What you might not know you don’t know about “R.I.C.E” after an injury

RICE (rest, ice, compression, elevation) is a common but outdated protocol for recovering from an injury - new evidence shows it actually slows the healing process.

RICE (rest, ice, compression, elevation) is a common but outdated protocol for recovering from an injury – new evidence shows it actually slows the healing process.

After missing a day due to some technical difficulties, I’m back with a quick tip for the “What you might not know you don’t know about your body” series! Today’s topic is a super interesting one and will definitely leave some people scratching their heads. If you’re like me and have had lots of ankle sprains, muscle strains, and all sorts of assorted injuries, you’ll be wishing you read this long ago!

So I’ll start by stating flat out that I am far from the expert in this topic. The physiological mechanisms that underpin the healing and regeneration process of various types of tissues are things I’ve studied many times, but the true experts in this field are the clinicians who know these processes in much more depth. Physicians, Naturopathic Physicians, Physiotherapists, Chiropractors, Osteopaths, Massage Therapists but to name a few are the pioneers in pushing this information forward, and I’m simply passing on the knowledge I’ve been fortunate enough to gain from amazing mentors. Knowledge that has helped my body immensely and has transformed the healing of many of my clients.

Alright, let’s dive in! 

The real purpose of this post is to expose the RICE protocol (Rest, Ice, Compression, Elevation) for post-injury recovery as the detrimental process we now know it to be and suggest a better alternative.

No doubt if you’ve had an ankle sprain or any other sprain or strain, you’ve gone through this protocol.

The basic premise was that with injured tissue you wanted to rest it to avoid further injury and to limit the painful inflammation that is always secondary to an acute injury. Icing, compressing, and elevating all stopped swelling and inflammation from fully setting in, so the damage thought to be done by inflammation would be reduced, allowing a faster recovery. Not an entirely far fetched thinking process, except for one thing.

Inflammation is a natural process necessary for healing!

So all of the inflammation that was kept at bay was a missed opportunity for increased circulation to the injured area and a natural cascade of all the body’s healing mechanisms. Enter the incompletely healed ligament or muscle that keeps causing issues years after the initial injury.

Hands on therapy as part of the "Treatment" step of the MEAT protocol goes a long way to help tissues recover fully.

Hands on therapy as part of the “Treatment” step of the MEAT protocol goes a long way to help tissues recover fully.

What type of issues? Limited range of motion of the injured tissue becomes a major factor, because without restoring that movement, the compensation train begins and the body starts to adjust its movement, usually not for the better. Tissue that isn’t fully repaired is also weaker and prone to another injury.

The past 2 decades worth of research have started to clearly show this (great review article here if you want the full scoop) and top-notch clinicians now fully understand that stopping the body’s natural healing process is a step in the wrong direction.

So what to do instead of RICE? Try “MEAT” instead, popularized in the world of prolotherapy – a regenerative injection therapy which helps to rebuild damaged tissue by triggering inflammation and proper healing.

What’s MEAT?
  • MOVEMENT: gentle movement within pain tolerance brings more circulation to the injured area which can speed up healing. This can also help the injured tissue to repair under a small amount of load, creating a stronger and more organized rebuild.
  • EXERCISE: as soon as you’re able, gentle exercise to increase circulation will help remove the by-products of healing from the injured site and infuse it with new blood and fluids to continue the rebuilding.
  • ANALGESICS: aka reduce the pain. High levels of pain can inhibit the healing process and be downright uncomfortable. But think twice before reaching for NSAID (non-steroidal anti-inflammatories) like aspirin & ibuprofen (full list here) – these will inhibit healing just like any other treatment that reduces inflammation. Tylenol (acetaminophen) has painkilling effects without reducing inflammation, but can be very hard on the liver. This is where natural approaches like acupuncture, essential oils, arnica, and countless herbs and foods have shown great results with zero side effects.
  • TREATMENT: this is when the clinicians shine! Hands on therapies that restore range of motion and increase circulation will help a ton. Contrast hydrotherapy also works wonders to increase circulation – so there is a role for ice after all!. This is also where getting back into some stability and motor control work becomes very important to have the tissue develop back to its original strength. Many times there are secondary reactions to the initial injury – areas that become tight or imbalanced in an effort to protect the injured area – and those need to be identified and corrected as early as possible. Finishing off this treatment phase is the very important and under-appreciated step of restoring total function, not just getting rid of pain. Pain-free does not mean you’re ready to jump back into sport. Working with a qualified coach at this point is a crucial step to make sure your movement gets back to baseline in terms of mobility, stability, strength, power, and speed. Until all of these areas are back to normal and the injured tissue doesn’t show signs of guarding or compensation, the healing is not complete.

So hopefully next time an injury pops up for you or someone you care about you can remember these wise words – choose MEAT over RICE!

If you feel you have an injury that didn’t properly go through the phases above and is still holding you back, don’t hesitate to get in touch for a free consultation and I’d be happy to share what I think may help. Until then I’ll be knocking on wood and hoping no phone calls means no one’s getting injured 🙂

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