURY, FROM THE MOMENT OF TRAUMA THROUGH THE RECOVERY…

Injury recovery involves three phases of inflammatory, repair, and remodeling. It’s a sequence of events where one must occur before proceeding to the next, which means that inflammation must be successfully completed before the injury can undergo the repair process, which must also be completed before the remodeling phase can take place.

Inflammation is the body’s defense mechanism and aims at protecting the injured tissue from aggravating while preparing it for repair. It begins with a period of vasoconstriction or the narrowing of the blood vessels, restricting the blood flow and allowing blood clot to form to prevent excess blood loss. After which, vasodilation occurs as the blood vessels dilate to provide oxygen-rich blood to the area. Certain cells enter the damage area to carry out their specific functions. Neutrophils prevents infection, while macrophages clears the area of dead cells and bacteria and produce growth factors essential for tissue repair, regeneration, and fibrosis. The waste products produced by cells are drained by the lymphatic system, which requires muscle contractions for propulsion.  Once excess fluid is drained, the repair process begins. New blood vessels are formed to provide additional supply of oxygen and nutrients and new tissues are developed to form the structural foundation for tissue reconstruction. Following these processes, tissue remodeling is initiated to reinforce the newly formed tissue, and the recovery process has completed.

The  Flaws in the R.I.C.E. Protocol

The R.I.C.E. is a lot about preventing swelling, but swelling naturally occurs as new blood and nutrients come in.

• REST:As mentioned, lymph flow is necessary to drain the accumulated waste from the injury, and this requires voluntary muscle contraction. Therefore, rest period will not adequately evacuate the damaged site and the area will remain congested with metabolic waste, which delays the completion of the inflammatory process, and the recovery.
• ICE:The use of ice is to reduce inflammation. However, as described, inflammation is an important part of the recovery process and anything that disturbs the inflammatory phase also delays healing. Inflammation allows transport of inflammatory cells to the injured site through the subsequent vasodilation. The application of ice causes prolonged vasoconstriction and therefore prevents this important process.
• COMPRESSION: Compression is generally aimed at stopping bleeding and reducing swelling. However, there is limited evidence that compression can enhance recovery.
• ELEVATION:Elevation is intended to reduce swelling of the extremities through gravity. However, there is no evidence available for the effectiveness of elevation and that it can enhance tissue repair.

The M.E.A.T. Method

The M.E.A.T. incorporates movement in the protocol. It emphasizes the importance of maintaining joint range of motion and muscle strength through early mobilization.

• Movement: While rest is a necessary step, gentle movements at the pain-free and available range should begin the soonest possible time. Not only that it will maintain strength in the muscles, but it also provides adequate load to growing fibers, helping in the right alignment. Movement encourages blood and lymph flow, flushing out waste while bringing in fresh blood and oxygen.
• Exercise: Following gentle movements, exercise-based rehab with resistance and stretching can begin to recover loss strength and flexibility.
• Analgesics: Pain impedes movement of the injury, and nonsteroidal anti-inflammatory drugs (NSAIDs) are the usual prescription. However, NSAIDs inhibit inflammation and therefore, may delay the initiation of the recovery process. Analgesics in this method specifically refer to pain medications of natural sources, such as ginger, turmeric, capsaicin, and valerian root, which are known natural pain remedies.
• Treatment: This refers to a wide range of modalities that can be implemented based on the individual’s specific needs, specifically on the signs and symptoms, stage of healing, and severity of injury.

THE TAKEAWAY:

Inflammation sets the stage for healing. Regardless of the stage of recovery and severity of injury, the healing process takes off from inflammation While rest is necessary to prevent further injury and to allow the inflammatory process to take place, early mobilization is just as important to prevent adverse effects of immobilization. Both conditions are important, and it’s just a matter of timing and prioritization.

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