Wednesday, February 29, 2012


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

Kerkhoffs GMMJ et al (2002). Immobilisation And Functional Treatment For Acute Ankle Ligament Sprains In Adults. Cochrane Database of Systematic Reviews 2002, Issue 3.

Sunday, February 19, 2012

More On LARS

Have a look at the evidence on LARS for ACL reconstruction posted at the Physio Solutions blog.

You can find it here.

Tuesday, February 14, 2012

Happy Valentine's Day

Happy Valentine's to all our patient's and readers. Remember to love your heart as well and exercise and remain strong.

*Picture by Jessica Hische