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M.E.A.T. Instead of R.I.C.E. for Soft Tissue Rehabiliatation

For many decades , the acronym R.I.C.E. has been used to treat all acute soft tissue injuries (viz. muscles, tendons and ligaments). It means you Rest to prevent the area from further injury, and Ice, Compress and Elevate the area to decrease swelling and inflammation. The use of ice, in the form of packs or ice baths, to reduce inflammation and pain is now being challenged, since there is no evidence to prove that it actually speeds up recovery ( as per researchers for the British Journal of Sports Medicine, the Journal of Strength and Conditioning Research and the National Athletic Trainers’ Association).

In support of this, research published in the Journal of Applied Physiology, and the Journal of Strength and Conditioning Research, suggests that the use of ice may delay muscle repair by inhibiting macrophage activities (these are important immune system cells), slowing down muscle regeneration and collagen synthesis. Cooling the tissues also results in a reduction of the delivery of hormones such as insulin-like growth factor-1 to damaged tissues. Normally, the inflammatory response is the body’s way to begin the healing process, sending fluid, nutrients and blood to the injured area to begin tissue repair. This is why Rest, as in not using the injured body part much at all, is also cited as slowing down recovery, since the circulation to the area is then compromised, resulting in less removal of waste products and fewer nutrients feeding into the healing area.

Enter MCE or M.E.A.T.- these are two new acronyms meant to replace R.I.C.E. 

MCE means to move safely as much as you can , compress the injury and elevate the limb. Movement can prevent excessive scar tissue and adhesions from forming in the affected area and assist the healing process by providing adequate circulation of oxygen-rich and nutrient-filled blood to the area. Compression and elevation are still important to reduce unwanted swelling and allow for a freer range of motion of the injured area. An eg. would be the post- operative knee patient being discharged with a passive range- of -motion device versus immobilizing splints or sleeves.

M.E.A.T.- movement, exercise, analgesia and treatment for sprains and strains. Safe movement of the injured area should begin immediately eg. non- weight bearing free movement of the area. Exercise then goes a step further in the rehabilitation process using isometric contractions and very light resistance training to further encourage circulation, reduce atrophy, prevent scar tissue and alleviate stiffness. This is when hydrotherapy (partial weight- bearing) is often prescribed. Analgesia is pain managementРwhen there is less pain, you can move with more ease, however, you do not want pain medications to interfere with your healing, so speak to your doctor or pharmacist about what pain medication( if utilized at all) is best to use for your particular injury. Your treatment is typically dictated by a doctor, physiotherapist or other health care professional  and can include kinesiotaping, hydrotherapy, myofascial release, corrective exercise or manual therapy. Factors that must be taken into consideration are the severity and location of the injury, timetable for return to specific activity, and frequency and  length of treatment/therapy.

So, to recap, the recent Icing protocol suggests icing for 10 minutes, removing the ice for 20 minutes and repeating that process once or twice, but there is no reason to continue icing more than six hours after an injury, The rationale: Ice only works to reduce the pain of an acute injury, and icing longer than that will simply delay healing.

Reference: Eric Velazquez, CSCS

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