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.
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 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.
- 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.
- 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.
- 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. \
- 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.
By Steffen Hess, PTA, Tulsa Bone & Joint Bartlesville
When you think of surgery, do you first think about pain or pain relief? What if there was a way to have pain relief and to help your recovery process before you have surgery? For many, being told you need to have surgery can be a scary notion to accept. For those who have lived extended periods of time with pain, surgery can be a way to see some normalcy or regain their independence in the future.
According to the American Physical Therapy Association (APTA), physical therapy before surgery (pre-hab) can help to improve mobility, improve the patient’s range of motion, increase stamina, help to reduce pain, improve balance, and speed up recovery time.
When entering a pre-hab program, a patient will meet with a physical therapist (PT) that will talk to them about what they should expect from not only therapy but also what they should expect after surgery. A pre-hab program will include therapeutic exercises that will help to rebuild muscles that may have been neglected or have atrophied over the years. Muscular imbalances in the body can cause increased joint pressure and premature wear and tear on the cartilage in our joints, causing pain.
Some of the exercises in a pre-hab program will also help with flexibility. Working on flexibility and rebuilding muscle will increase the patient’s mobility and will help start to alleviate pain. The PT will also give the patients tests to measure their range of motion. Pre-hab exercises before surgery can help to reduce muscle loss, decreased range of motion and may help prevent the development of excessive scar tissue. Lastly, the patient will be screened for fall risk. If the patient is at high risk for falls, physical therapists will provide exercises that safely and carefully challenge his or her balance as a way to mimic real-life situations.
There are also additional treatments that your PT can use to help to reduce your pain. Some of these treatments that can help are hot/cold treatments, taping (such as rock tape) and electrical stimulation. Although these treatments offer temporary pain relief, they can help the patient to relax which promotes healing. According to renowned physical therapist Adriaan Louw, teaching people about pain can be one of the most beneficial ways to help the patients to learn why they are in so much pain and how they can use what they have learned to help to reduce their pain. Even if prehab only lasts for a couple weeks before surgery, it can be very beneficial and help you get back to an independent lifestyle sooner.
The Alter G rehab treadmill allows athletes, runners and surgery patients alike to recover at a quicker rate, while minimizing stress on injuries. Listen to how Cathy was able to quickly get back to work! Call the Tulsa Bone & Joint Physical Therapists at 918-392-1482 for more info.