Kelly Starrett from Mobility Wod brought this issue to the light with a post last year. His findings showed that, yes, cryotherapy can be effective in reducing pain following injury, but it was inconclusive as to whether or not it improved clinical outcomes. Again, this modality can be useful in preventing the body from healing its natural way, but do we really want to do that? You might ask then about other methods of limiting pain and swelling in the area. Starrett suggests utilization of compression to limit the swelling, along with elevation at times. Another method to decrease swelling is muscle activation. Mobility (when safe) is an incredibly useful method to a) maintain strength, b) evacuate swelling through muscle pumping, and c) help to restore collagen alignment. Now we're not suggesting ice should suddenly be abandoned in physical therapy altogether, but it should be given a more serious consideration as to its appropriateness. In fact, an interesting response by Nick Heudecker was brought up to this post, questioning the analysis of the literature cited and the method of the studies as well.
Perhaps it is time to consider a shift from the traditional RICE theory to a MEAT theory, as discussed by The Sports Physiotherapist. We have actually seen the MEAT protocol in practice with impressive effectiveness for returning injured athletes to play. M=movement, E=exercise, A=analgesics (non-NSAID), T=treatment. What are your thoughts on the RICE vs MEAT debate? Should we choose one or the other? Or is there a middle-ground that is more desirable?
3/18/2013 01:47:44 am
I guess this is something 'fresh' other than the RICE management. MEAT could work its way out. It is somewhat debatable but if there are researches done comparing these two, then we should know which is more appropriate then for patients :)
3/18/2013 09:46:40 am
It's kind of hard to argue with the points Heudecker brought up with respect to Starrett's analysis of the literature. The idea that we are interfering with the natural healing process with icing and that in itself is a bad thing also seems a bit disingenuous. The "natural" inflammation process is what causes all that edema and pain in the first place!
"Inflammation serves a vital role in the healing process. Inflammation has both protective and curative features. Every step serves a specific purpose and is necessary as the body responds to tissue injury or damage. The ultimate goal of the inflammatory process is to replace injured tissue with healthy regenerated tissue, a fibrous scar, or both" (Goodman & Fuller, 2009).
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