RICE = Rest, Ice, Compression, Elevation
MEAT = Movement, Exercise, Analgesics, Treatment

Part of the reason I began investigating new therapies in sports medicine was because of my own athletic injuries and knowing there were far more research at our fingertips awaiting proper application. Nevertheless, I still believe RICE can have an important role in sports medicine therapy for the following reasons:

1) In early phases, it can vasoconstrict and restrict blood flow to the injured tissue, suppress inflammation and edema, decrease nerve conduction velocities and provide anesthesia, alter cell metabolism and create a sort of "pre-conditioning" effect where cells adapt to this hypoperfusion with expression of protective genes and activation of healing signaling pathways. In addition, the activity of inflammatory pathways and degradation enzymes like matrix metalloproteinase, collagenase, elastase, hyaluronidase, and other proteases may be suppressed.

2) After 10-15 minutes of icing, blood vessels vasodilate and increase vascular blood flow (i.e., Lewis Hunting reaction), or they vasodilate on re-warming, thereby increasing perfusion and creating a sort of "post-conditioning" effect where cells futher adapt with additional nutrients and restorative signaling factors.

3) Cold temperatures can help induce proper folding, binding, and self-organization of collagen fibers, although some evidence suggests that sub-zero freezing of collagen fibrils can result in ice crystal formation between fibrils and further destabilization of collagen matrix (1). Thus, in general, icing should not cool the tissue to sub-zero temperatures and does not need to be done longer than 10 minutes at a time, though more research is needed to optimize indications and protocols.

On the other hand, MEAT takes a more proactive approach by encouraging movement and activity that provides early stimulation of tissue to regain function. In some cases, this early return to activity stimulates earlier recovery and biomechanically load the tissue to stimulate proper functional repair, while in other cases it may possibly result in more delayed healing or chronic injury, so the decision on which path to follow should depend on an accurate diagnosis and imaging assessment of your injury characteristics, a thorough treatment plan, as well as listening to your own body. In general, movement helps restore joint mobility, joint hydration, and lymphatic fluid flow, and exercises should focus on eccentric movements without eliciting significant pain. Analgesics can also be difficult to appropriately balance, as pain can be an important guide in injury recovery and some inflammation may help long-term injury healing while out-of-control inflammation can do significantly more long-term damage. Furthermore, some medications like corticosteroids can provide strong inhibition of inflammatory pathways but can also inhibit collagen synthesis, prevent strengthening of tendons and ligaments, and counteract muscle strengthening, and thus these should only be used when necessary. Fortunately, other medications and therapies are also available that can be more targeted to specific injuries and conditions. Beneficial treatments can include PRF & injections, shockwave therapy, peptides, and customized compounding creams. An anti-inflammatory diet and good nutrition can also help the healing process.


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