“RICE Method” is out-dated

Discussion in 'Injuries' started by Rob3rt, Sep 7, 2016.

  1. Rob3rt

    Rob3rt Regular Member

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    "In my professional opinion, the RICE method is outdated and actually hinders your recovery, hear me out:

    We’ve all been there, using muscles we haven’t used in a while or didn’t warm up enough. You swing, stride, throw, or jump and BAM! There comes the pain.

    Pulled muscles, AKA strains are actually partial tearing of muscle fibers, the extent of tearing varies, with extreme cases requiring surgical intervention. This is not about those kinds of injuries, this post is for the weekend warriors and athletes that just did a little too much.

    Many people are familiar with the “RICE Method”, that is: rest, ice, compress, elevate. While this is all fine and dandy if you have a week before your next competition or can take a week off of training, but most athletes can’t afford that kind of down time, or simply don’t want to wait.

    Here’s why the RICE method may slow your recovery:

    Rest – Obviously important immediately following an injury to prevent further damage, but after 12-24 hours, rest means disuse, which means potential atrophy and scar deposition. Atrophy is the loss of muscle because the area is not being used, and since it is not being used, your body will deposit scar tissue indiscriminately over the injury site, potentially causing a loss of range of motion or contractile strength even after the injury is fully healed. Know anyone that has had a hip or knee replacement recently? Ask how long they “rested” after surgery...

    Ice – Try to swallow this one, ice is useless aside from pain control. There. I said it. Contrary to what your coaches told you, there is no quality evidence that demonstrates ice is effective at healing an injury, in fact, it may delay the process. Think about it, cold therapy constricts blood vessels, decreasing metabolism and circulation, also decreasing the process of inflammation. Fact: YOU CANNOT HEAL WITHOUT INFLAMMATION. Aside from certain ‘runaway inflammatory’ conditions (UC, Crohn’s, RA, etc.), inflammation is a good thing, without it you would not repair. The only time I would use ice to treat an injury is in a competition setting to limit the inflammatory process (mostly swelling) so that someone can continue to compete (think icing a boxer’s face between rounds). Furthermore, cold therapy only penetrates so far, rarely getting to the source. Even more compelling, the doctor that coined the term “RICE” in 1978 (Dr. Gabe Mirkin) has since declared otherwise (see for yourself: (http://www.drmirkin.com/fitness/why-ice-delays-recovery.html).

    Compression and elevation have their merits, mostly to control swelling and lymphatic movement. Severely swollen tissues will limit your range of motion. The compression supports the movement of lymph fluid and the elevation uses gravity to help it flow. Lymph fluid is what carries in the repairmen and takes away the damaged materials. This leaves you with “CE” from “RICE”.

    How about a better alternative that will help you recover faster??

    “MESH” will get you back on the field faster
    Following a mild injury/strain, remember this new acronym “M-E-S-H”, here’s how it works:

    Movement – As long as no bones are broken and nothing is unstable, start moving the injured area. This can be done by light dynamic stretching, vibration therapy, non-weightbearing movements/oscillations, or something as simple as motion within a tolerable range (flex, extend, rotate, laterally bend). This does not need to be aggressive movement, it should be uncomfortable but not too painful. The goal here is to regain/maintain range of motion, prevent atrophy/scar formation, and stimulate the movement of lymphatic fluid. As you regain motion, you can use more aggressive modalities like foam rolling, muscle sticks, lacrosse balls, and resistance bands.

    Elevate – Elevation is used to support the movement of lymphatic fluid and the clearing of damaged tissue from the injured area. Elevate the injured area above the level of the heart (if able to) while at rest so gravity can help fluid move out of the area so it doesn’t become stagnant and accumulate.

    Support – Use an ace bandage, elastic taping (KT, Rocktape, etc.) or compression sleeve to support the injured area. This will protect the area from further injury and allow you to get some movement in supported ranges of motion. The added compression from your support will also prevent excessive swelling.

    Heat – Yes, heat. The opposite of ice. This is not a necessary step, but will increase blood flow, cell metabolism, and also inflammation (remember, it’s not a bad thing when healing). Heat is best to apply in the days after an injury as a means to loosen stiffness and regain more motion. It should be applied for 10-15 minutes at a time, followed by movement. Do not reapply until the skin temperature has returned to normal.
    As you can see, a recurring theme with MESH is movement. Movement is the most important part of healing an injury and the -ESH aims to facilitate the motion. Don’t believe me? Try it for yourself.

    If the injury seems to be getting worse over a few days or seems unstable, consult your healthcare provider as it may be more than a mild sprain/strain."

    Source: http://www.mooresvillehbs.com/meshinjuryrecovery/
     
  2. Gollum

    Gollum Regular Member

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    Just a reminder: you shouldn't be copying and pasting a whole article from someone else's website, unless they've given you permission. It infringes copyright. Just provide the link, and possibly a few short quotes.

    As for the article, well, I'm not convinced. It seems to rather miss the point of (P)RICE, which is to protect the joint from additional injury and calm down the immediate inflammatory response.

    This is potentially very dangerous advice. Depending on the injury, failure to rest long enough can have catastrophic results. If you get a bad ankle sprain and return to badminton after 24 hours, then your ankle will be completely wrecked.

    It's important to understand that rest does not mean complete inactivity. Rest means complete avoidance of any aggravating activity, at least for the first 48 hours or so.

    It is correct that you want to get the joint moving early, to minimise scar tissue. However, you must strike a balance between using the joint and protecting it from further injury while it's still very vulnerable.

    So with a bad ankle sprain, the sensible thing would be extreme care in the first two days, avoiding weight-bearing as much as possible (think crutches). Following that, a gradual return to weight-bearing over the next few days if possible, or at least try to gently mobilise the joint. Remember that pain is a warning sign; try to get moving, but listen to your body.


    The problem with inflammation is that it can lead to further tissue damage, as bleeding increases the interstitial pressure, causing more small blood vessels to rupture, which causes more inflammation. This is a short-term vicious cycle, and the purpose of ice is to get it under control and limit further damage.

    Just like with rest, you can overdo ice. It's correct that ice delays the healing process, which is why you shouldn't continue to use it beyond about 48 hours. And of course it should only be used in small doses -- say, 10 minutes every 2 hours max. Excessive icing can cause tissue damage.

    Again, it's a balance. Early on, you have a lot of uncontrolled bleeding into the area, and that's largely your enemy not your friend. Later, you want a healthy blood supply as you need it for healing (this is mainly why bones and muscles heal so much better than cartilage and ligaments: they have a much better blood supply).

    The advice about movement, elevation and support is all fine.


    Again, I think this is bad advice during the first 48 hours, for the same reasons that ice is useful during that period. Later, the balance changes, and heat is likely a good thing.

    Of course, if we're talking about a mild pulled muscle, then the amount of inflammation may be small. In that case, you could make an argument for skipping the precautionary / preventative aspects of RICE and jumping straight into gentle activity, heat, and massage. Not every injury needs the exact same approach.
     
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  3. visor

    visor Regular Member

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    Totally summarized in that last line.

    Compare an ankle sprain with a pulled muscle.
     
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  4. Gollum

    Gollum Regular Member

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    ...although if in doubt, it's better to be over-protective of mild injuries than under-protective of serious ones!

    If you use PRICE for a slight pulled muscle, nothing bad will happen. Whereas if you play badminton the day after a bad ankle sprain, you could do permanent damage.
     
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  5. visor

    visor Regular Member

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    ^ First do no harm.
     
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  6. DarthHowie

    DarthHowie Regular Member

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    When i strained my hamstring -> see doctor & get referral for physiotherapist -> see physiotherapist.
    I would say i had a combination of both rice/price/mesh. In the first 24/48 hours of my injury i had ice to control the swelling..after that it was mainly progressive exercises to slowly rebuild strength, flexibility and range of motion. This treatment was followed by 5 min of heat and then a lot of treatment on the table by my therapist.

    This was an 8 week process. it wasn't until the 6-7 week mark that i could maybe do one step hitting. Even after the 8 weeks i was gradual with my recovery ...no games for 4 weeks. Just drills to build good habits and footwork. It's a good way to rebuild confidence and shake fear of reinjury.

    The point is.. I would see a physiotherapist clinic that specializes in helping athletes recover from injury since they have that experience.
     
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  7. necrohiero

    necrohiero Regular Member

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    Well.. I think Rest is necessary. Always necessary.

    Even muscle training are actually inducing micro injuries... And to get any effect from it, we have to rest.

    But. well rest doesn't mean just stay quiet and let ur injured body stay still like vegetable though.
     
  8. SystemicAnomaly

    SystemicAnomaly Regular Member

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    Dr Gabe Mirkin coined/developed RICE in the late 1970s. In the past few years he had changed his thinking on his RICE protocol for inuries

    http://www.drmirkin.com/fitness/why-ice-delays-recovery.html
    https://en.wikipedia.org/wiki/RICE_(medicine)

    I have not seen the acronym MESH previous to this thread. However, in the past few years, I have seen a number of references to METH (Movement, Elevation, Traction, Heat) and MEAT (Movement, Elevation, Analgesia, Treatment) for treatment of injury. The METH acronym/paradigm & was coined by John Paul Catanzaro.

    http://www.fitforlifewellnessclinic...ew-approach-for-healing-soft-tissue-injuries/
    https://www.healthsnap.ca/blog/meth-new-rice-ice-rest-move-treat-injury-sprain.html

    http://www.thesportsphysiotherapist.com/rice-or-meat-protocol-for-acute-ligament-sprain-treatment/

    [​IMG]
     
  9. SystemicAnomaly

    SystemicAnomaly Regular Member

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  10. Uncle tan

    Uncle tan Regular Member

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    Guys, this is a very bad influence post, as the title“RICE Method” is out-dated". , reader may get confused and may tell other friends about it.....the articles he posted is not the whole story about injuries....We must know about the physiological, psychology and other complications after injury....Icing or cooling still the best for acute injury knowing the contraindications, and PRICE still the best for immediate action, later best/must consult and check by physiotherapist or professional...

    TRUST ME....I'M A PHYSIOTHERAPIST.
     
    #10 Uncle tan, Apr 15, 2017
    Last edited: Apr 15, 2017
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