MEAT vs. RICE
Recovering from a sprain or strain? Learn what method is best.
Anne Stein, M.S.
Sports & Fitness Journalist/Author
The long-accepted approach to managing joint sprains and muscle and tendon strains within the first 24-48 hours is with RICE, which stands for Rest, Ice, Compression and Elevation. Some health and fitness professionals and websites, however, are challenging this long-held practice, advocating MEAT (Movement, Exercise, Analgesia, Treatment) instead and claiming that RICE, with its emphasis on decreasing inflammation, is detrimental to healing.
The Reason to RICE
A good understanding of RICE, however, makes it clear that there is no reason to switch from RICE to MEAT. However, it is also important to understand that injury recovery is an ongoing process that does not end with RICE (sometimes called PRICE, the P standing for Protection) and should include other methods of recovery as well.
The purpose of RICE is fairly simple. According to the National Athletic Trainers’ Association:
“Resting an injured area is necessary to allow the body time to get the effects of the trauma under control and to avoid additional stress and damage to the injured tissue…People who do not rest an acute (sudden or traumatic) injury can prolong the inflammation period and increase the healing time required, thereby delaying the recovery.”
“Ice applied promptly to an injury can slow down or minimize some of the inflammation….The local tissue metabolism slows down, reducing its need for oxygen and nutrients, and the nerve impulses are slowed considerably to reduce pain….”
“Compression is the application of an Ace Bandage or similar item around the injured area. Its purpose is to help control swelling and to provide mild support.”
“Elevation involves raising the injured area above the level of the heart….This position promotes the lessening or elimination of swelling through the use of gravity and lymph drainage system.”
Reducing pain and decreasing inflammation, which is the body’s way of mobilizing the immune system to manage injury/trauma, are key components of RICE.
MEAT Lovers’ Beef
According to MEAT proponents, “Anything that decreases the metabolic rate or blood supply to ligaments, such as rest, immobilization and ice, will further promote the decline of ligaments, and profoundly delay their healing.”
MEAT in a nutshell:
Movement of the injured area should begin immediately after the injury, to prevent adhesions and increase circulation.
Exercise (after the acute stage of injury) should start gradually to strengthen the injured part.
Analgesia is the use of medications, natural or pharmaceutical, to decrease pain but not to suppress the inflammatory response, which is crucial to healing.
Treatment, such as physical therapy, massage and electrical stimulation, improve blood flow and help soft tissue to heal.
The MEAT approach is particularly popular among doctors who practice prolotherapy, which involves injecting substances at the sites where ligaments and tendons attach to the bones, thus stimulating the ligaments and tendons to proliferate or grow at the injection sites, according to prolotherapy.org. See: http://www.caringmedical.com/symptoms/meatvsrice.asp; also see: http://www.anabolic-enhancement.com/forum/archive/index.php/t-4027.html
The PRICE is Right
Dr. Lynn Millar, a professor of physical therapy at Andrews University and a fellow of The American College of Sports Medicine, explains why the argument against RICE is misguided. First, while inflammation is the body’s healing response to injury, it needs to be managed. Second, “RICE has never been meant to be long-term,” she says. “It’s for acute injuries and is to be applied for 24 to 48 hours maximum.” Third, many physical therapists and doctors use the term “relative rest” instead of “Rest.” “It’s not ‘don’t do anything.’ Once the pain starts to diminish in a day or so, do some movement. Progressive movement and therapy [the M and T in MEAT] have always been a part of RICE.”
While it’s true that the inflammatory response is the body’s way of healing trauma, compression and ice are intended to control inflammation, not stop it completely. “If we let inflammation go, it can end up damaging tissues around the area that weren’t originally damaged,” Millar explains. In addition, ice is extremely useful immediately post-injury because it’s an analgesic: it decreases pain.
If you put heat on an acute injury, you can increase swelling, says Millar. “We usually use heat after 24-48 hours. If someone’s going through rehab and they exercise and inflame the area, they can use ice temporarily. I tend to go with what the patient’s comfortable with.”
MEAT proponents say that non-steroidal anti-inflammatories (NSAIDS) can hinder healing. No argument here: “Most sports medicine doctors will tell you to use them the first 24-48 hours, then get off of them to improve healing,” says Millar.
“The trend is PRICE or RICE, then we progress into movement and exercise (physical therapy, which may include massage, ultrasound, myofacial release, and other PT methods),” Millar says. “None of the research would support skipping those initial steps.”