RICE (rest, ice, compression & elevation) is a standard treatment protocol for acute sports injuries. But, what if I say that for ligaments and tendons, RICE can actually hinder the healing process. Please read on if you like to find out a little more.
Muscles have very good blood supply while tendons and ligaments have very poor blood supply. So if you reduce blood supply (and hence decrease blood flow & nutrients) to ligaments & tendons by administering RICE, ligaments and tendons may take a longer time to heal as a result.
The MEAT (movement, exercise, analgesics & treatment) protocol on the other hand is proposed to be superior to treating ligaments and tendons.
Movement - The key here is controlled movement. Controlled movement of the affected area/ limb will stimulate blood flow to the ligaments & tendons while allowing for the regenerating collagen fibres (or scar tissue) to be laid in the areas of stress to improve recovery.
The authors in a study of patients with ankle ligament sprains had better treatment outcomes (less swelling, and quicker return to sports) with controlled functional movement treatment compared to immobilization (Kerkhoffs et al, 2002).
Exercise - Again here the key is controlled & correctly prescribed exercises. Range of motion, strength and especially proprioception (joint position sense) help improve function and weight bearing in patients with acute ankle sprains (Bleakley et al, 2010).
Analgesics - It is suggested that natural analgesics such as proteolytic enzymes e.g. bromelain (found in pineapples), papain (found in papayas) and not anti inflammatory medications (which can hinder healing) be used as natural analgesics decrease the painful swelling but do not stop the natural inflammatory reactions to lead to healing. Codeine (a narcotic) can also be used, although large amounts may cause constipation.
Treatment - Well, not much to add here except to say that you need a competent physiotherapist (that's why you need us at Physio & Sports Solutions) to implement evidenced-based treatments to assist in your recovery and quick return to sports.
It is important for me to point out that RICE should still be used in acute muscle strains & injuries. It would be best to incorporate both RICE & MEAT in the treatment of soft tissue injuries depending on where the injury is, which stage the injury is at and what the injury is.
Bleakley CT et al (2010). Effect Of Accelerated Rehabilitation On Function After Ankle Sprain: Randomised Controlled Trial. BMJ 340: c1964
Caring Medical and Rehabilitation Services (2010). MEAT vs RICE Treatments. Retrived from http://www.caringmedical.com/symptoms/meatvsrice.asp
Kerkhoffs GMMJ et al (2002). Immobilisation And Functional Treatment For Acute Ankle Ligament Sprains In Adults. Cochrane Database of Systematic Reviews 2002, Issue 3.
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About Gino Ng
Prior to joining Physio Solutions and starting up Sports Solutions, Gino Ng worked as a senior sports physiotherapist at the Singapore Sports Council (SSC) from 1999-2009. He graduated with a double masters in Musculoskeletal and Sports Physiotherapy from the University of South Australia on a SSC sponsorship.
Gino's position is perhaps most unique amongst sports physiotherapists in Singapore having seen all sides of the field as a practitioner, an athlete and as a patient.
His special interests are in the treatment of articular cartilage injuries having done research in the area whilst undergoing his postgraduate training. He specializes in treating sports injuries, as well as devising sports rehabilitation programmes after reconstructive surgeries to the shoulder, knee and ankle joints.
As a former national triathlete, Gino is a 2-time Singapore National Triathlon champion (2000-2001), National Duathlon champion (2001), 10-time winner of the National Vertical Marathon (1998-2001, 2004-2005, 2007-2010). He has also placed 4th at the 2001 Asian Duathlon Championships in Hong Kong and made several podium finishes in the Asian Cup Triathlon Series events over the years while holding down a full time job as a physiotherapist.
Partly as a result of his gruelling training regime, Gino needed 3 knee surgeries in 2002 and 2003. After which he made a comeback and placed 4th in the 2005 SEA Games triathlon event.
When not participating, Gino has kept close to sports, travelling widely with the Singapore medical teams for major overseas events such as the various SEA Games, 2002, 2006 Commonwealth Games, the 2006 Asian Games and he is the only local Singaporean physiotherapist to have been to both the 2004 Athens and 2008 Beijing Olympics.
Gino is also one of only three certified Kinesio Taping Instructors (CKTI) in Singapore and teaches the Kinesio Taping Level 1, 2 & 3 courses. He is also a frequent speaker at symposiums and sporting events.
While out cycling in April 2013, Gino had an accident and fractured his skull and spine. Thankfully, he is a lot better now and is back working part time. Having neck and back pain? Well, now you know who came back from a broken skull and back.