Putting ice on an acute injury is something that comes almost as natural as immediately grabbing your finger after you accidentally hit it with a hammer. The only difference? The one is a natural response from your brain and body, wanting to protect you, the other is something we just do, without thinking about it. Why? Because that is what we were taught, so why not?
Inflammation has been seen as the enemy, as something that should be stopped as soon as possible. Our answer to the enemy was ice, because it helps to reduce swelling and inflammation and aids in pain relief, so it felt like the perfect solution. Luckily now we know that inflammation plays a key role in the healing process, so we should probably ditch the ice. Looks like our body actually knows how to take care of itself, doesn't it?
Don't get me wrong, ice isn't all bad, it has its place, it just depends on the situation. Like in the middle of the Rugby World Cup final, if someone had taken a hit, causing some bleeding, would you have told them to get off the field and let the healing process take its course? NO! You would have iced it to stop bleeding and DELAY swelling so that they could go win us the world cup! It all depends on the situation and the reason behind using the ice.
So, making the decision to leave ice out of the equation, will help us to make the shift from RICE to MEAT, that actually supports everything we as physiotherapists believe in.
What does MEAT say about treating an acute injury?
- M - MOVEMENT: Movement should be responsible, and pain free. If done right, it can stimulate blood flow, reduce the formation of poorly aligned scar tissue and decrease recovery time.
- E - EXERCISE: This is closely linked to movement, and the correct type of exercises is very important. The reduction of swelling relies on muscle activation, so exercise plays a key role in helping to reduce swelling.
- A - ANALGESICS: This will help to control acute pain, but does not include anti-inflammatories, as they inhibit the normal process of healing.
- T - TREATMENT: This is where we, as physiotherapists, use all the different treatment modalities to speed up the recovery time.
Together with the MEAT principle we can add some principles of PEACE (Protection, Elevation, Avoiding NSAID's, Compression, Education) and LOVE (Loading, Optimism, Vascularization, Exercise). After all, don't we all just want a little peace and love after an injury?
Although some of the aspects of these two principles are already addressed in the MEAT approach, some important aspects such as education and optimism will be beneficial to add to the treatment of an acute injury.
It is important to educate patients on the benefits of an active approach to recovery and explaining the condition and load management will help to avoid overtreatment of patients. Optimism during recovery of an injury is also vitally important, as this aims to address certain psychological factors of patients. It is important to stay realistic but encourage optimism to aid in the chance of optimal recovery.
Understanding and respecting the body's healing phases and the processes involved in each, will aid us in providing the optimal care and treatment for patients. Making the shift from viewing inflammation as the enemy to seeing it in a positive light will also help to guide our treatment principles. Although the above principles are good guidelines in treating the acute injury, we should always remember to treat each patient as an individual and being careful to not use these principles as a set recipe.
So, remember, your body knows what it needs to take care of an injury, and rather than trying to stop what your body is trying to do, ask yourself: How can I help the healing process, without disrupting it? And maybe keep the ice for a nice glass of white wine...
Ilse van Vuuren
Frost, G., 'WHY YOU SHOULDN’T ICE AN INJURY (OR RICE)', Your Wellness Nerd, 8 February 2019, https://yourwellnessnerd.com/why-you-should-not-ice-an-injury/, (Accessed 18 January 2020)
Dubois, B., Esculier, J., 'Soft tissue injuries simply need PEACE and LOVE', British journal of Sport's Medicine Blog(BJSM), 26 April 2019, https://edusasp.ituta.net/pluginfile.php/137/mod_label/intro/C1T4%20Task1%20-%202019%20PEACE%20%20LOVE.pdf, (Accessed 18 January 2020)
Bleakley, C M., Glasgow, P., MacAuley D C., 'PRICE needs updating, should we call the POLICE?', British journal of Sport's Medicine, 7 September 2011, https://edusasp.ituta.net/pluginfile.php/137/mod_label/intro/C1T4%20Task1-%202012%20ICE%2B%20Updating%20PRICE%20to%20POLICE_Bleakly%20et%20al.pdf, (Accessed 18 January 2020)
Mannix, L., 'Putting ice on injuries could be doing more damage than good', The Sunday Morning Herhald, 13 October 2019, https://edusasp.ituta.net/pluginfile.php/137/mod_label/intro/C1T4%20Task1-%202019%20usefulness%20or%20not.%20-%20newspaper%20article%20with%20references.pdf, (Accessed 18 January 2020)