We all know the age-old acronym for sports injury: RICE (Rest, Ice, Compression, Elevation). The philosophy of this approach is that much of the pain from injury is due to Inflammation, so take away inflammation and take away the pain. Traditionally, we add over-the-counter non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen. These drugs work by blocking the chemical signals which initiate the inflammatory cascade. All of this makes sense, right?
What if I told you that there is an emerging trend away from RICE and toward MEAT (Movement, Exercise, Analgesia, Treatment)? Why? Inflammation is our body’s natural mechanism to allow healing to occur. It is a complex series of biochemical events which concentrate white blood cells, platelets, and growth factors to the area of injury to allow our inherent clean-up and repair teams to do their thing. When we use RICE and anti-inflammatory medications we decrease pain by blocking the inflammatory cascade, but in doing so we suppress healing. This is worsened by the use of anti-inflammatory medication. Apart from the fact that NSAIDs can cause perforating ulcers (which can kill you especially if mixed with alcohol), NSAIDs have been shown to inhibit bone healing after fracture. In my opinion, it is reasonable to suspect that if NSAIDs inhibit bone healing, then they may inhibit healing of tendons and ligaments. RICE + NSAIDS = less pain now, but sub-optimal healing. Thus, the shift from RICE to MEAT (sorry, vegetarians).
For a strain/sprain type injury, I recommend RICE for the first 4 hours after the injury (ice 15 minutes on, 15 minutes off and no NSAIDs), then shift to MEAT. MEAT encourages the body’s own natural healing capacity to do its thing.
Movement
Movement of the affected body part prevents the formation of adhesions and increases circulation which transports in nutrients and carries away metabolic waste. Range of motion movements such as the “alphabet in space” (drawing the alphabet with you foot, hand, finger, whatever is injured) can and should begin immediately after the injury (although there may be very little movement possible in the early stages).
Exercise
After the acute stage of injury, exercises should gradually commence. This strengthens the injured part, and also prevents pain signals from getting “hard-wired” into your nervous system by “working through” the pain. It is important, however, that you are not in fact further injuring the tissue by doing too much too soon.
Analgesia
This is the use of medications (whether natural or pharmaceutical) to decrease pain without interfering with healing. You heal faster when you are not in pain. Acetaminophen (i.e. Tylenol) has a substantial risk profile (liver toxicity) but it can help to decrease pain and has not been shown to inhibit healing. Certain over-the-counter nutritional supplements can be effective for pain. The enzyme bromelain can be effective for mild to moderate pain without interfering with normal tissue healing. The dosage is 500-1000mg three to four times per day between meals. For severe pain, you need to be evaluated by a doctor, but don’t be shy to ask for prescription pain meds (not NSAIDs).
Treatment
Just say NO to cortisone shots… like NSAIDs, they inhibit tissue healing. Alternating heat and ice increases circulation and helps with healing – heat 2 minutes, ice 30 seconds, do around 10 or so reps a few time per day. Good treatments for acute injuries are acupuncture and mesotherapy. The best treatment I know of for chronic sports injuries involving ligaments or tendons is regenerative injection therapy (aka Prolotherapy) using platelet rich plasma which can regenerate damaged ligaments and tendons to restore function and eliminate pain. For information on these therapies, please visit http://www.docereclinics.com/.