By Steven Smith, PTA, Tulsa Bone & Joint
For the majority of people out there who have sustained an acute injury, such as an ankle sprain, you have probably heard of the RICE method. This method quickly became the go to protocol for quick assessments of such injuries as of 1978 when it was created by Dr. Gabe Mirkin, MD in his best selling “Sports Medicine Book.” The guidelines for this protocol have since been used by coaches, athletic trainers, and physical therapy clinics with the intent of expediting the recovery process and reducing inflammation for acute injuries. However, as people are paying closer attention to results and the long- and short-term effects, they are finding it may not be the best way to address such injuries. A new era of treatment is evolving, where the MEAT protocol is proving to potentially be the better path.
R– Rest
I– Ice
C– Compression
E– Elevation
M– Movement
E– Exercise
A– Analgesics
T– Treatment
There are varying opinions/problems with RICE:
- Rest. Studies have shown that it can actually be detrimental to the healing process. As the “Journal of Athletic Training” in 2012 points out, with earlier movement of the tendons, ligaments, and muscles injured, it could result in less time at a follow up clinic, or away from sport.
- Ice has long been the go-to for the prevention of swelling and reduction of pain at the injury site. But ice has been noted to actually delay and potentially reduce the healing process, as some people commonly confuse inflammation and swelling. The two in fact are vastly different, as inflammation is the first phase of the tissue repair, while swelling is accumulation of waste that has not yet been evacuated from the area. Inflammation is an important part of the healing process as an instantaneous defense mechanism whose main goal is to control the extent of cell injury, and preparing that tissue for the process of repair. Injuries to structures that have limited blood supply like ligaments, tendons, and cartilage are hindered by cryotherapy, which reduces blood flow thus prolonging the healing process in the acute stage. The RICE method wants to reduce swelling and decrease blood flow to the injured area. However, blood flow invites more oxygen and more nutrient- rich blood to the area which ultimately accelerates your recovery.
There is a substantial amount of evidence to support the new era of MEAT, and that gentle movement and exercise help expedite recovery, improve range of motion and blood flow, and prevent instability in the joint post injury. Movement should be started as quickly, and without exceeding pain tolerance, as possible. Gentle movements will allow for a small amount of load on the ligament, which could help the tissue grow back in a stronger way.
Rest is important when it comes to an acute injury, but in moderation. This is because collagen fibers (scar tissue) can quickly build up if a joint is left in the same position for extended periods, ultimately threatening long term stability. Evidence has shown that the more movement to the injury, the stronger and more flexible it will be in its healing process.
Analgesics are pain relieving medications that can be helpful to allow for movement and exercise before pain starts. Though these should not generally be anti-inflammatory for reasons listed above, as inflammation is important to the healing process. Over the counter medications that are good options include Advil, Ibuprofen or Tylenol, but always consult with your doctor first to decide which is safest for you!
The last two steps, Exercise and Treatment, go hand in hand, as a structured exercise determined by therapists in a treatment setting will show greater results than rest alone. A structured exercise routine will create functional stability and strength with a regimen and manual techniques provided by a certified therapist, and potentially prevent recurrent injuries. Therapeutic guided exercise is an excellent form of rehabilitation that minimizes the detrimental deconditioning effects of rest and immobility. These include muscle atrophy and weakening of connective tissue, such as tendons and ligaments.
While there is still not sufficient side-by-side evidence to prove that MEAT is in all cases superior than RICE, there is sufficient evidence that shows that movement, exercise, and treatment from a physical therapist leads to a faster, more complete healing than rest, elevation and compression.
By Paige Hrdlicka, PTA
Tension or cervicogenic headaches can cause symptoms of pain and tightness at the base of your neck. There are a group of small muscles at the base of your skull called suboccipitals. If these muscles are tight, they can cause this tension type of headache. The pain can wrap across the top of your head to your forehead, and sometimes the pain can be focused on one side more than the other. People often experience neck stiffness and light sensitivity with these types of headaches. They are typically the result of an injury, though neck pain can be spontaneous.
Treatment for cervicogenic and tension headaches can consist of manual release techniques, stretching, cervical spine strengthening, posture activities, and working on neck and thoracic spine range of motion. Symptoms may vary from person to person, and an evaluation from a skilled physical therapist would be best to determine the right exercises for you.
If you are experiencing some of these symptoms, here are 2 stretches and 3 exercises you can try at home to alleviate some of you pain:
Neck flexion and extension
Image from https://universityorthopedics.com/educational_resources/neck_exercises.html
Neck lateral flexion
Standing chin tuck
Still point inducer
Product avaialble at https://www.walmart.com/ip/Still-Point-Inducer-Relieving-Headaches-Helping-Reduce-Stress/823139858
You can also complete chin tucks while laying on the still point inducer.
If you suffer from these, PT may be able to help. Call 918-392-1482 today to schedule an appointment with a PT. We are one big team here at Tulsa Bone and Joint, and we would love to work with you to help find relief for all your orthopedic needs.
By Lacy Clevenger, PTA
If you’re experiencing a nagging, achy pain on the outside of your hip or knee, you may be dealing with IT band syndrome. This is common with running and endurance sports or any activity that requires repetitive bending of the knee. The IT band is a thick connective tissue that starts at the top of the hip and attaches below the knee. Pain starts to occur when there is friction between the IT band and the bones of the hip or knee, though pain is more commonly experienced at the knee. Weak hips and lack of lower extremity flexibility can make you more prone to this.
Here are 5 stretches/exercises to treat IT band syndrome and help prevent recurrence:
- Foam rolling: Lie on the affected side with the foam roller just below the hip bone. Slowly roll until the foam roller is just above the knee joint, then roll back to the starting position. Repeat this 10-15 times. Discomfort is common with this, but will improve with time.
Photo from https://www.lesmills.com/fit-planet/fitness/foam-rolling/
- Hip flexor stretch: Sit on the edge of a bed and hug one knee toward your chest. Lie back, then actively pull the opposite heel down towards the floor as well as back towards the bed. This should create a stretch along the front of your hip/thigh. Hold this for 30-60 seconds and repeat 3-5 times.
Photo from https://azopt.net/hip-flexor-stretch/
- Glute stretch: Lie on your back with knees bent and feet flat on the floor/bed. Cross one ankle onto the opposite knee then pull your knee towards your opposite shoulder. A stretch should be felt on the back and/or side of the hip. Hold this for 30-60 seconds and repeat 3-5 times.
Photo from https://www.knee-pain-explained.com/piriformis-stretches.html
- Clam shells: Lie on your side with both knees bent. Try to keep your shoulders, hips, and knees in a straight line so that your feet are resting behind you. Keep your heels together and lift the top knee, stopping just before you feel the hips start to roll backwards. Repeat slowly 20-30 times. An elastic band can be added around the legs, just above the knees to add resistance and increase difficulty. \
Photo from http://www.shutterstock.com/image-vector/woman-doing-clamshells-clams-exercise-flat-1992523874
- Side leg lifts: Lie on one side and lift the opposite leg up towards the ceiling, keeping the knee straight. As you lift the leg, keep it slightly behind the hip which helps to engage the glutes. Do not let your hips roll backwards. Repeat 20-30 times or until muscle fatigue is felt.
Photo from https://www.skyhinews.com/news/fitness-trail-hip-abduction-exercise-progression/
Whether it’s running, walking, soccer, or another outdoor winter activity, it’s important that you prepare your body for the cold temps you will experience when you exercise outside.
Here are a few tips from Tulsa Bone & Joint Physical Therapist Amanda Lynch, who is also an accomplished ultra marathon runner:
- Wear layers, especially on the top. The outermost layer should be wind and water-resistant.
- Wear a hat to help retain body heat and prevent exposed skin. Keep as much of your body covered as possible.
- Keep drinking to stay hydrated, even if you don’t feel thirsty like you would when it’s hot outside. You can still get dehydrated and cramp in the cold weather.
- Know the signs of hypothermia, particularly uncontrollable shivering, slurred speech, and confusion.
- Have warm, dry clothes immediately after your outdoor exercise to change into.
Stay safe during your winter exercising! If you should need a physical therapy consultation, please contact us at 918-392-1482.
By Kayla Cheney, PTA, Tulsa Bone & Joint Owasso
The human body has an innate mechanism to promote physical and mental health that is often better than certain pharmaceuticals. Laughing has been proven to help individuals of all ages overcome difficult life situations both physically and emotionally. Thousands of studies have been done all over the world on this very topic. One study from Norway followed over 53,000 participants for 15 years and found those with a better sense of humor that laughed more readily outlived their counterparts by an average of 8 years.
So what does laughter actually do for our bodies? The Mayo Clinic and the University of St. Augustine for Health Sciences have compiled a list of physical and mental health benefits of laughing:
● Laughing is a natural painkiller. When you laugh, your body releases endorphins, the happiness hormone, which decreases the perception of pain.
● Laughing increases the intake of oxygen-rich air which stimulates heart, lungs, and other organs. This increase of oxygen in the blood improves vascular function and decreases the risk of heart attacks.
● Laughter stimulates circulation and aids in muscle relaxation, which can be especially beneficial for a postoperative patient.
● Laughing can lower blood pressure by releasing endorphins that negatively affect stress hormones.
● Laughing boosts the immune system by combating the chemical reactions created by negative thoughts and emotions. When you laugh, you release infection-fighting antibodies and neuropeptides that help fight stress.
● Laughing assists in weight loss. Chronic stress causes weight gain. Laughing for 10-15 minutes a day can burn 40 calories.
With so much evidence supporting better heart health, improved immune system, and the release of stress fighting endorphins, we would all benefit from more laughter. Did I mention the weight loss thing? Laughter has no negative side effects and is readily available. Perhaps we should take laughter more seriously in living a longer, healthier life.
Although physical therapy is no laughing matter, at Tulsa Bone & Joint Physical Therapy, we strive to make your experience positive, encouraging, and enjoyable.
